Pharmacological management of diabetic dyslipidaemia


Authors: Ľubomíra Fábryová
Authors‘ workplace: Metabol KLINIK s. r. o., Ambulancia pre diabetológiu, poruchy látkovej premeny a výživy, Bratislava
Published in: Forum Diab 2017; 6(3): 0
Category: Topic

Overview

Cardiovascular diseases are extremely common in type 2 diabetics. This is due to the presence of characteristic atherogenic dyslipidemia, which significantly contributes to increased cardiovascular risk. Atherogenic dyslipidemia is associated with a worse cardiovascular prognosis, but its management, especially treatment options that lead to a decrease in residual risk, are often ignored in clinical practice. The primary goal of treating diabetic dyslipidemia is to reduce LDL-cholesterol by statins, and diabetics not achieving LDL-cholesterol targets can add ezetimibe to treatment, which further reduces not only LDL-cholesterol but also cardiovascular risk. For diabetic patients achieving LDL-cholesterol targets with statin and/or ezetimibe with atherogenic dyslipidemia addition of fenofibrate leads to further improvement of lipid abnormalities with possible risk reduction. Treatment with fenofibrate is also very useful in diabetic patients with microvascular complications. A new promises for diabetics at very high cardiovascular risk are PCSK9 inhibitors. The management of atherogenic dyslipidemia, in addition to primary LDL-cholesterol management, presents a higher chance of reducing residual cardiovascular risk in an increasingly large group of type 2 diabetics.

Key words:
atherogenic dyslipidemia, cardiovascular disease, ezetimibe, fenofibrate, PCSK9 inhibitors, pemafibrate, statins


Sources

1. European cardiovascular disease statistics. Dostupné z WWW: <http://www.ehnheart.org/cvd-statistics.html>. [18 Oct 2016].

2. Katsiki N, Tentolouris N, Mikhailidis DP. Dyslipidaemia in type 2 diabetes mellitus: bad for the heart. Curr Opin Cardiol 2017; 32(4): 422–429. Dostupné z DOI: <http://dx.doi.org/10.1097/HCO.0000000000000407>.

3. Anabtawi A, Moriarty PM, Miles JM. Pharmacologic Treatment of Dyslipidemia in Diabetes: A Case for Therapies in Addition to Statins. Curr Cardiol Rep 2017; 19(7): 62. Dostupné z DOI: <http://dx.doi.org/10.1007/s11886–017–0872–8>.

4. Fábryová Ľ. Aterogénna dyslipidémia – nový cieľ v kardiovaskulárnej prevencii. AtheroRev 2016; 1(3): 126–137.

5. Halcox JP, Banegas JR, Roy C et al. Prevalence and treatment of atherogenic dyslipidemia in the primary prevention of cardiovascular disease in Europe: EURIKA, a cross-sectional observational study. BMC Cardiovasc Disord 2017;17(1):160. Dostupné z DOI: <http://dx.doi.org/10.1186/s12872–017–0591–5>.

6. Stone NJ, Robinson JG, Lichtenstein AH et al. ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 2014; 63(25 Pt B): 2889–2934. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2013.11.002>. Erratum in J Am Coll Cardiol 2015; 66(24): 2812. J Am Coll Cardiol 2014; 63(25 Pt B): 3024–3025.

7. Lloyd-Jones DM, Morris PB, Ballantyne CM et al. ACC expert consensus decision pathway on the role of non-statin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Task Force on clinical expert consensus documents. J Am Coll Cardiol 2016; 2016(68): 92–125. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2016.03.519>.

8. [American Diabetes Association]. Standards of medical care in diabetes-2017. 9. Cardiovascular Disease and Risk Management. Diabetes Care 2017; 40(Suppl 1): S75–S87. Dostupné z DOI: <https://doi.org/10.2337/dc17-S012>.

9. Piepoli MF, Hoes AW, Agewall S et al. European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016; 37(29): 2315–2381. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehw106>.

10. Catapano AL, Graham I, De Backer G et al. [Task Force Members; Additional Contributor]. ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J 2016; 37(39): 2999–3058. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehw272>.

11. Chapman MJ, Blankenberg S, Landmesser U. The year in cardiology 2015: prevention. Eur Heart J 2016; 37(6): 510–519. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehv721>.

12. Collins R, Armitage J, Parish S et al. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 2003; 361(9374): 2005–2016.

13. Colhoun HM, Betteridge DJ, Durrington PN et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 2004; 364(9435): 685–696.

14. Kearney PM, Blackwell L, Collins R et al. Efficacy of cholesterol lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008; 371(9607): 117–125. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(08)60104-X>.

15. Mihaylova B, Emberson J, Blackwell L et al. [Cholesterol Treatment Trialists‘ (CTT) Collaborators]. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012; 380(9841): 581–590. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(12)60367–5>.

16. Preiss D, Seshasai SR, Welsh P et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. Jama 2011; 305(24): 2556–2564. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.2011.860>.

