Feature Article

Dyslipidaemia in type 2 diabetes: cardiovascular risk assessment and management

NICK S.R. LAN, Kharis Burns, DAMON A. BELL, GERALD F. WATTS

Figures

© creativaimages/ istockphoto.com model used for illustrative purposes only
© creativaimages/ istockphoto.com model used for illustrative purposes only

Abstract

GPs play a crucial role in reducing the burden of atherosclerotic cardiovascular disease (ASCVD) in high-risk patients with type 2 diabetes, using a multifactorial approach to risk-factor modification.

Key Points

  • Dyslipidaemia is common in type 2 diabetes and is primarily due to insulin resistance.
  • The typical lipid profile of dyslipidaemia in type 2 diabetes is an increase in triglyceride and apolipoprotein B levels, and a reduction in HDL-cholesterol levels.
  • Fasting is not routinely required for measuring the lipid profile, unless triglyceride levels are more than 5 mmol/L in the nonfasting state or a change in therapy is planned.
  • Remnant lipoproteins are highly atherogenic triglyceride-rich particles and should be quantitated by calculating non-HDL-cholesterol from the standard lipid profile report; measurement of apolipoprotein B levels is also useful but is not currently Medicare rebatable.
  • Glycaemic control, lifestyle factors, obesity, secondary causes of dyslipidaemia and other cardiovascular risk factors should be addressed.
  • Risk-enhancing factors may be used to improve cardiovascular risk stratification beyond traditional risk factors.
  • Patients with dyslipidaemia and diabetes should be treated with a moderate- or high-intensity statin as first-line therapy to reduce LDL-cholesterol levels.
  • Ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors should be added to statin therapy if lipid targets are not reached in high-risk patients.
  • Fenofibrate should be added to statin and ezetimibe therapy in high-risk patients with optimal LDL-cholesterol levels who remain hypertriglyceridaemic.

Figures

© creativaimages/ istockphoto.com model used for illustrative purposes only
© creativaimages/ istockphoto.com model used for illustrative purposes only