Dyslipidemia in Diabetes When and How to Treat?

Atherosclerotic cardiovascular disease (ASCVD) remains the major cause of morbidity and mortality in diabetes, and diabetes increases ASCVD risk two-fold compared with those without diabetes.1 Dyslipidemia is a risk factor for ASCVD in diabetes and a therapeutic target for risk reduction. Despite a decrease in the absolute rate of ASCVD in the past 2 decades, which may be attributable in part to the success of cardioprevention management strategies,2 uncertainties remain on when and how to treat diabetic dyslipidemia. There are several reasons for this, including gaps in the understanding of the nature and atherogenicity of dyslipidemia in diabetes, greater recognition of the heterogeneity of cardiovascular risk in the population with diabetes together with insufficient information in lower-risk younger as well as aging individuals, and recognition of the limitations in benefits of some available lipid-lowering agents. This review provides an up-to-date assessment of the nature of dyslipidemia in diabetes, evaluation of ASCVD risk, evidence for clinical benefit from lipid lowering, and current approaches to pharmacologic management.