17. Livingstone SJ, Looker HC, Akbar T et al. Effect of atorvastatin on glycaemia progression in patients with diabetes: an analysis from the Collaborative Atorvastatin in Diabetes Trial (CARDS). Diabetologia 2016; 59(2): 299–306. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–015–3802–6>.

18. Erqou S, Lee CC, Adler AI. Statins and glycaemic control in individuals with diabetes: a systematic review and meta-analysis. Diabetologia 2014; 57(12): 2444–2452. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–014–3374-x>.

19. Cannon CP, Blazing MA, Braunwald E. Ezetimibe plus a statin after acute coronary syndromes. N Engl J Med 2015; 373(15): 1476–1477. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMc1509363>.

20. Barkas F, Elisaf M, Liberopoulos E et al. Statin therapy with or without ezetimibe and the progression to diabetes. J Clin Lipidol 2016; 10(2): 306–313.Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacl.2015.11.015>.

21. Chapman MJ, Ginsberg HN, Amarenco P et al. [European Atherosclerosis Society Consensus Panel]. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: eveidence and guidance for management. Eur Heart J 2011; 32(11): 1345–1361. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehr112>.

22. Wang D, Liu B, Tao W et al. Fibrates for secondary prevention of cardiovascular disease and stroke. Cochrane Database Syst Rev 2015; (10): CD009580. Dostupné z DOI: <http://dx.doi.org/10.1002/14651858.CD009580.pub2>.

23. Min J, Celine F,Jicheng LV et al. Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis. Lancet 2010; 375(9729): 1875–1884. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(10)60656–3>.

24. Sacks FM, Hermans MP, Fioretto P et al. Association between plasma triglycerides and high-density lipoprotein cholesterol and microvascular kidney disease and retinopathy in type 2 diabetes mellitus: a global case-control study in 13 countries. Circulation 2014; 129(9): 999–1008. Dostupné z DOI: <http://dx.doi.org/10.1161/CIRCULATIONAHA.113.002529>.

25. Hermans MP, Fruchart JC, Davignon J et al. Residual Microvascular Risk in Type 2 Diabetes in 2014: Is it Time for a Re-Think? A Perspective from the Residual Risk Reduction Initiative (R3i). J Diabetes Metab 2014; 5(8): 1000413. Dostupné z DOI: <http://dx.doi.org/10.4172/2155–6156.1000413>.

26. Fruchart JC. Selective peroxisome proliferator-activated receptorα modulators (SPPARMα): The next generation of peroxisome proliferator-activated receptor α-agonists. Cardiovasc Diabetol 2013; 12: 82. Dostupné z DOI: <http://dx.doi.org/10.1186/1475–2840–12–82>.

27. Fábryová Ľ. Monoklonálne protilátky proti PCSK9 – nova nádej pre pacientov s vysokým kardiovaskulárnym rizikom. Interná Med 2014; 14(10): 408–416.

28. Gouni-Berthold I, Descamps OS, Fraass U et al. Systematic review of published phase 3 data on anti-PCSK9 monoclonal antibodies in patients with hypercholesterolaemia. Br J Clin Pharmacol 2016; 82(6): 1412–1443. Dostupné z DOI: <http://dx.doi.org/10.1111/bcp.13066>.

29. Sabatine MS, Giugliano RP, Keech AC et al. [FOURIER Steering Committee and Investigators]. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med 2017; 376(18): 1713–1722. <http://dx.doi.org/10.1056/NEJMoa1615664>.

30. Druce I, Abujrad H, Ooi TC. PCSK9 and triglyceride-rich lipoprotein metabolism. J Biomed Res 2015; 29. Dostupné z DOI: <http://dx.doi.org/10.7555/JBR.29.20150052>.

31. Sattar N, Preiss D, Robinson JG et al. Lipid-lowering efficacy of the PCSK9 inhibitor evolocumab (AMG 145) in patients with type 2 diabetes: a meta-analysis of individual patient data. Lancet Diabetes Endocrinol 2016; 4(5): 403–410. Dostupné z DOI: <http://dx.doi.org/10.1016/S2213–8587(16)00003–6>.

32. Sattar N, Preiss D, Blom D et al. Evaluation of the one-year efficacy, safety and glycaemic effects of evolocumab (AMG 145) in 4,802 subjects with, at high risk for or at low risk for diabetes mellitus. Presented in the European Association for the Study of Diabetes Stockholm, Sweden, 2015, Sept, 17 Session OP 27.

33. Colhoun HM, Ginsberg HN, Robinson JG et al. No effect of PCSK9 inhibitor alirocumab on the incidence of diabetes in a pooled analysis from 10 ODYSSEY Phase 3 studies. Eur Heart J 2016; 37(39):2981–2989. Dostupné z DOI: <https://doi.org/10.1093/eurheartj/ehw292>.

34. Filippatos TD, Florentin M, Georgoula M et al. Pharmacological management of diabetic dyslipidemia Expert Rev Clin Pharmacol 2017; 10(2): 187–200. Dostupné z DOI: <http://dx.doi.org/10.1080/17512433.2017.1263565>.

Labels
Diabetology Endocrinology Internal medicine
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