Hypertriglyceridaemia in Type 2 Diabetes
Hypertriglyceridaemia in Type 2 Diabetes
Cardiovascular disease (CVD) associated with type 2 diabetes will impose an increasing burden on primary care over the next few decades. Several mutually reinforcing factors account for the increased CVD risk among patients with diabetes, including hypertriglyceridaemia, the importance of which has been generally underestimated. A consensus from the literature suggests that fasting triglyceride levels of 1.7 mmol/L or above may be a cause for cardiovascular concern and warrant further investigation. Apart from CVD, hypertriglyceridaemia can increase the risk of pancreatitis. Clinicians in primary care should become active in identifying and managing secondary causes of hypertriglyceridaemia and encourage patients with diabetes to implement lifestyle changes. Statins are the mainstay of treatment for diabetic dyslipidaemia that remains inadequately controlled. However, the National Institute for Health and Clinical Excellence (NICE) suggests prescribing a fibrate if triglyceride levels remain >4.5 mmol/L after addressing secondary causes. Clinicians could consider adding a fibrate if triglyceride levels remain between 2.3 and 4.5 mmol/L despite statin monotherapy for patients at high CVD risk. NICE advocates a trial of highly concentrated, licensed omega-3 fish oils if lifestyle measures and fibrate fail to adequately reduce hypertriglyceridaemia.
CVD in people with type 2 diabetes is likely to impose a growing burden. The National Heart Forum predicts that rates of diabetes will rise by 98% between 2006 (2,869 cases per 100,000 of the population) and 2,050 (7,072 per 100,000). Type 2 diabetes accounts for 85–95% of cases of diabetes.
Patients with diabetes are at markedly higher risk of CVD, partly because of an increased incidence of hypertriglyceridaemia, a key component of diabetic dyslipidaemia that is also associated with pancreatitis. The paper attempts to stimulate primary care physicians to manage lipid disorders in diabetes more proactively and take evidence-based decisions when treating patients with both diabetes and hypertriglyceridaemia.
Abstract and Introduction
Abstract
Cardiovascular disease (CVD) associated with type 2 diabetes will impose an increasing burden on primary care over the next few decades. Several mutually reinforcing factors account for the increased CVD risk among patients with diabetes, including hypertriglyceridaemia, the importance of which has been generally underestimated. A consensus from the literature suggests that fasting triglyceride levels of 1.7 mmol/L or above may be a cause for cardiovascular concern and warrant further investigation. Apart from CVD, hypertriglyceridaemia can increase the risk of pancreatitis. Clinicians in primary care should become active in identifying and managing secondary causes of hypertriglyceridaemia and encourage patients with diabetes to implement lifestyle changes. Statins are the mainstay of treatment for diabetic dyslipidaemia that remains inadequately controlled. However, the National Institute for Health and Clinical Excellence (NICE) suggests prescribing a fibrate if triglyceride levels remain >4.5 mmol/L after addressing secondary causes. Clinicians could consider adding a fibrate if triglyceride levels remain between 2.3 and 4.5 mmol/L despite statin monotherapy for patients at high CVD risk. NICE advocates a trial of highly concentrated, licensed omega-3 fish oils if lifestyle measures and fibrate fail to adequately reduce hypertriglyceridaemia.
Introduction
CVD in people with type 2 diabetes is likely to impose a growing burden. The National Heart Forum predicts that rates of diabetes will rise by 98% between 2006 (2,869 cases per 100,000 of the population) and 2,050 (7,072 per 100,000). Type 2 diabetes accounts for 85–95% of cases of diabetes.
Patients with diabetes are at markedly higher risk of CVD, partly because of an increased incidence of hypertriglyceridaemia, a key component of diabetic dyslipidaemia that is also associated with pancreatitis. The paper attempts to stimulate primary care physicians to manage lipid disorders in diabetes more proactively and take evidence-based decisions when treating patients with both diabetes and hypertriglyceridaemia.