Dyslipidemia in type 2 diabetes mellitus

Mooradian, Arshag D

AD Mooradian is a Professor and Chair of the Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA.

Correspondence:

Department of Medicine, University of Florida College of Medicine, 653-1 West 8th Street, 4th Floor—LRC, Jacksonville, FL 32209, USA

[email protected]

Received 25 July 2008 Accepted 26 November 2008

www.nature.com/clinicalpractice

doi:10.1038/ncpendmet1066

Nature Clinical Practice Endocrinology & Metabolism 5(3):p 150-159, March 2009.

SUMMARY

Dyslipidemia is one of the major risk factors for cardiovascular disease in diabetes mellitus. The characteristic features of diabetic dyslipidemia are a high plasma triglyceride concentration, low HDL cholesterol concentration and increased concentration of small dense LDL-cholesterol particles. The lipid changes associated with diabetes mellitus are attributed to increased free fatty acid flux secondary to insulin resistance. The availability of multiple lipid-lowering drugs and supplements provides new opportunities for patients to achieve target lipid levels. However, the variety of therapeutic options poses a challenge in the prioritization of drug therapy. The prevalence of hypercholesterolemia is not increased in patients with diabetes mellitus, but mortality from coronary heart disease increases exponentially as a function of serum cholesterol levels, and lowering of cholesterol with statins reduces diabetic patients' relative cardiovascular risk. Although drug therapy for dyslipidemia must be individualized, most people with diabetes mellitus are candidates for statin therapy, and often need treatment with multiple agents to achieve therapeutic goals.

REVIEW CRITERIA

This Review is based on English manuscripts published between July 1998 and July 2008 that were identified through a MEDLINE search. The literature search was limited to core clinical journals that have accessible full texts; the search terms used were “lipids” and “diabetes”. A total of 451 manuscripts were reviewed and the choice of individual references was made at the discretion of the author. This literature, along with the author's clinical experience, was used to construct practical suggestions.