Evaluating the Options in Correcting Dyslipidemia

Charles A. Reasner, MD.

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Abstract and Introduction

Pharmacologic treatment of dyslipidemias, in both diabetic and nondiabetic patients, has been well proven to prolong patient survival and reduce the incidence of cardiovascular events, including myocardial infarction and cardiovascular deaths. For patients with type 2 diabetes mellitus, treatment may result in greater decreases in cardiovascular mortality than in nondiabetic patients. The clinical improvements demonstrated with pharmacologic, lipid-lowering approaches may be among the most significant that modern medicine can offer to patients with diabetes. However, even for nondiabetic patients, minimally elevated fasting glucose levels seem to be associated with increased rates of cardiovascular events, suggesting that aggressive lipid management in insulin-resistant patients may be extremely beneficial.

Diabetes is a very atherogenic disease. Patients with either the insulin resistance syndrome or diabetes mellitus are at high risk for the development of coronary artery disease (CAD) associated with cardiovascular disability and mortality. Mortality caused by coronary artery disease over a 24-year period was recorded for a cohort of diabetic patients at the Joslin Diabetes Center and compared with that for a cohort of similarly aged nondiabetic patients in the Framingham study. Analysis of the data demonstrated that men with diabetes were twice as likely to die of heart disease than nondiabetic men, and women with diabetes were four times more likely than nondiabetic women to die of heart disease during follow-up.[1] The risk of cardiovascular mortality conferred by the mere presence of diabetes is equivalent to that of a nondiabetic individual with a history of prior myocardial infarction (MI). Patients with diabetes who have a prior MI have much worse survival rates than the two previously mentioned groups; a 42% cardiovascular mortality rate after 7 years of follow-up has been demonstrated. [2]

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