糖尿病患者高胆固醇血症的处理。

C Packard, A G Olsson
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引用次数: 0

摘要

冠心病(CHD)是2型糖尿病患者死亡的主要原因。作为该疾病特征的高血糖通常伴有一系列其他危险因素,如血脂异常和高血压,对糖尿病患者的有效管理需要针对纠正所有增加心血管风险的异常进行治疗。大约90%的糖尿病患者患有2型糖尿病,这些患者的血脂异常的特征是血浆甘油三酯和极低密度脂蛋白(VLDL)升高,高密度脂蛋白胆固醇(HDL-C)降低,LDL分布转向小而致密的颗粒。所有这些脂质异常都是冠心病的重要危险因素。回顾性亚组分析和前瞻性研究表明,降脂治疗可以减缓糖尿病患者动脉粥样硬化的进展,降低心血管事件的风险,国家胆固醇教育计划成人治疗小组III和美国糖尿病协会都为这些患者制定了积极的降脂治疗目标。所有用于治疗其他人群高脂血症的主要药物(烟酸、贝特酸、胆汁酸隔离剂和他汀类药物)都已被有效地用于改善糖尿病患者的血脂水平。他汀类药物通常被接受为这些患者的一线治疗,尽管贝特类药物在明显的高甘油三酯血症患者中也有重要作用。他汀类药物可显著降低低密度脂蛋白胆固醇(LDL-C)。这些药物对血浆甘油三酯也有实质性的影响,并且在高甘油三酯血症患者中,极低密度脂蛋白胆固醇(VLDL-C)的降低程度与LDL-C大致相同。在这方面,在最近的试验中,新药物瑞舒伐他汀比目前上市的化合物更能降低这些脂蛋白。积极使用治疗2型糖尿病患者特有的脂质异常的药物有可能显著降低这些个体的冠心病风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management of hypercholesterolaemia in the patient with diabetes.

Coronary heart disease (CHD) is the leading cause of death in patients with type 2 diabetes. The hyperglycaemia that characterises this disease is often accompanied by a cluster of other risk factors, such as dyslipidaemia and hypertension, and effective management of the patient with diabetes requires treatment directed at correcting all of the abnormalities that increase cardiovascular risk. Approximately 90% of patients with diabetes have type 2 disease, and dyslipidaemia in these patients is characterised by elevated plasma triglycerides and very-low-density lipoproteins (VLDL), by reduced high-density lipoprotein cholesterol (HDL-C), and by a shift in LDL distribution towards small, dense particles. All of these lipid abnormalities are important risk factors for CHD. Retrospective subgroup analysis and prospective studies have shown that lipid-lowering therapy can slow the progression of atherosclerosis and reduce the risk for cardiovascular events in patients with diabetes, and both the National Cholesterol Education Program Adult Treatment Panel III and American Diabetes Association have established aggressive treatment goals for lipid-lowering therapy in these patients. All of the major medications used to treat hyperlipidaemia in other populations (niacin, fibrates, bile acid sequestrants and statins) have been used effectively to improve the plasma lipid profile in patients with diabetes. Statins are generally accepted as first-line treatment for these patients, although fibrates also have an important role in patients with pronounced hypertriglyceridaemia. Statins significantly reduce low-density lipoprotein cholesterol (LDL-C) in a broad range of patients. These agents also have substantial effects on plasma triglycerides and, in patients with hypertriglyceridaemia, lower very-low-density lipoprotein cholesterol (VLDL-C) to approximately the same extent as LDL-C. In this regard, the new agent rosuvastatin has been shown, in recent trials, to produce greater decreases in these lipoproteins than currently marketed compounds. Aggressive use of agents that attack the lipid abnormalities characteristic of patients with type 2 diabetes has the potential to significantly reduce CHD risk in these individuals.

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