Role of Glucose and Lipids in the Atherosclerotic Cardiovascular Disease of Patients with Diabetes

Cardiovascular disease is a major cause of morbidity and mortality in both men and women with T1DM and T2DM. In patients with T1DM, intensive glycemic control results in a reduction in cardiovascular disease. However, intensive glycemic control does not have a major impact in reducing cardiovascular disease in patients with T2DM. Metformin, pioglitazone, SGLT2 inhibitors, and certain GLP-1 receptor agonists have been shown to decrease cardiovascular disease in patients with T2DM to a greater extent than other treatment modalities. In patients with T2DM other risk factors including, hypertension and dyslipidemia, play a major role in inducing cardiovascular disease, and control of these risk factors is paramount. In patients with T1DM in good glycemic control, the lipid profile is very similar to the general population. In contrast, in patients with T2DM, even with good glycemic control, there are frequently lipid abnormalities (elevated triglycerides and non-HDL-C, decreased HDL-C, and an increase in small dense LDL). In both T1DM and T2DM, poor glycemic control increases triglyceride levels and decreases HDL-C levels with only modest effects on LDL-C levels. Extensive studies have demonstrated that statins decrease cardiovascular disease in patients with diabetes. Treatment with high doses of potent statins reduces cardiovascular events to a greater extent than low dose statin therapy. Adding fibrates or niacin to statin therapy has not been shown to further decrease cardiovascular events. In contrast, recent studies have shown that the combination of a statin and ezetimibe, a PCSK9 inhibitor, or EPA, an omega-3-fatty acid, does result in a greater decrease in cardiovascular events than statins alone. Current recommendations state that most patients with diabetes should be on statin therapy. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG .