Diabetic Dyslipidemia and Atherosclerosis

Atherosclerosis is the primary cause of death in patients with type 2 diabetes mellitus (DM) and it seems to be closely related to a specific cluster of lipid abnormalities, including low levels of high-density lipoprotein cholesterol, increased numbers of small dense low-density lipoprotein particles, and elevated triglyceride levels. Each of these abnormalities is associated with an increased risk for cardiovascular morbidity and mortality. This review describes the atherogenic dyslipidemia that characterizes type 2 DM, the causes of this so-called diabetic dyslipidemia, and pharmacologic approaches to normalizing the lipid profile in these patients. The management of patients with type 2 DM usually centers on glycemic and blood pressure control. Most of the commonly used antidiabetic agents have neutral or only mildly beneficial effects on diabetic dyslipidemia; thus, achieving better glycemic control may only slightly improve the lipid profile. Treatment of dyslipidemia usually requires pharmacotherapy to achieve major improvements in lipid profiles, yet current management of diabetic dyslipidemia generally is not optimal. Even when treated with statins, patients with type 2 DM frequently exhibit a residual risk for cardiovascular disease; therefore, additional treatment options that use mechanisms of action that differ from those of statins are needed. New agents such as ezetimibe, along with the more traditional treatments of statins, fibrates, and nicotinic acid, may potentially improve the lipid profiles of patients with diabetic dyslipidemia.