Tratamiento integral de la dislipidemia diabética: beneficios y nuevas alternativas terapéuticas

Diabetic dyslipidemia, characterized by the lipid triad (elevated plasma triglycerides, low HDL cholesterol and predominance of small, dense LDL particles), is a significant contributor to the elevated cardiovascular risk of type 2 diabetic patients. Statin monotherapy has shown, in different prospective trials, significant reductions in cardiovascular events and mortality. However, the residual risk in these subjects remains elevated, probably due to the incomplete control of diabetic dyslipidemia. In this review we discuss the global therapeutic approach, underlying the need of combining statins with agents that more effective in reducing triglycerides and elevating HDL cholesterol, even in subjects whose LDL cholesterol values are at target. Available data supports that such combinations contribute to normalize the lipid profile with possible beneficial effects on the cardiovascular risk. Ongoing clinical trials, using different combinations and focusing on cardiovascular morbidity and mortality are also discussed. In our opinion, the future treatment of diabetic dyslipidemia will include the combination of statins and other hypolipidemic agents.