Position Paper on Lipid Therapy in Patients with Diabetes Mellitus

Introduction

Patients with diabetes mellitus generally have a significantly increased cardiovascular risk. For this reason, lipid therapy and a reduction in LDL cholesterol based on risk stratification are an integral part of diabetes therapy. This following position paper should therefore also be viewed as a topic-related supplement to the annually updated recommendation for the treatment of type 2 diabetes and should also be updated annually in future together with the DDGʼs practical recommendations.

The published guidelines and recommendations of the European Society of Cardiology (ESC), the European Atherosclerosis Society (EAS), the American Association of Clinical Endocrinologists (AACE), the American Diabetes Association (ADA) and the American National Lipid Society (NLA) [1] [2] [3] [3] [5] form the basis for the information contained below.

This position paper is therefore to be understood as a short, current, clinically-oriented recommendation for action in patients with diabetes; for in-depth explanations on lipid metabolism and the use of lipid disorders, please refer to the literature provided.

Publication History

Article published online:
31 March 2022

• References

• 1 Mach F, Baigent C, Catapano AL. et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020 Jan 1; 41(1): 111–188. doi: 10.1093/eurheartj/ehz455.
• 2 Jacobson TA, Ito MK, Maki KC. et al. National lipid association recommendations for patient-centered management of dyslipidemia: part 1-full report. J Clin Lipidol 2015; 9: 129-169
• 3 Jacobson TA, Maki KC, Orringer CE. et al. National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 2. J Clin Lipidol 2015; 9: S1-S122 e1
• 4 Jellinger PS, Handelsman Y, Rosenblit PD. et al. American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease – Executive Summary. Complete Appendix to Guidelines available at http://journals.aace.com Endocr Pract 2017; 23: 479-497
• 5 American Diabetes Association. 9 Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018; 41: S86-S104
• 6 Gregg EW, Li Y, Wang J. et al. Changes in diabetes-related complications in the United States, 1990-2010. N Engl J Med 2014; 370: 1514-1523
• 7 Yusuf S, Hawken S, Ounpuu S. et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the Interheart study): case-control study. Lancet 2004; 364: 937-952
• 8 Nordestgaard BG, Langsted A, Mora S. et al. Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points-a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. Eur Heart J 2016; 37: 1944-1958
• 9 Sniderman AD, De Graaf J, Couture P. et al. Regulation of plasma LDL: the apoB paradigm. Clin Sci (Lond) 2010; 118: 333-339
• 10 Parhofer KG. The Treatment of Disorders of Lipid Metabolism. Dtsch Arztebl Int 2016; 113: 261-268
• 11 Moriarty PM, Parhofer KG, Babirak SP. et al. Alirocumab in patients with heterozygous familial hypercholesterolaemia undergoing lipoprotein apheresis: the ODYSSEY ESCAPE trial. Eur Heart J 2016; 37: 3588-3595
• 12 Parhofer KG, Laufs U. The Diagnosis and Treatment of Hypertriglyceridemia. Dtsch Arztebl Int 2019; 116: 825-832 DOI: 10.3238/arztebl.. 2019.0825
• 13 Bhatt DL, Steg PG, Miller M. et al. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med 2019; 380: 11-22
• 14 Ewald N, Kloer HU. Treatment options for severe hypertriglyceridemia (SHTG): the role of apheresis. Clin Res Cardiol Suppl 2012; 7: 31-35