Abstract
Diabetes mellitus is a risk factor for development of cardiovascular diseases. Type 2 diabetics and patients with metabolic syndrome and pre-diabetes typically have dyslipidemia with low levels of HDL-cholesterol, high levels of triglycerides and mildly elevated or normal levels of LDL-cholesterol.
Their LDL-particles are however small, dense and highly atherogenic. These patients often have other, genetically determined disorders of lipoprotein metabolism, in particular it is usually combined dyslipidemia with heightened LDL-cholesterol levels.
Due to a number of other factors connected to insulin resistance, clinically significant atherosclerotic complications often manifest earlier than clinically manifest disorders of glycide metabolism. Type 1 diabetics usually have lack of endogenous insulin production as their primary metabolic disorder, with lipoprotein metabolism disorders generally worsening as a result of poor diabetes management.
However, a type 1 diabetics can too have an accompanying hereditary lipid metabolism disorder. Most patients with pre-diabetes, along with type 2 diabetics and type 1 diabetics with positive microalbuminuria fall into the groups with high to very high cardiovascular risk.
The target values of the lipid spectrum are much stricter in these high risk patients, in comparison to an ordinary person. It is also equally important to monitor and try to influence the factors of residual risk.
The high-risk patients are indicated for treatment with statins or a combined hypolipidemic treatment. In combined therapy, ezetimib is used for lowering LDL-cholesterol levels even further, while fibrates can be used to influence the levels of triglycerides and HDL-cholesterol.
Usage of niacin with laropiprant has at present been halted in EU countries. New preparations are in development.