Diabetic Dyslipidemia: Current Concepts in Pathophysiology and Management OE06-OE09
Dr. Debasish Chaudhury,
Dilshad Colony-110095, New Delhi, India.
Diabetes Mellitus (DM) has assumed pandemic proportions worldwide. The increase in prevalence of this non-communicable disease has been quite alarming. South East Asia is home to approximately 71.4 million of the diabetics, out of which 61.3 million diabetics are in India in 2011 as per the data of International Diabetic Federation. The leading causes of morbidity and mortality for such patients have been attributed to the rising incidences of Cardiovascular Diseases (CVD) as a complication of type 2 diabetes. A major proportion of CVDs are attributed to the occurrence of atherogenic dyslipidemia. The pathophysiologic mechanisms and treatment regimens for dyslipidemia have been evolving and several newer mechanisms are being proposed. The purpose of the review is to throw light on the new concepts regarding pathophysiology and management guidelines of diabetic dyslipidemia. A literature review was performed in pubMed and google using the key words: type 2 DM, dyslipidemia, pathophysiology, treatment. A total of 30 articles over last 10 years were scanned for review. The newer mechanisms of dyslipidemia included: activation of transcription factors, decreased Lipoprotein Lipase (LPL), decreased clearance. The role of remnant particles, adiponectin an anti-inflammatory molecule has also been proposed. The current treatment regimens are based on Low Density Lipoproteins (LDL) and high density lipoproteins (HDL) and the recommendations are different for the various associations. Statins are considered the standard lipid lowering agents in diabetics and have shown mortality benefits in these patients. However, many new drugs like Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) inhibitors, saroglitazar are emerging as possible alternates for statins in the treatment of dyslipidemia, though their overall cardiovascular benefit is yet to be studied.