Hypertriglyceridemia in Diabetes Mellitus

Implications for Pediatric Care

Jacob C. Hartz; Sarah de Ferranti; Samuel Gidding

Disclosures

J Endo Soc. 2018;2(6):497-512. 

In This Article

Abstract and Introduction

Abstract

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). It is estimated that the risk of CVD in diabetes mellitus (DM) is 2 to 10 times higher than in the general population. Much of this increased risk is thought to be related to the development of an atherogenic lipid profile, in which hypertriglyceridemia is an essential component. Recent studies suggest that dyslipidemia may be present in children and adolescents with DM, particularly in T2DM and in association with poor control in T1DM. However, the role of hypertriglyceridemia in the development of future CVD in youth with DM is unclear, as data are scarce. In this review, we will evaluate the pathophysiology of atherogenic hypertriglyceridemia in DM, the evidence regarding an independent role of triglycerides in the development of CVD, and the treatment of hypertriglyceridemia in patients with DM, highlighting the potential relevance to children and the need for more data in children and adolescents to guide clinical practice.

Introduction

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).[1–3] It is estimated that the risk of CVD in diabetes mellitus (DM) is 2 to 10 times higher than in the general population.[4–6] Much of this increased risk is thought to be related to the development of an atherogenic lipid profile, in which hypertriglyceridemia is an essential component.[7] Recent studies suggest that dyslipidemia may be present in children and adolescents with DM, particularly in T2DM and in association with poor control in T1DM.[8,9] However, the role of hypertriglyceridemia in the development of future CVD in youth with DM is unclear as data are scarce. Current guidelines recommend a primary treatment goal to lower triglyceride levels, only in the prevention and treatment of triglyceride-induced pancreatitis.[10–13]

Studies in childhood DM highlight the importance of understanding the relationship of triglycerides to CVD risk.[4,9] In the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) trial, dyslipidemia worsened over the nearly 4 years of the study, including in those who were started on metformin; increasing hemoglobin A1c was associated with worsening dyslipidemia.[9] In the SEARCH for Diabetes in Youth Case-Control Study, patients with T1DM and T2DM who had excellent glucose control had lower triglyceride levels and higher high-density lipoprotein cholesterol (HDL-C) compared with those with poor control.[14]

In this review, we will evaluate the pathophysiology of atherogenic hypertriglyceridemia in DM, the evidence regarding an independent role of triglycerides in the development of CVD, and the treatment of hypertriglyceridemia in patients with DM, highlighting the potential relevance to children and the need for more data in children and adolescents to guide clinical practice.

Although this paper is not a systematic review, relevant literature was found by searching MEDLINE, Google Scholar, the Cochrane Library, and Web of Science for references published up to December 2017. In addition, we searched the references listed in the relevant publications. There were no language restrictions. The search terms were kept general and included hypertriglyceridemia, cardiovascular disease, diabetes mellitus, insulin resistance, diet, hyperglycemia, physical activity, statins, fibrates, omega-3 fatty acids, and combinations of these search terms.

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