Ebook Managing cardiovascular complications in diabetes: Part 2
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Ebook Managing cardiovascular complications in diabetes: Part 2
CHAPTER 7Dyslipidemia and ItsManagement in Type 2 DiabetesD. John BetteridgeUniversity College London Hospital. London. UKKey Points•Dyslipidemia is a Ebook Managing cardiovascular complications in diabetes: Part 2an integral component of metabolic syndrome and type 2 diabetes.•Dyslipidemia involves both quantitative and qualitative lipid and lipoprotein abnormalities: moderate hypertriglyceridemia, low HDL-cholesterol, small dense LDL particles, and accumulation of cholesterol-rich remnant particles.•Dyslipi Ebook Managing cardiovascular complications in diabetes: Part 2demia is a major independent risk predictor for atherosclerosis-related disease.•Increasing LDL-cholesterol concentrations and decreasing HDL-cholesteEbook Managing cardiovascular complications in diabetes: Part 2
rol concentrations were the strongest risk predictors for myocardial infarction observed in UKPDS.•Patients with type 2 diabetes are at high risk of CCHAPTER 7Dyslipidemia and ItsManagement in Type 2 DiabetesD. John BetteridgeUniversity College London Hospital. London. UKKey Points•Dyslipidemia is a Ebook Managing cardiovascular complications in diabetes: Part 2based on a wealth of data from well-conducted robust RCT.•Some patients are statin intolerant and other drug classes such as ezetimibe, fibrates, nicotinic acid, and colesevalam may be required.•New LDL-cholesterol-lowering strategies are in development that should ensure, if proved to be effective Ebook Managing cardiovascular complications in diabetes: Part 2and safe, that more patients achieve LDL-cholesterol goals.•Low HDLEbook Managing cardiovascular complications in diabetes: Part 2
ls are achieved in the statin trials.•To date no evidence IS available from RCT to support measures to increase HDL-cholesterol to lower CVD events.•ICHAPTER 7Dyslipidemia and ItsManagement in Type 2 DiabetesD. John BetteridgeUniversity College London Hospital. London. UKKey Points•Dyslipidemia is a Ebook Managing cardiovascular complications in diabetes: Part 2elated disease, coronary heart disease (CHD), peripheral vascular disease (PVD), and thrombotic stroke are major complications inManaging Cardiovascular Complications in Diabetes. First Edition.Edited by D. John Betteridge and Stephen Nicholls.0 2014 John Wiley & Sons, Ltd. Published 2014 by John Wi Ebook Managing cardiovascular complications in diabetes: Part 2ley & Sons, Ltd.165166 Managing Cardiovascular Complications in Diabetespeople with type 2 diabetes mellitus 111- A recent meta-analysis of 102 prospeEbook Managing cardiovascular complications in diabetes: Part 2
ctive studies demonstrated a hazard ratio of 2 for coronary death and non-fatal myocardial infarction (Ml) and 2.5 for ischemic stroke [2]. In the UniCHAPTER 7Dyslipidemia and ItsManagement in Type 2 DiabetesD. John BetteridgeUniversity College London Hospital. London. UKKey Points•Dyslipidemia is a Ebook Managing cardiovascular complications in diabetes: Part 2ent relates to patients with type 2 diabetes, but the increased lifetime risk for those with type I diabetes should be remembered when considering lipid lowering, particularly those with albuminuria, hypertension, and chronic kidney disease 14].The pathogenesis of atherosclerosis in diabetes Is mult Ebook Managing cardiovascular complications in diabetes: Part 2ifactorial and the task for the physician is to manage all modifiable risk factors to prevent CVD events. However, it is clear from prospective studieEbook Managing cardiovascular complications in diabetes: Part 2
s that plasma cholesterol and low-density lipoprotein (LDL)-cholesterol in particular are major Independent risk factors. In the United Kingdom ProspeCHAPTER 7Dyslipidemia and ItsManagement in Type 2 DiabetesD. John BetteridgeUniversity College London Hospital. London. UKKey Points•Dyslipidemia is a Ebook Managing cardiovascular complications in diabetes: Part 2t predictor of MI was low levels of high-density lipoprotein (HDL)-cholesterol ahead of glycated hemoglobin, systolic blood pressure, and cigarette smoking 15].Diabetic DyslipidemiaThe dyslipidemia of metabolic syndrome. Insulin resistance, and type 2 diabetes consists of both quantitative and quali Ebook Managing cardiovascular complications in diabetes: Part 2tative lipid and lipoprotein abnormalities [6], Moderate hypertriglyceridemia is accompanied by low levels of HDL-cholesterol and an increase in choleEbook Managing cardiovascular complications in diabetes: Part 2
