Controversial issues in the treatment of dyslipidemias in patients with diabetes mellitus

Abstract

Patients with diabetes mellitus have an elevated cardiovascular risk. Lipid-lowering therapy is a successful strategy to prevent atherosclerotic events in these patients. Therefore, almost all professional societies recommend statin therapy for patients with diabetes under certain conditions. Despite this broad consensus, a number of controversial issues remain. Thus, it remains unclear in which patients the lipid parameters should be determined in the fasting state and in which postprandial values are sufficient. It is also an open issue whether all patients with diabetes should receive statin therapy and which goals should be achieved. While the benefit of statin-ezetimibe and statin-PCSK9-inhibition combinations has been shown in large outcome trials, results of outcome trials involving statins with triglyceride lowering drugs have been ambiguous. Thus, it is currently unclear which patients benefit from such combinations. Finally, the best strategy to address severe hypertriglyceridemia in patients with diabetes is unclear. This article discusses these issues and aims to provide help and information to practicing physicians taking care of patients with diabetes mellitus.