Current Understanding of Diabetic Dyslipidemia: A Review

Abstract

Diabetes is a chronic disease associated with a variety of metabolic abnormalities. Principal cause of disability and deaths in diabetes are coronary, peripheral, and cerebral vascular diseases mainly due to lipid abnormalities. Diabetic dyslipidemia is characterized by elevated small-dense low-density lipoprotein (LDL) cholesterol and triglycerides (TG) and low high-density lipoprotein (HDL) cholesterol. Elevated LDL cholesterol has been proven as causative for cardiovascular disease. Treatment thresholds for this variable have been advocated in multiple clinical practice recommendations and intensity of LDL lowering is dependent on associated risk factors. Statins are mainstay for treatment although combination therapies with ezetimibe and PCSK9 inhibitors are needed in very high-risk individuals. Recent research has confirmed role of raised TG as a cardiovascular risk factor. However, limited options are currently available as drug therapy. Low HDL cholesterol appears to be less of a contributor to cardiovascular risk than previously considered a risk marker. Primary cardiovascular disease prevention strategies in diabetes should focus on risk assessment, aggressive lifestyle interventions and treatment with statins, etc. In the present review we have focused on role of lipids in pathophysiology of diabetes associated cardiovascular disease and focus on evidence guided management.