Management of Dyslipidemia in Patients with Diabetes Mellitus

Abstract

Most patients with diabetes mellitus (DM) have dyslipidemia, which is characterized by increased triglycerides, decreased high-density lipoprotein cholesterol, and increased small dense low-density lipoprotein cholesterol (LDL-C). Dyslipidemia is an important modifiable risk factor for cardiovascular disease (CVD). Therefore active management is essential. Despite its increasing prevalence, the proportion of patients with adequately-controlled dyslipidemia is small, and efforts to improve this pattern are required. The Korean Diabetes Association guidelines recommend setting goals by evaluating each patient’s future CVD risk, including the presence or absence of CVD, target organ damage, major cardiovascular risk factors, and the duration of DM. The primary target is an LDL-C level below 55 mg/dL (and a reduction in LDL-C level by 50% or more from baseline), 70 mg/dL, and 100 mg/dL from the highest risk group to the lowest risk group, respectively. Statins are the first-line drug of choice, and if the LDL-C target is not reached by a maximum tolerable dose of statin, combination therapy with ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors is recommended. In hypertriglyceridemia, lifestyle changes including weight loss and abstinence from alcohol are very important, along with glycemic control.