Dislipidemia Aterogenik pada Pasien Diabetes Melitus Tipe 2: Patofisiologi dan Pilihan Terapi

Abstract

Atherogenic dyslipidemia is characterized by increase in triglyceride and small dense lipoprotein (sdLDL) level and decrease in high-density lipoprotein (HDL) level. This condition is accompanied by increased TG-rich very-low-density lipoprotein, apolipoprotein B, and oxidized low-density lipoprotein (oxLDL). This lipid profile plays an important role in the pathogenesis of cardiovascular disorders such as coronary heart disease, peripheral artery disease, and stroke. Diabetes mellitus is an independent risk factor for premature atherosclerosis. High- and moderate-intensity statins are recommended therapeutic options in the management of this disorder. Currently, there are also some therapeutic options other than statin to accompany statin therapy. Ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor are mentioned a lot in current lipid management guidelines in addition to nonpharmacologic approach such as diet and physical exercise.Dislipidemia aterogenik mempunyai karakteristik berupa peningkatan kadar trigliserida dan small dense low-density lipoprotein (sdLDL), serta penurunan kadar high-density lipoprotein (HDL). Kondisi ini disertai dengan peningkatan kadar dari very-low-density lipoprotein yang kaya akan trigliserida, apolipoprotein B, dan oxidized low-density lipoprotein (oxLDL). Profil lipid ini mempunyai peranan penting di dalam patogenesis gangguan kardiovaskular seperti penyakit jantung koroner, peripheral artery disease, dan stroke. Diabetes melitus adalah faktor risiko independen untuk terjadinya aterosklerosis prematur. Statin intensitas tinggi dan sedang (moderate) masih merupakan pilihan terapi yang direkomendasikan dalam tata laksana kelainan ini. Saat ini juga makin berkembang alternatif terapi di luar statin yang perannya masih mendampingi pemberian statin. Ezetimibe dan proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor mulai banyak disebutkan dalam panduan penatalaksanaan dislipidemia terkini, selain tetap mengedepankan pendekatan nonfarmakologis seperti pengaturan diet dan latihan fisik.