Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. May 15, 2019; 10(5): 280-290
Published online May 15, 2019. doi: 10.4239/wjd.v10.i5.280
Management of diabetic dyslipidemia: An update
Ishwarlal Jialal, Gurdeep Singh
Ishwarlal Jialal, California North-state University College of Medicine, VA Medical Center, Mather, CA 95757, United States
Gurdeep Singh, Lady of Lourdes Memorial Hospital, New York, NY 10041, United States
Author contributions: Jialal I and Singh G both contributed substantially to the work. Jialal I devised the format and edited to final submission. Singh G worked on the drafts and contributed significantly to the writing and referencing.
Conflict-of-interest statement: None of the authors have any conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ishwarlal Jialal, MD, PhD, Professor, Assistant Dean, California North-state University College of Medicine, VA Medical Center, 9700 West Taron Drive, Elk Grove, Mather, CA 95757, United States.
Telephone: +1-530-7502859 Fax: +1-916-6867310
Received: March 11, 2019
Peer-review started: March 12, 2019
First decision: May 8, 2019
Revised: May 13, 2019
Accepted: May 13, 2019
Article in press: May 14, 2019
Published online: May 15, 2019

Diabetic dyslipidemia is a cluster of lipoprotein abnormalities characterized by increased triglyceride level, decreased high-density lipoprotein-cholesterol levels and increase in small dense low-density lipoprotein (LDL) particles. It is extremely common in type 2 diabetes (T2DM) affecting around 70 % of patients. Diabetic is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD) which is the most common cause of death in the United States and LDL-cholesterol is the number 1 predictor of ASCVD events in T2DM. The purpose of this review is to discuss the pathophysiology and treatment of diabetic dyslipidemia. In this review, we have discussed both non-pharmacological and pharmacological treatment modalities including major treatment trials which have impacted the cardiovascular outcomes in patients with diabetes. Statin therapy is the mainstay of treatment to reduce ASCVD by decreasing LDL-C by 30%-49% or at least 50% depending on risk level. Attractive adjunctive therapies include Ezetimibe which is more cost effective and PCSK9 inhibitors which display potent LDL-cholesterol lowering and ASCVD event reduction. For severe hypertriglyceridemia, to avert the risk of pancreatitis, both fish oil and fenofibrate in concert with diet is the best strategy.

Keywords: Diabetes, Dyslipidemia, Statins, Atherosclerosis, Ezetimibe, PCSK9

Core tip: Atherosclerotic cardiovascular disease (ASCVD) is the major cause of mortality in diabetes. Low-density lipoprotein (LDL)-cholesterol lowering with statins reduce ASCVD and is the mainstay of therapy. Also, both ezetimibe and PCSK9 inhibitors are useful strategies when statins cannot be tolerated or the LDL-cholesterol goal is not achieved.