PARHOFER K.

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Management of Dyslipidemia and Hypertension in Diabetic Patients KLAUS PARHOFER Professor of Endocrinology and Metabolism / Medical Department II - Grosshadern, University of Munich, Germany

Numerous studies have shown that diabetic patients have an increased risk for cardiovascular diseases. In fact, the diagnosis of diabetes confers an equivalent risk to aging 15 years [1]. Since the rate of cardiovascular events is related to HbA1c a number of studies have tested the hypothesis that lowering HbA1c will prevent cardiovascular disease. As it is well known these studies (ACCORD, ADVANCE, VADT) have failed to reach this result. [2, 3, 4]. Since obviously lowering HbA1c is not sufficient to prevent cardiovascular disease in diabetic patients other factors must be addressed. Since many patients with diabetes are also characterized by an abnormal lipid profile and an elevated blood pressure, these factors are obvious targets. During this presentation I will discuss the management of dyslipidemia and hypertension in type 2 diabetes.

Dyslipidemia Patients with type 2 diabetes are characterized by an elevated total cholesterol, elevated triglycerides, low HDL-cholesterol and a moderately elevated LDL-cholesterol level. However, this LDL-cholesterol level represents predominantly small-dense LDL-particles and therefore represents a higher risk than the same LDL-cholesterol level observed in nondiabetic patients [5]. The pathophysiology behind this lipid abnormality is closely linked to an increased secretion of triglyceride-rich lipoproteins from the liver. This, in turn is related to an increased flux of substrate (free fatty acids, glucose, etc.) to the liver. An increased concentration of triglyceride-rich lipoproteins results in lower levels of HDL-cholesterol and the predominance of small-dense LDL-particles (both mediated trough the action of CETP). While lowering HbA1c has overall failed to prevent cardiovascular disease, lowering LDLcholesterol has been highly successful in this situation [6, 7]. However, it should also be noted that lipid lowering therapy only results in a risk reduction of approximately 35%. Thus, the majority of events can not be prevented. Further strategies to improve this rate are either to 55


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