Increasing evidence suggest that the “ quality ”rather than only the “ quantity ” of low densitylipoproteins (LDL) exerts a great infl uence on thecardiovascular risk. Hypertriglyceridemia, lowHDL-cholesterol and increased levels of smalldense LDL characterise diabetic dyslipidemia.In subjects with type-2 diabetes LDL size seemsalso to represent a good marker of clinical apparentand non-apparent atherosclerosis. Recently,the Coordinating Committee of the National CholesterolEducation Program stated that high-riskpatients may benefi t of stronger therapeuticalapproaches, a category of subjects that includethose with type-2 diabetes. Screening for thepresence of small, dense LDL may potentiallyidentify those with even higher risk and maycontribute in directing specifi c treatments inorder to prevent new cardiovascular events.Hypolipidemic treatments are able to favourablymodulate LDL size and subclasses in patients athigher cardiovascular risk. Regarding subjectswith type-2 diabetes this seems particularly truefor fi brates and less for statins. Analysis of allpublished studies revealed that atorvastatin representsthe most effective agent among statins,while fenofi brate, bezafi brate and gemfi brozilare all very benefi cial in modifying LDL size andsubclasses towards less atherogenic particles.Nicotinic acid has been found also effective butthe extended-release form should be preferredfor the reduced intolerance, while fi sh oils havebeen shown to be less benefi cial. Promising dataare also available with the use of ezetimibe, acholesterol absorption inhibitor.
|Numero di pagine||6|
|Rivista||EXPERIMENTAL AND CLINICAL ENDOCRINOLOGY & DIABETES|
|Stato di pubblicazione||Published - 2007|
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