Update on the Management of Diabetic Dyslipidaemia

Abstract

Diabetic dyslipidaemia (DD) comprises a complex group of potentially atherogenic lipid and lipoprotein abnormalities, including both quantitative and qualitative changes. It is characterised by low high-density lipoprotein cholesterol, elevated low-density lipoprotein cholesterol (LDL-C), and a higher prevalence of small, dense LDL particles, as well as elevated fasting and postprandial triglycerides. Patients with Type 2 diabetes mellitus have an increased prevalence of lipid abnormalities and controlling dyslipidaemia in these patients has a big impact on morbidity and mortality. Lifestyle changes are still the pillar of treatment for DD and statins are the drugs of choice that decrease LDL-C and reduce cardiovascular events and cardiovascular death, either in primary or secondary prevention, in diabetic patients. Pitavastatin has a number of pleiotropic effects that reduce the metabolic changes associated with adiposity and improve glucose metabolism, which distinguishes it from other statins. New treatments, such as PCSK9 inhibitors, have proven to be powerful LDL-C-lowering agents; however, the need for long-term safety studies and the high associated costs are the main challenges. Future treatments, such as an intracellular PCSK9 inhibitor, a dual proliferator-activated receptor-alpha/gamma agonist, and bempedoic acid, are in development. The aim of this article is to review the pathophysiology of DD and discuss its role in cardiovascular event risk and treatment, as well as to study the effects of lipid-lowering therapy on glucose metabolism and the outcomes of antidiabetic treatment on dyslipidaemia.