Management of cardiovascular risk in the light of current recommendations
Authors:
Peter Sabaka
Authors‘ workplace:
Klinika infektológie a geografickej medicíny LF UK, SZU a UNB, Nemocnica akad. L. Dérera, Bratislava
Published in:
Forum Diab 2018; 7(1): 5-9
Category:
Overview
Presence of type 2 diabetes mellitus (T2DM) significantly increases risk of cardiovascular events and cardiovascular death. Lipoprotein metabolism disorders in patients with T2DM are significantly contributing to this risk. For a diabetic dyslipidemia, high concentration of triacylglycerol (TAG) and low concentration of high density lipoprotein (HDL) is typical. On the level of lipoprotein subclasses, high concentration of small dense low-density lipoproteins (LDL) and very low-density lipoproteins and remnant particles are almost constant findings in patients with diabetes. The dyslipidemia in T2DM should treated by combination of non-pharmacologic and pharmacologic therapy. Mainstay of pharmacologic therapy are statins. If statin monotherapy is not sufficient to achieve target levels of LDL, combination therapy is recommended. There is sufficient evidence about effectivity of statin combination with ezetimibe or PCSK9 inhibitor. Fibrates are recommended only in selected patients like those with retinopathy or very high TAG levels
Key words:
diabetes mellitus type 2, dyslipidemia, lipoproteins
Received:
22. 12. 2017
Accepted:
31. 1. 2018
Sources
1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006, 3(11): e442. Dostupné z DOI: <http://doi:10.1371/journal.pmed.0030442>.
2. Kannel WB, McGee DL. Diabetes and cardiovascular risk factors: the Framingham study. Circulation 1979; 59(1): 8–13.
3. Berry JD, Dyer A, Cai X et al. Lifetime risks of cardiovascular disease. N Engl J Med 2012; 366(4): 321–329. Dostupné z DOI: <http://doi:10.1056/NEJMoa1012848>.
4. Chiha M, Njeim M, Chedrawy EG. Diabetes and Coronary Heart Disease: A Risk Factor for the Global Epidemic. Int J Hypertens 2012; 2012:697240. Dostupné z DOI: <http://doi:10.1155/2012/697240>.
5. Mahmood SS, Levy D, Vasan RS et al. The Framingham Heart Study and the Epidemiology of Cardiovascular Diseases: A Historical Perspective. Lancet 2014; 383(9921): 999–1008. Dostupné z DOI: <http://doi:10.1016/S0140–6736(13)61752–3>.
6. Haffner SM, Stern MP, Hazuda HP et al. Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA 1990; 263(21): 2893–2898.
7. Schofield JD, Liu Y, Rao-Balakrishna P et al. Diabetes Dyslipidemia. Diabetes Therapy 2016; 7(2): 203–219. Dostupné z DOI: <http://doi:10.1007/s13300–016–0167-x>.
8. Vergès B. Pathophysiology of diabetic dyslipidaemia: where are we? Diabetologia 2015; 58(5): 886–899. Dostupné z DOI: <http://doi: 10.1007/s00125–015–3525–8>.
9. de Bruin TW, Brouwer CB, Gimpel JA et al. Postprandial decrease in HDL cholesterol and HDL apo A-I in normal subjects in relation to triglyceride metabolism. Am J Physiol 1991, 260(3 Pt 1): E492–498. Dostupné z DOI: <http://doi:10.1152/ajpendo.1991.260.3.E492>.
10. Tian L, Long S, Li C et al. High-density lipoprotein subclass and particle size in coronary heart disease patients with or without diabetes. Lipids Health Dis 2012; 11:54. Dostupné z DOI: <http://doi: 10.1186/1476–511X-11–54>.
11. Wojczynsk MK, Glasser SP, Oberman A et al. High-fat meal effect on LDL, HDL, and VLDL particle size and number in the Genetics of Lipid-Lowering Drugs and Diet Network (GOLDN): an interventional study. Lipids Health Dis 2011, 10:181. Dostupné z DOI: <http://doi: 10.1186/1476–511X-10–181>.
