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Diabetic Dysipidemia2 PDF
Diabetic Dysipidemia2 PDF
of Diabetic Dyslipidemia in a VA
Population: Beyond the LDL Target
Wei Gu, MD; Ronna Mallios, PhD; Peter Baylor, MD; Alan Cohen, MD;
Vishal Pall, MD; and Jian Huang, MD
Although low-density lipoprotein level has long been considered the primary target
in lipid-lowering therapy, these authors also suggest targeting non–high-density
lipoprotein level, especially in patients with diabetic dyslipidemia.
S
ignificant progress has been a decreased high-density lipoprotein and intermediate-density lipoproteins
achieved in treating diabetic (HDL) level, an elevated triglyceride (IDLs), are important to the patho-
dyslipidemia in VA patients (TG) level, and a normal or elevated genesis of atherosclerosis and its
since the implementation of LDL level, with smaller and denser clinical consequences. Although in-
the VA clinical guidelines, which rec- particles.7-10 The association of low terventional clinical trials are still un-
ommend a low-density lipoprotein HDL level with increased CVD mor- derway to determine the relationship
(LDL) target level at < 100 mg/dL.1 bidity and mortality has been well between elevated TG level and CVD
Metabolic derangement of lipids in recognized in the literature, includ- morbidity and mortality in the dia-
type 2 diabetes is complicated, how- ing in the Framingham heart study.11 betic population, observational stud-
ever, and treatment to LDL target Elevated serum TG level appears to ies have indicated that elevated TG
alone does not attenuate cardiovas- be a marker for other lipoprotein level is associated with increased risk
cular events satisfactorily. Current abnormalities, such as increased for CVD and mortality.15-17 Therefore,
knowledge and research data suggest atherogenic LDL particles and the ac- it is reasonable to target TG level as
the need for a multifaceted approach cumulation of TG-rich lipoproteins well as LDL level in lipid-lowering
to the management of diabetic dys- (TGRLPs).12-13 treatment among both the diabetic
lipidemia. It is widely accepted that LDL and general populations. Further-
Cardiovascular complications are level is the primary target of lipid- more, diabetic patients often have el-
the major cause of morbidity and lowering therapy in such high risk evated TG levels and, because of the
mortality in patients with type 2 dia- populations as patients with CVD limitation of the Friedewald formula,
betes.2-3 Diabetic dyslipidemia plays and diabetes. However, cumulative their LDL levels cannot be routinely
an important role in the development data have found that a significant per- calculated when their TG values are
and progression of cardiovascular dis- centage of patients with atheroscle- excessively high. In addition, directly
ease (CVD),4-6 and is characterized by rotic vascular disease have an LDL measured LDL values, by themselves,
level within the optimal range. In ad- underestimate the cardiovascular risk
dition, some studies have found that in the presence of hypertriglyceride-
Dr. Gu is a staff physician in the Department of
Primary Care; Drs. Baylor, Pall, and Huang are patients who received treatment and mia.
staff physicians; and Dr. Cohen is associate chief achieved an LDL level even lower There is a high prevalence of type
of staff for ambulatory care, all at the Roseburg than 70 mg/dL still developed the 2 diabetes in the VA population. Em-
VA Medical Center in Oregon. Dr. Mallios is a
biostatistician in the University of California, San complications of CVD, which is re- phasis on aggressive LDL lowering,
Francisco (UCSF) Fresno Medical Education Pro- ferred to as residue risk.14 without targeting TG level, may not
gram. In addition, Drs. Gu, Cohen, and Pall are There is increasing evidence that be optimal in lipid management. In
clinical assistant professors, and Drs. Baylor and
Huang are clinical associate professors, all in the elevated TGRLPs, including very the VA primary care setting, LDL
UCSF Fresno Medical Education Program. low-density lipoproteins (VLDLs) level < 100 mg/dL is considered the
when TG levels were higher. Among addition, our data only reflect a spe- Quadrant HealthCom Inc., the U.S.
the 42% of our diabetic patients with cial population of veterans who are Government, or any of its agencies.
TG levels higher than normal, a sig- predominantly male and elderly. We This article may discuss unlabeled or
nificant proportion did not reach the also were unable to obtain accurate investigational use of certain drugs.
non–HDL target, despite their LDL information on ethnic background Please review complete prescribing in-
goal attainment. Therefore, non–HDL because of incomplete data. There- formation for specific drugs or drug
level may be superior to LDL level as fore, our study findings should be combinations—including indications,
the lipid target in patients with diabe- interpreted with caution and should contraindications, warnings, and ad-
tes and hypertriglyceridemia. In addi- not lead to generalization or causality. verse effects—before administering
tion, achievement of non–HDL goal Our data suggest the use of non– pharmacologic therapy to patients.
of < 130 mg/dL among different TG HDL level as one of the major lipid
groups was at 60% in the borderline- treatment targets in patients with REFERENCES
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