sterol-rich remnant particles of chylomicrons and very low-density lipoprotein (VLDL) metabolism. LDL-cholesterol concentrations reflect those of the CHAPTER 7Dyslipidemia and ItsManagement in Type 2 DiabetesD. John BetteridgeUniversity College London Hospital. London. UKKey Points•Dyslipidemia is a Ebook Managing cardiovascular complications in diabetes: Part 2articles that are thought to be more atherogenic |7|.This complex phenotype is present at the time of diabetes diagnosis as it is part of the metabolic syndrome and prediabetes. In an individual patient it will be Influenced by gender and lifestyle factors, particularly central obesity, the degree o Ebook Managing cardiovascular complications in diabetes: Part 2f physical activity, poor glycemic control, cigarette smoking, and alcohol intake. In addition, other secondary' causes including renal and hepatic dyEbook Managing cardiovascular complications in diabetes: Part 2
sfunction, hypothyroidism, and concurrent medication may have a significant effect. Concurrent primary dyslipidemias such as familial hypercholesterolCHAPTER 7Dyslipidemia and ItsManagement in Type 2 DiabetesD. John BetteridgeUniversity College London Hospital. London. UKKey Points•Dyslipidemia is a Ebook Managing cardiovascular complications in diabetes: Part 2f insulin resistance on lipid and lipoprotein metabolism has Increased enormously, much remains to beDyslipidemia and Its .Management in Type 2 Diabetes 167learned. A basic abnormality is the overproduơion of large VLDL from the liver, partly as a result of an increased flux of fatty acids from adip Ebook Managing cardiovascular complications in diabetes: Part 2ose tissue combined with lack of inhibition of VLDL assembly |8|. In the postprandial state, hepatic VLDL production Is not suppressed and this, togetEbook Managing cardiovascular complications in diabetes: Part 2
her with exogenous fat absorbed In the form of chylomicrons, saturates activity of the enzyme lipoprotein lipase (LPL). LPL activity itself can also bCHAPTER 7Dyslipidemia and ItsManagement in Type 2 DiabetesD. John BetteridgeUniversity College London Hospital. London. UKKey Points•Dyslipidemia is a Ebook Managing cardiovascular complications in diabetes: Part 2gation of the postprandial phase of lipid metabolism Is associated with Increased cholesterol and triglyceride exchange through the activity of cholesterol ester transport protein (CETP). CETP facilitates a mole-for-mole transfer of cholesterol esters from HDL to VLDL, IDL and chylomicron remnants, Ebook Managing cardiovascular complications in diabetes: Part 2and LDL In exchange for triglycerides. As a result, LDL and HDL are triglyceride enriched and become substrates for the enzyme hepatic lipase, the actEbook Managing cardiovascular complications in diabetes: Part 2
ivity of which Is Increased In diabetes. As a result of the triglyceride hydrolysis by this enzyme, LDL and HDL become smaller and denser. Smaller, deCHAPTER 7Dyslipidemia and ItsManagement in Type 2 DiabetesD. John BetteridgeUniversity College London Hospital. London. UKKey Points•Dyslipidemia is a Ebook Managing cardiovascular complications in diabetes: Part 2diabetes and concomitant metabolic syndrome Including dyslipidemia that are at highest risk. In the National Health and Nutrition Examination (NHANES III) performed in the USA, the prevalence of metabolic syndrome in diabetes was 86%. The prevalence of CHD in this group was 19.2%. In those with diab Ebook Managing cardiovascular complications in diabetes: Part 2etes and no evidence of metabolic syndrome, CHD prevalence was 7.5%, which is comparable to those without diabetes or metabolic syndrome 110Ị.CHAPTER 7Dyslipidemia and ItsManagement in Type 2 DiabetesD. John BetteridgeUniversity College London Hospital. London. UKKey Points•Dyslipidemia is aCHAPTER 7Dyslipidemia and ItsManagement in Type 2 DiabetesD. John BetteridgeUniversity College London Hospital. London. UKKey Points•Dyslipidemia is aGọi ngay
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