12. Packard CJ. Triacylglycerol-rich lipoproteins and the generation of small, dense low-density lipoprotein. Biochem Soc Trans 2003; 31(Pt 5): 1066–1069.
13. Lamarche B, Tchernof A, Moorjani S et al. Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic heart disease in men. Prospective results from the Quebec cardiovascular study. Circulation 1997; 95: 69–75. Dostupné z DOI: <http://doi:10.1161/01.CIR.95.1.69>.
14. Austin MA, Rodriguez BL, McKnight B et al. Low-density lipoprotein particle size, triglycerides, and high-density lipoprotein cholesterol as risk factors for coronary heart disease in older Japanese-American men. Am J Cardiol 2000; 86(4): 412–416.
15. Assmann G, Schulte H, von Eckardstein A. Hypertriglyceridemia and elevated lipoprotein(a) are risk factors for major coronary events in middle-aged men. Am J Cardiol 1996; 77(14): 1179–1184. Dostupné z DOI: <http://doi:10.1016/S0002–9149(96)00159–2>.
16. Kadota A, Hozawa A, Okamura T et al. Relationship between metabolic risk factor clustering and cardiovascular mortality stratified by high blood glucose and obesity: NIPPON DATA90, 1990–2000. Diabetes Care 2007; 30:1533–1538. Dostupné z DOI: <http://doi:10.2337/dc06–2074>.
17. Onat A, Sari I, Yazici M et al. Plasma triglycerides, an independent predictor of cardiovascular disease in men: a prospective study based on a population with prevalent metabolic syndrome. Int J Cardiol 2006; 108(1): 89–95. Dostupné z DOI: <http://doi: 10.1016/j.ijcard.2005.06.056>.
18. Chen YDI, Swami S, Skowronski R et al. Differences in postprandial lipemia between patients with normal glucose tolerance and noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1993; 76(1):172–177. Dostupné z DOI: <http://doi:10.1210/jcem.76.1.8421086>.
19. Nordestgaard BG, Benn M, Schnohr P et al. Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA 2007, 298(3): 299–308. Dostupné z DOI: <http://doi:10.1001/jama.298.3.299>.
20. Freemantle N, Holmes J, Hockey A et al. How strong is the association between abdominal obesity and the incidence of type 2 diabetes? Int J Clinic Pract 2008; 62(9): 1391–1396. Dostupné z DOI: <http://doi:10.1111/j.1742–1241.2008.01805.x>.
21. Sabaka P, Kruzliak P, Gaspar L et al. Postprandial changes of lipoprotein profile: effect of abdominal obesity. Lipids Health Dis 2013; 12:179. Dostupné z DOI: <http://doi:10.1186/1476–511X-12–179>.
22. Dukát A, Fábryová L, Oravec S et al. Lipids and the size of lipoprotein particles in newly diagnosed and untreated patients with type 2 diabetes mellitus. Vnitr Lek 2013; 59(6): 450–452.
23. Phillips NR, Waters D, Havel RJ. Plasma lipoproteins and progression of coronary artery disease evaluated by angiography and clinical events. Circulation 1993; 88(6): 2762–2770. Dostupné z DOI: <http://doi:10.1161/01.CIR.88.6.2762>.
24. International Diabetes Federation Guideline Development Group. Global guideline for type 2 diabetes. Diabetes Res Clin Pract 2014; 104(1): 1–52. Dostupné z DOI: <http://doi:10.1016/j.diabres.2012.10.001>.
25. IIanne-Parikka P, Eriksson JG, Lindstrom J et al. Effect of lifestyle intervention on the occurrence of metabolic syndrome and its components in the Finnish diabetes prevention study. Diabetes Care 2008; 31(4): 805–807. Dostupné z DOI: <http://doi:10.2337/dc07–1117>.
26. Piepoli MF, Hoes AW, Agewall S et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37(29): 2315–2381. Dostupné z DOI: <http://doi:10.1093/eurheartj/ehw106>.
