Managing dyslipidemia in patients with Type 2 diabetes.
Christopher Wai Kei LamNivritti Gajanan PatilManson FokChristopher Wai Kei LamPublished in: Expert opinion on pharmacotherapy (2021)
Lifestyle modification should always be encouraged, and statin treatment is indicated in most patients with T2DM based on the outcome of randomized controlled trials. If LDL-C goals are not achieved, first, ezetimibe and subsequently proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors should be added. Patients with T2DM derive greater benefits from ezetimibe and PCSK9 inhibitors due to their higher absolute ASCVD risk compared to patients without T2DM. If triglyceride levels remain elevated, a high dose of eicosapentaenoic acid ethyl ester should be added. Fibrates should be used for severe hypertriglyceridemia to prevent acute pancreatitis. Novel treatments including pemafibrate and inclisiran are undergoing cardiovascular outcome trials, and RNA-based therapies may help to target residual hypertriglyceridemia and high lipoprotein(a) with the long acting treatments offering potential improved adherence to therapy.
Keyphrases
- low density lipoprotein
- high dose
- end stage renal disease
- glycemic control
- cardiovascular disease
- newly diagnosed
- chronic kidney disease
- ejection fraction
- prognostic factors
- peritoneal dialysis
- metabolic syndrome
- low dose
- physical activity
- stem cells
- weight loss
- type diabetes
- adipose tissue
- patient reported outcomes
- replacement therapy
- stem cell transplantation
- combination therapy
- climate change
- patient reported
- bone marrow
- skeletal muscle
- global health
- risk assessment
- smoking cessation