Published online May 15, 2019. doi: 10.4239/wjd.v10.i5.280
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.
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.