Treatment goals and medication strategies for dyslipidemia in diabetic patients
How should lipid-lowering therapy be implemented in diabetic patients?
Diabetic patients often present with dyslipidemia, characterized by high triglycerides (TG) and low HDL-C, most commonly with significantly elevated total cholesterol (TC) and TG levels. In other words, diabetic dyslipidemia is characterized by elevated TG, decreased HDL-C, and elevated or normal LDL-C.
Studies have shown that even in patients primarily characterized by elevated TG, the prevention of cardiovascular and cerebrovascular diseases mainly benefits from lowering LDL-C. Therefore, LDL-C treatment should remain the primary goal for diabetic patients. Lipid-lowering therapy can significantly reduce the risk of cardiovascular events in diabetic patients.
Before initiating drug therapy, a comprehensive risk assessment should still be performed on diabetic patients to evaluate their risk of cardiovascular and cerebrovascular events over the next 10 years and determine the target LDL-C level. Studies have shown that even diabetic patients without coronary artery disease have the same risk of myocardial infarction within 10 years as those already diagnosed with coronary artery disease. Therefore, serum LDL-C levels in diabetic patients aged 40 and above should be controlled below 2.6 mmol/L (100 mg/dL). HDL-C target values should be maintained above 1.0 mmol/L (40 mg/dL).
Diabetic patients with confirmed cardiovascular disease should be assessed as extremely high-risk. The treatment target is LDL-C below 1.8 mmol/L (60 mg/dL), and drug therapy should be initiated immediately. Statins are the first-line treatment based on the characteristics of the dyslipidemia. If high TG is present with or without low HDL-C, a combination of statins and fibrates can be used.
Similarly, even if LDL-C levels in diabetic patients are already within the target range, the existing LDL-C level should be reduced by 30%–40%.
For diabetic patients with elevated triglycerides (TG) and decreased HDL-C, it is necessary to reduce total calorie intake, especially fat, cholesterol, and saturated fatty acids, appropriately increase the proportion of protein and carbohydrates, reduce or abstain from alcohol, engage in appropriate exercise, and quit smoking.
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