Metabolic background as the basis for comorbidity in patients with type 2 diabetes mellitus

Abstract

The main cause of death among people with DM2 is atherosclerotic cardiovascular diseases (ARDS), the risk of which in this cohort increases 2–4 times. The features of the metabolic background in comorbid patients with type 2 diabetes mellitus are characterized by an aggressive course of dyslipidemia with a predominance of its atherogenic forms. Despite the achievement of lipid targets on the background of statin therapy, the residual risk of cardiovascular diseases in this group of patients remains quite high. The results of a number of major research papers indicate that hypertriglyceridemia may play an important role in this. In this regard, triglycerides (TG) are no less important for the prevention and control of cardiovascular risk in carbohydrate metabolism disorders, in addition to LDL. According to the consensus statement of the European Atherosclerosis Society, the risk of ASD becomes clinically significant at an empty stomach TG level >1.7 mmol/l. The main tool for controlling hypertriglyceridemia today is fibrate therapy. According to available data, the combination of statins and fenofibrate is more effective in reducing total cholesterol, LDL, TG and increasing HDL. To date, fenofibrate is the only molecule that has shown an optimal safety profile and reduced risk of cardiovascular diseases. In the Russian clinical guidelines on lipid metabolism disorders from 2023, it was proposed to divide patients into 3 main categories according to the severity of the increase in TG, on which the management tactics depend: 1.7–2.3 mmol/l; 2.3–5 mmol/l; ≥5 mmol/l. In individuals with TG levels >2.3 mmol/l on the background of moderate or high intensity statin therapy, the use of fenofibrate is recommended, preferably in combination with statins.