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Review
. 2019 Feb 26;19(4):13.
doi: 10.1007/s11892-019-1136-3.

Triglycerides: Emerging Targets in Diabetes Care? Review of Moderate Hypertriglyceridemia in Diabetes

Anastasia-Stefania Alexopoulos  1   2 , Ali Qamar  3   4 , Kathryn Hutchins  3   4 , Matthew J Crowley  3   4 , Bryan C Batch  3   4 , John R Guyton  3
Affiliations
Review

Triglycerides: Emerging Targets in Diabetes Care? Review of Moderate Hypertriglyceridemia in Diabetes

Anastasia-Stefania Alexopoulos et al. Curr Diab Rep. .

Abstract

Purpose of review: Moderate hypertriglyceridemia is exceedingly common in diabetes, and there is growing evidence that it contributes to residual cardiovascular risk in statin-optimized patients. Major fibrate trials yielded inconclusive results regarding the cardiovascular benefit of lowering triglycerides, although there was a signal for improvement among patients with high triglycerides and low high-density lipoprotein (HDL)-the "diabetic dyslipidemia" phenotype. Until recently, no trials have examined a priori the impact of triglyceride lowering in patients with diabetic dyslipidemia, who are likely among the highest cardiovascular-risk patients.

Recent findings: In the recent REDUCE IT trial, omega-3 fatty acid icosapent ethyl demonstrated efficacy in lowering cardiovascular events in patients with high triglycerides, low HDL, and statin-optimized low-density lipoprotein (LDL). The ongoing PROMINENT trial is examining the impact of pemafibrate in a similar patient population. Emerging evidence suggests that lowering triglycerides may reduce residual cardiovascular risk, especially in high-risk patients with diabetic dyslipidemia.

Keywords: Diabetic dyslipidemia; Hypertriglyceridemia; Medications; Type 2 diabetes.

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Conflict of interest statement

Conflict of Interest John R. Guyton has received research support from Sanofi, Regeneron Pharmaceuticals, and Amarin Pharmaceuticals.

Anastasia-Stefania Alexopoulos, Ali Qamar, Kathryn Hutchins, Matthew J. Crowley, Bryan C. Batch, and John R. Guyton declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Triglyceride-rich lipoprotein metabolism. TRL, triglyceride-rich lipoproteins; VLDL, very low-density lipoprotein; FA, fatty acids; LPL, lipoprotein lipase; TG, triglycerides; CE, cholesterol esters; CETP, cholesteryl ester transfer protein; LDL, low-density lipoprotein; HDL, high-density lipoprotein; NEFA, nonesterified fatty acids; HSL, hormone sensitive lipase; ATL, adipocyte triglyceride lipase
Fig. 2
Fig. 2
Proposed approach to management of triglycerides in diabetic dyslipidemia. LDL, low-density lipoprotein; HDL, high-density lipoprotein
See this image and copyright information in PMC

References

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