| Topic: | Diabetes (DM) |
| Title: | Preventing Cardiovascular Complications of Type 2 Diabetes: Focus on Lipid Management. |
| Author: | Henry, R.R. |
| Source: | Clinical Diabetes. 19(3): 113-120. June 2001. |
| Availability: | Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. |
| Abstract: | This review article focuses on the prevention of cardiovascular complications of type 2 diabetes. Diabetes is a well recognized independent risk factor for cardiovascular disease (CVD) in both men and women. Most adults who have diabetes have one or more lipid abnormalities. The presence of increased triglyceride and decreased high density lipoprotein (HDL) levels is the best predictor of CVD in people with type 2 diabetes. A clustering of risk factors, which has been termed the metabolic syndrome, occurs commonly in type 2 diabetes and simultaneously affects the development of CVD and diabetes. The main feature of the metabolic syndrome is insulin resistance. This condition appears to induce other metabolic disturbances included in the metabolic syndrome: atherogenic dyslipidemia, impaired glucose tolerance, and hypertension. Thus, intensive treatment of dyslipidemia, high blood pressure, and hyperglycemia is considered essential in the treatment of diabetes. According to current American Diabetes Association (ADA) recommendations, the major emphasis for treating diabetic dyslipidemia should be placed on lowering low density lipoprotein (LDL) cholesterol levels to less than 100 milligrams (mg) per deciliter (dl). Diet and exercise are the foundation of therapy for all people with dyslipidemia. Pharmacological tools are available to treat all lipid abnormalities in people who are at very high risk for CVD. Drug therapy should follow when a 3 to 6 month trial of lifestyle modifications alone fails to lower LDL cholesterol levels adequately. The ADA recommends initiation of a lipid lowering agent in people who have diabetes but no preexisting CVD if LDL cholesterol level remains at 130 mg per dl or more despite a modified diet and exercise. People who have diabetes and established CVD or a very high LDL cholesterol level at diagnosis should receive pharmacological therapy at the same time as lifestyle modifications. Statins are the drug of first choice for reducing LDL levels. Fibric acids are the drugs of first choice for treating elevated triglyceride levels. Combination therapy with statins and fibric acids may be required if aggressive statin therapy does not achieve lipid and lipoprotein goals. Bile acid binding resins may be used in combination with a fibric acid derivative as a third line choice for high LDL levels. 4 tables. 43 references. |
| Format: | Journal Article |
| Language: | English. |
| Major Keywords: | Diabetes Mellitus. Type 2 Diabetes. Cardiovascular Risk Factors. Pathogenesis. Blood Lipids. Prevention. Intensive Diabetes Management. Lifestyle. Behavior Modification. Drug Therapy. Drug Effects. |
| Minor Keywords: | Arteriosclerosis. Cholesterol. Hyperglycemia. Insulin Resistance. Impaired Glucose Tolerance. Hypertension. Diet. Exercise. Clinical Research. |
| Publication Number: | DMJA09832 |
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