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.
- 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.