Choosing approaches to treatment of hyperlipoproteinaemia and dyslipidaemia in a patient with diabetes
Abstract
Diabetes-related DLP is characterized by low HDL-cholesterol (HDL-C) and higher triglycerides, accompanied by increased levels of "small dense" LDL particles. And it is the therapy aiming at HDL where we still run into difficulties.
The development of the rather promising niacin (in combination with laropiprant) was stopped, the group of CETP (cholesterol ester transfer protein) inhibitors does not seem to have foung any clear perspective (the development of anacetrapib and evacetrapib is ongoingwhile that of torcetrapib and dalcetrapib has been stopped). Recently great hope was associated, mainly in patients with diabetes, with the combined alfa and gama PPAR agonists, glitazars.
Primary failure of the first molecules from this group of hypolipidemics/antidiabetics has been recently compounded by the failure of the alleglitazar study. Adding the discontinued development of rimonabant (an ideal agent for completely developed metabolic syndrome including DM, HLP, obesity...), we have to admit that our armamentarium is by no means very rich.
We still continue to rely on fibrates, i.e. traditional drugs that we almost exclusively use in combination with statins, doing this precisely in patients with typical diabetics DLP. The basic will thus remain, also in patients with diabetes, "LDL-C modifying treatment".
In practice, this especially means treatment with statins, and statins with ezetimibe for combination treatment. Therapy with the combination statin + ezetimibe has been shown to provide favourable results in patients with type 2 DM as well, though this is based on a mortality study that has not been very extensive so far.