Lipid-lowering therapies and cardiovascular risk-stratification strategies in adults with type 1 diabetes.

IF 2.6 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Current Opinion in Endocrinology & Diabetes and Obesity Pub Date : 2023-04-01 DOI:10.1097/MED.0000000000000790

Nick S R Lan, Damon A Bell, Gerald F Watts, P Gerry Fegan

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引用次数: 3

Abstract

Purpose of review: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of mortality in adults with type 1 diabetes (T1D). Although dyslipidaemia is a modifiable and prevalent risk factor in individuals with T1D, determining when to initiate lipid-lowering therapy for primary prevention of ASCVD can be challenging. In this article, recommendations for lipid-lowering therapy from updated clinical guidelines over the last 5 years, additional risk-stratification methods, hypertriglyceridaemia management and potential barriers to optimal care in adults with T1D are discussed.

Recent findings: Low-density lipoprotein cholesterol (LDL-C) is the primary target for lipid-lowering. However, international guidelines recommend differing approaches to ASCVD risk-stratification, lipid-lowering, and LDL-C goals in individuals with diabetes, predominantly reflecting evidence from studies in type 2 diabetes. Despite guideline recommendations, several studies have demonstrated that statins are underused, and LDL-C goals are not attained by many individuals with T1D. Additional risk-stratification methods including T1D-specific ASCVD risk calculators, coronary artery calcium scoring, and lipoprotein(a) may provide additional information to define when to initiate lipid-lowering therapy.

Summary: Clinical trial evidence for lipid-lowering therapies in T1D is lacking, and further studies are needed to inform best practice. Optimization and harmonization of ASCVD risk-stratification and lipid management in individuals with T1D is required.

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1型糖尿病成人降脂治疗和心血管风险分层策略

综述目的:动脉粥样硬化性心血管疾病(ASCVD)是成人1型糖尿病(T1D)患者死亡的主要原因。尽管血脂异常在T1D患者中是一个可改变且普遍的危险因素，但确定何时开始降脂治疗以一级预防ASCVD可能具有挑战性。在这篇文章中，我们讨论了最近5年更新的临床指南中关于降脂治疗的建议、额外的风险分层方法、高甘油三酯血症的管理以及成人T1D患者最佳护理的潜在障碍。最新发现:低密度脂蛋白胆固醇(LDL-C)是降脂的主要目标。然而，国际指南对糖尿病患者的ASCVD风险分层、降脂和LDL-C目标推荐了不同的方法，主要反映了2型糖尿病研究的证据。尽管有指南建议，但一些研究表明，他汀类药物的使用不足，许多T1D患者没有达到LDL-C目标。其他的风险分层方法，包括t1d特异性ASCVD风险计算器、冠状动脉钙评分和脂蛋白(a)，可以为确定何时开始降脂治疗提供额外的信息。总结:T1D降脂治疗的临床试验证据缺乏，需要进一步的研究来告知最佳实践。在T1D患者中，ASCVD风险分层和血脂管理的优化和协调是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Endocrinology & Diabetes and Obesity ENDOCRINOLOGY & METABOLISM-

CiteScore

5.80

自引率

3.10%

发文量

128

审稿时长

6-12 weeks

期刊介绍： Current Opinion in Endocrinology, Diabetes and Obesity delivers a broad-based perspective on the most recent and exciting developments in the field from across the world. Published bimonthly and featuring twelve key topics – including androgens, gastrointestinal hormones, diabetes and the endocrine pancreas, and neuroendocrinology – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.