Cập nhật điều trị rối loạn lipid máu ở bệnh nhân đái tháo đường typ 2 ADA 2018/AACE - ACE 2018

Từ khóa

Bệnh tim mạch xơ vữa
Non-HDL-C Atherosclerotic cardiovascular disease (ASCVD)
low-density lipoprotein cholesterol (LDL-C)
non-HDL cholesterol (non-HDL-C)

Ngôn ngữ sử dụng

Cách trích dẫn

Thuy, N. H. (2023). Cập nhật điều trị rối loạn lipid máu ở bệnh nhân đái tháo đường typ 2 ADA 2018/AACE - ACE 2018. Vietnam Journal of Diabetes and Endocrinology, (32), 14-28. Truy vấn từ https://vjde.vn/journal/article/view/173

Tóm tắt

Type2 diabetic patients have a type of dyslipidemia that is consist with increased triglycerides (TG), low-density lipoprotein are smaller and more dense (LDPsd) and decreased high-density lipoprotein (HDL). Type 2 diabetics also have increased amounts of intermediate lipid particles, including very low-density lipoprotein (VLDL) and intermediate density lipoprotein (IDL). This can lead to an increased non-HDL cholesterol (non-HDL-C) level—which is associated with an even higher risk of atherosclerotic cardiovascular disease (ASCVD) than increased LDL levels in type 2 diabetics. Lifestyle modification should be recommended to improve the lipid profile. Statin use is recommended for most persons with diabetes aged ≥ 40 years without additional ASCVD factors. For diabetic patients of all ages with ASCVD, highintensity statin therapy should be added to lifestyle therapy, if LDL cholesterol is ≥70 md/dL on maximally tolerated statin dose, consider adding additional LDL-lowering therapy (such as ezetimibe or PCSK9 inhibitor) after evaluating the potential for further ASCVD risk reduction. For diabetic patients with fasting TG levels of ≥ 5.7 mmol/L, evaluation for secondary causes of hypertriglyceridemia should be done and medical therapy should be considered to reduce the risk for pancreatitis. Therapy with a statin and fenofibrate may be considered for men with a TG level of ≥2.3 mmol/L and a HDL.C level of <0.9 mmol/L Recently, new classes of lipid-lowering drugs have been developed and some of them are available for the clinical practice. The Cholesteryl ester transfer protein (CEPT) inhibitor, Microsomal triglyceride transport protein (MTP) inhibitor and antisense oligonucleotide against apolipoprotein B (ApoB) and the apolipoprotein A1 (ApoA1) mimetics pursuing the beneficial effect on management of atherosclerosis