Type 2 diabetes mellitus: Optimizing lipid management for a hidden disease with serious consequences
While statins reduce the risk of ASCVD, some patients with T2DM can have relatively normal baseline low-density lipoprotein cholesterol (LDL-C) levels. Indeed, the higher incidence of ASCVD in patients with T2DM may be related to qualitative changes in lipids and densely packed LDL-C particles. As such, previous advice for the use of statin therapy recommended achieving and maintaining set plasma LDL-C targets for patients with T2DM, whereas the new guidance focuses on a drug- and dose-based approach where statin therapy is recommended independently of LDL-C goals. Dr Lau noted that this change in approach has significant implications for reducing the risk of ASCVD for Asian patients with T2DM.
“The shift away from a target, LDL-centric approach towards a global risk approach will help to effectively reduce the risk of ASCVD.”
Recent international guidelines also offer specific guidance on statin therapy for patients with chronic kidney disease (CKD), a common comorbidity in patients with T2DM and an additional risk factor for ASCVD. Dr Lau commented that “the management of patients with ASCVD and CKD needs to be intensified with at least moderate-to-high intensity statin therapy.” While statin therapy is not generally recommended for patients under the age of 40 years, it may indeed be necessary for patients aged 18–49 years who have T2DM and CKD.
Statin therapy using a target-based approach, in conjunction with lifestyle modifications, is still recommended for most patients with dyslipidaemia, but major treatment gaps remain in Asia. Dr Lau offered potential reasons for these gaps, stating that “it [diabetes] is a silent disease in Asia. We are not cognizant of how dangerous it can be. Especially the hidden cardiovascular risk. Then, there is still a lot of apprehension about the type of management to be dispensed.”
“Diabetes is a silent disease and sometimes we are not conscious of how dangerous it can be.”
As recommended by evidence-based international guidelines, it is important for physicians to reiterate to their patients that pharmacological therapy should be accompanied by lifestyle changes, such as stopping smoking, increasing physical exercise and achieving weight loss. This is particularly the case for patients with young-onset T2DM, where early lifestyle changes can reduce the likelihood of morbidity later in life.
Click here to access the full article: Lau TWL, et al. J Diabetes 2017 [Epub ahead of print]
Click here to view the interview video with one of the authors – Dr Titus WL Lau