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Diabetic dyslipidaemia

机译:糖尿病性血脂异常

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Purpose of reviewThe purpose is to discuss recent developments in the understanding of lipoprotein metabolism in diabetes, the cardiovascular risk associated with both type 1 and type 2 diabetes, recently published guidelines on the management of this risk, concerns over the use of statin treatment in diabetes, and other therapeutic options.Recent findingsDiabetic dyslipidaemia can be gross with massive hypertriglyceridemia, or subtle with a lipid profile which would be regarded as normal in a nondiabetic patient, but which hides underlying increases in atherogenic subfractions of LDL (e.g., small dense LDL, glycated LDL) and remnant lipoproteins. Statins can decrease these without the clinician being aware from routine biochemistry. In type 2 diabetes, HDL cholesterol levels are often reduced, whereas in type 1, insulin can raise HDL, but its antiatherogenic properties are compromised. Dyslipidaemia and hypertension predate the onset of glycaemia of diabetic proportions (metabolic syndrome). Obese people can thus die of diabetes before they develop it. Obesity should be prevented and treated. Statins decrease the risk of cardiovascular disease in diabetes or metabolic syndrome regardless of whether glycaemia worsens.SummaryOne unassailable truth is that statin therapy is beneficial and should rarely, if ever, be withheld.
机译:审查目的目的是讨论对糖尿病患者脂蛋白代谢的了解的最新进展,与1型和2型糖尿病相关的心血管风险,有关该风险管理的最新发表的指南,有关在糖尿病中使用他汀类药物治疗的担忧最近的发现糖尿病性血脂异常可以是伴有大量高甘油三酯血症的严重疾病,也可以是具有脂质特征的微妙现象,在非糖尿病患者中被认为是正常的,但是掩盖了低密度脂蛋白的动脉粥样硬化亚型增加(例如,小而稠密的低密度脂蛋白,糖化的LDL)和残留的脂蛋白。他汀类药物可以减少这些,而临床医生不知道常规生物化学。在2型糖尿病中,HDL胆固醇水平通常会降低,而在1型糖尿病中,胰岛素可以升高HDL,但其抗动脉粥样硬化特性受到损害。血脂异常和高血压在糖尿病患者血糖升高(代谢综合征)之前发生。肥胖的人因此可以在患上糖尿病之前死亡。肥胖应该预防和治疗。他汀类药物可降低糖尿病或代谢综合征患心血管疾病的风险,而不管血糖是否恶化。总结一个不可否认的事实是他汀类药物治疗是有益的,应很少(如果有的话)停止使用。

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