27. Talbot LA, Morrell CH, Fleg JLet al. Changes in leisure time physical activity and risk of all-cause mortality in men and women: the Baltimore Longitudinal Study of Aging. Prev Med 2007; 45(2–3): 169–176. Dostupné z DOI: <http://doi:10.1016/j.ypmed.2007.05.014>.
28. Sabaka P, Kruzliak P, Balaz D et al. Effect of short term aerobic exercise on fasting and postprandial lipoprotein subfractions in healthy sedentary men. Lipids Health Dis 2015; 14: 151. Dostupné z DOI: <http://doi:10.1186/s12944–015–0148–5>.
29. Mihailescu DV, Vora A, Mazzone T. Lipid effects of endocrine medications. Curr Atheroscler Rep 2011; 13(1): 88–94. Dostupné z DOI: <http://doi:10.1007/s11883–010–0146-z>.
30. Wulffele MG, Kooy A, de Zeeuw D et al. The effect of metformin on blood pressure, plasma cholesterol and triglycerides in type 2 diabetes mellitus: a systematic review. J Intern Med 2004; 256: 1–14. Dostupné z DOI: <http://doi:10.1111/j.1365–2796.2004.01328.x>.
31. Azad N, Bahn GD, Emanuele NV et al. VADT Study Group. Association of Blood Glucose Control and Lipids With Diabetic Retinopathy in the Veterans Affairs Diabetes Trial (VADT). Diabetes Care 2016; 39(5): 816–822. Dostupné z DOI: <http://doi:10.2337/dc15–1897>.
32. Ray KK, Seshasai SR, Erqou S et al. Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med 2010; 170(12): 1024–1031. Dostupné z DOI: <http://doi:10.1001/archinternmed.2010.182>.
33. Collins R, Armitage J, Parish S et al. MRC/BHF heart protection study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 2003; 361(9374): 2005–2016. Dostupné z DOI: <http://doi: 10.1016/S0140–6736(03)12475–0>.
34. Kearney PM, Blackwell L et al. Cholesterol Treatment Trialists Collaborators. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008; 371(9607): 117–125. Dostupné z DOI: <http://doi:10.1016/S0140–6736(08)60104-X>.
35. American Diabetes Association. Cardiovascular disease and risk management. Diabetes Care 2015; 38(Suppl): S49–S57. Dostupné z DOI: <http://doi:10.2337/dc15-S011>.
36. Cannon CP, Blazing MA, Giguliano RP et al. for the IMPROVE-IT Investigators. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 2015; 372(25): 2387–2397. Dostupné z DOI: <http://doi: 10.1056/NEJMoa1410489>.
37. Leiter LA, Cariou B, Müller‐Wieland D et al. Efficacy and safety of alirocumab in insulin‐treated individuals with type 1 or type 2 diabetes and high cardiovascular risk: The ODYSSEY DM‐INSULIN randomized trial. Diabetes Obes Metab 2017; 19(12): 1781–1792. Dostupné z DOI: <http://doi:10.1111/dom.13114>.
38. Ginsberg HN, Elam MB et al. The ACCORD Study Group. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med 2010; 362(17): 1563–1574. Dostupné z DOI: <http://doi:10.1056/NEJMoa1001282>.
39. Birjmohun RS, Hutten BA, Kastelein JJ et al. Efficacy and safety of high-density lipoprotein cholesterol-increasing compounds: a meta-analysis of randomized controlled trials. J Am Coll Cardiol 2005; 45(2): 185–197. Dostupné z DOI: <http://doi:10.1016/j.jacc.2004.10.031>.
40. Wright AD, Dodson PM. Medical management of diabetic retinopathy: fenofibrate and ACCORD Eye studies. Eye 2011; 25(7): 843–849. Dostupné z DOI: <http://doi:10.1038/eye.2011.62>.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Forum Diabetologicum
2018 Issue 1
Most read in this issue
- PCSK9 inhibitors and the role of evolocumab in the therapy for patients with hyperlipoproteinemia
- Vildagliptin: experience and prospects
- A consensual therapeutic recommendation for type 2 diabetes mellitus by the Slovak Diabetes Society (2018)
- Comprehensive approach in the management of patients with diabesity