Hyperlipidemia and cardiovascular risk factors in patients with type 2 diabetes

Atherosclerosis accounts for approximately 80% of all mortality caused by diabetes and for most hospitalizations necessitated by the complications of diabetes. Overall, individuals with diabetes have a 2- to 3-fold increased risk of cardiovascular disease compared with that in individuals without diabetes. The major risk factors contributing to the excess of cardiovascular disease caused by diabetes include: hyperglycemia, insulin resistance, dyslipidemia, hypertension, smoking, albuminuria, and the procoagulant state. Although the low-density lipoprotein (LDL) and total cholesterol levels of patients with diabetes are similar to those of the nondiabetic population, triglyceride levels are usually higher in those with diabetes. Evaluation of results in the subsets of the large Scandinavian Simvastatin Survival Study (4S) and the Cholesterol and Recurrent Events (CARE) trials that include subjects with diabetes indicates that cholesterol-lowering drugs can significantly reduce the cardiovascular event rate in patients with diabetes. Current options for the management of cardiovascular risk factors in those with diabetes include lowering the LDL cholesterol level below 100 mg/dL, lowering blood pressure below 130/85 mm Hg, improving hyperglycemia and the atherogenic lipid profile (ie, triglyceride and high-density lipoprotein [HDL] levels), treating microalbuminuria, reducing insulin resistance, and using aspirin to reduce the clotting risk.