Lipoproteine und Zielwerte bei Diabetes mellitus

Zusammenfassung

Patienten mit Diabetes mellitus sind in den allermeisten Fällen kardiovaskuläre Hochrisikopatienten. Deswegen sollte ein Zielwert für LDL-Cholesterin im Plasma < 100 mg/dl (2,6 mmol/l) angestrebt bzw. eine mindestens 30 - 40 %-ige Reduktion bei bereits niedrigen Ausgangswerten erreicht werden. Bei Patienten mit Diabetes und kardiovaskulären Komplikationen ist aufgrund der neuen Studienlage die Absenkung des LDL-Cholesterin < 70 mg/dl (1,8 mmol/l) eine gerechtfertigte therapeutische Option. In dieser Übersicht werden zudem Prinzipien der Pathogenese einer diabetischen Dyslipidämie skizziert und das grundsätzliche Vorgehen bei zusätzlich erhöhten Triglyzeriden und niedrigem HDL-Cholesterin vor dem Hintergrund klinischer Endpunktstudien dargestellt.

Abstract

Patients with diabetes mellitus have in most cases a high cardiovascular risk. Therefore a target value for LDL-Cholesterol < 100 mg/dl (2,6 mmol/l) or at least a reduction by 30 - 40 % in case of low basal levels is recommended. In patients with diabetes and cardiovaskular complications recents studies have provided evidence that lowering of LDL-Cholesterol below 70 mg/dl (1,8 mmol/l) is considered as a justified therapeutic option. In addition, this review will outline some principal mechanisms of the pathogenesis of diabetic dyslipidemia and basic aspects how to procede in case triglyceride levels are elevated and HDL-Cholesterol is low.

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