Diabetic dyslipidemia and the metabolic syndrome

As the incidence of the metabolic syndrome increases, the clustered cardiovascular risk factors that characterize this disorder are likely to contribute to an increased rate of cardiovascular disease. Among those risk factors, diabetic dyslipidemia may play a particularly important role in development of atherosclerosis. Diabetic dyslipidemia is characterized by low levels of high-density lipoprotein cholesterol (HDL-C) as well as elevated levels of triglycerides and small, dense low-density lipoprotein cholesterol (LDL-C) particles. Lifestyle modification remains as a cornerstone in the management of cardiovascular risk associated with the metabolic syndrome, but pharmacologic therapy may be required to address the risk associated with diabetic dyslipidemia. Statin treatment significantly lowers LDL-C and triglyceride levels and improves cardiovascular outcomes. Fibrates and niacin effectively lower triglycerides and can raise levels of HDL-C modestly but their use may be limited by issues of tolerability. Combination treatment with a statin and fibrate or niacin may be the best of currently available options to address diabetic dyslipidemia. Other drugs to elevate HDL-C levels are currently in development and may be useful to combine with statins for treatment of diabetic dyslipidemia.