PDF(Pubmed)
Abstract：
Diabetic atherosclerosis is a complex process that is characterized by diffuse and unstable lesions increasing 2-4-fold the risk of adverse cardiovascular (CV) events. Diabetic dyslipidemia has a predominant role in coronary artery disease (CAD) and has been the target of classical and emerging pharmaceutical agents with established or promising CV benefits. The aim of the present narrative review was to summarize the effects of classical and novel lipid-lowering pharmaceutical agents on lipid profile and CV outcomes in diabetic patients with established CAD or high risk of CAD. Statins remain the first-line treatment for all diabetic patients since they considerably ameliorate lipid parameters and non-lipid CV risk factors, leading to reduced CV morbidity and mortality. Complementary to statins, ezetimibe exerts lipid-lowering properties with modest but significant reductions in major adverse cardiovascular events (MACEs) and CV mortality. PCSK9 inhibitors considerably reduce LDL-C levels and lower MACEs in diabetic patients. On the other hand, fibrates may confer a very modest decline in MACE incidence, while the CV impact of omega-3 fatty acids is promising but remains questionable. Bempedoic acid and inclisiran have a potential therapeutic role in the management of diabetic dyslipidemia, but this is still not adequately documented. Given the heightened CV risk among individuals with diabetes, more decisive results would be of great importance in the utility of all these drugs.
摘要：
糖尿病性动脉粥样硬化是一个复杂的过程，其特征是弥漫性和不稳定的病变，使不良心血管（CV）事件的风险增加2-4倍。糖尿病性血脂异常在冠状动脉疾病（CAD）中具有主要作用，并且已成为具有既定或有希望的CV益处的经典和新兴药物的靶标。本叙述性综述的目的是总结经典和新型降脂药物对已建立CAD或CAD高风险的糖尿病患者的血脂和CV结局的影响。他汀类药物仍然是所有糖尿病患者的一线治疗，因为它们显著改善了血脂参数和非脂质CV危险因素。导致降低CV发病率和死亡率。补充他汀类药物，依泽替米贝具有降脂特性，可适度但显着降低主要不良心血管事件（MACE）和CV死亡率。PCSK9抑制剂显著降低糖尿病患者的LDL-C水平和降低MACE。另一方面,贝特类药物可能会使MACE发生率下降幅度很小，虽然omega-3脂肪酸的CV影响是有希望的，但仍然值得怀疑。Bempedoicacidandinclisiranhaveapotentialtreatmentalroleinthemanagementofdiabeticlipopulatory,但这仍然没有充分的记录。鉴于糖尿病患者的CV风险升高，更决定性的结果将对所有这些药物的应用非常重要。
