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Review
. 2022 Nov 28;21(1):263.
doi: 10.1186/s12933-022-01684-5.

Personalized management of dyslipidemias in patients with diabetes-it is time for a new approach (2022)

Maciej Banach #  1   2   3 , Stanisław Surma #  4   5 , Zeljko Reiner  6 , Niki Katsiki  7   8 , Peter E Penson  9   10 , Zlatko Fras  11   12 , Amirhossein Sahebkar  13   14 , Francesco Paneni  15   16 , Manfredi Rizzo  17   18 , John Kastelein  19
Affiliations
Review

Personalized management of dyslipidemias in patients with diabetes-it is time for a new approach (2022)

Maciej Banach et al. Cardiovasc Diabetol. .

Abstract

Dyslipidemia in patients with type 2 diabetes (DMT2) is one of the worst controlled worldwide, with only about 1/4 of patients being on the low-density lipoprotein cholesterol (LDL-C) target. There are many reasons of this, including physicians' inertia, including diabetologists and cardiologists, therapy nonadherence, but also underusage and underdosing of lipid lowering drugs due to unsuitable cardiovascular (CV) risk stratification. In the last several years there is a big debate on the risk stratification of DMT2 patients, with the strong indications that all patients with diabetes should be at least at high cardiovascular disease (CVD) risk. Moreover, we have finally lipid lowering drugs, that not only allow for the effective reduction of LDL-C and do not increase the risk of new onset diabetes (NOD), and/or glucose impairment; in the opposite, some of them might effectively improve glucose control. One of the most interesting is pitavastatin, which is now available in Europe, with the best metabolic profile within statins (no risk of NOD, improvement of fasting blood glucose, HOMA-IR, HbA1c), bempedoic acid (with the potential for the reduction of NOD risk), innovative therapies-PCSK9 inhibitors and inclisiran with no DMT2 risk increase, and new forthcoming therapies, including apabetalone and obicetrapib-for the latter one with the possibility of even decreasing the number of patients diagnosed with prediabetes and DMT2. Altogether, nowadays we have possibility to individualize lipid lowering therapy in DMT2 patients and increase the number of patients on LDL-C goal without any risk of new onset diabetes and/or diabetes control worsening, and in consequence to reduce the risk of CVD complications due to progression of atherosclerosis in this patients' group.

Keywords: Cardiovascular risk; Diabetes; Individual therapy approach; Lipid lowering therapy; Statins.

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Conflict of interest statement

MB: speakers bureau: Amgen, Herbapol, Kogen, KRKA, Polpharma, Mylan/Viatris, Novartis, Novo-Nordisk, Sanofi-Aventis, Teva, Zentiva; consultant to Abbott Vascular, Amgen, Daichii Sankyo, Esperion, Freia Pharmaceuticals, NewAmsterdam, Novartis, Polfarmex, Sanofi-Aventis; Grants from Amgen, Mylan/Viatris, Sanofi and Valeant; CMO at the Nomi Biotech Corporation; NK: has given talks, attended conferences and participated in trials sponsored by Amgen, Astra Zeneca, Boehringer Ingelheim, Elpen, Novartis, Novo Nordisk, Sanofi, Servier, Viatris, Vianex and WinMedica; PEP: owns four shares in AstraZeneca PLC and has received honoraria and/or travel reimbursement for events sponsored by AKCEA, Amgen, AMRYT, Link Medical, Mylan, Napp, Sanofi; ZR has received honoraria and participated in trials sponsored by Novartis, Arrowhead; MR: has given lectures, received honoraria, and research support, and participated in conferences, advisory boards, and clinical trials sponsored by Amgen, Astra Zeneca, Boehringer Ingelheim, Kowa, Eli Lilly, Meda, Mediately, Mylan, Merck Sharp and Dohme, Novo Nordisk, Novartis, Roche Diagnostics, Sanofi, and Servier. All other authors have nothing to declare.

Figures

Fig. 1
Fig. 1
Cardiovascular risk categories in patients with diabetes mellitus according to the Polish Lipid Association 2021 (with permission). [1, 13] 1Target organ damage is defined as the presence of microalbuminuria, retinopathy, neuropathy, and/or left ventricular myocardial damage; 2“Other” means 2 or more; 3Major risk factors include: age ≥ 65 years, hypertension, dyslipidaemia, smoking, obesity; 4Not applicable to young adults (< 35 years of age) with type 1 diabetes lasting < 10 years. Lp(a) lipoprotein(a), hsCRP high-sensitivity C-reactive protein, eGFR estimated glomerular filtration rate
Fig. 2
Fig. 2
Recommendations by Polish Lipid Association 2021 on treatment of lipid disorders in patients with diabetes (with permission). [13] LDL-C low-density lipoprotein cholesterol, HDL-C high-density lipoprotein cholesterol, Lp(a) lipoprotein a, hsCRP high-sensitivity C-reactive protein, eGFR estimated glomerular filtration rate
Fig. 3
Fig. 3
2021 European Society of Cardiology recommendation on low-density lipoprotein cholesterol goals. [4] CVD cardiovascular risk, ASCVD atherosclerotic cardiovascular disease, DM diabetes mellitus
Fig. 4
Fig. 4
Proposed therapy scheme for patients with diabetes and dyslipidemia. CV cardiovascular, LDL-C low density lipoprotein cholesterol, LLT lipid lowering therapy, FDC fixed dose combination, PCSK9 proprotein convertase subtilisin/kexin 9, TG triglyceride, ASCVD atherosclerotic cardiovascular disease. LLT in maximum, tolerated doses. *Patients at the risk of diabetes (with metabolic disorders, obesity, metabolic syndrome, insulin resistance in the course of various diseases), pre-diabetes and finally diabetes with concomitant metabolic disorders. 1Pitavastatin is preferable; 2In case of other statin—rosuvastatin or atorvastatin—always consider fixed dose combination with ezetimibe; 3FDC of statin and ezetimibe plus BA might also be an option; 4In most of the countries, reimbursement criteria does not allow the upfront triple combination therapy with PCSK9 inhibitors; Inclisiran is still not reimbursed in many countries; 5IPE is still not available in Europe
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