Clinical Case Database / Category: Teaching and Training
The management of dyslipidaemia in type 2 diabetes
Jonathan Shaw, Edward Jude
Foundation Years Journal, volume 4, issue 9, p.21 (123Doc Education, London, December 2010)
Total cholesterol and low-density lipoprotein (LDL) cholesterol exhibit an independent and strong correlation with cardiovascular events. The National Service Framework (NSF) for Diabetes, and the NICE Guideline on the Management of Blood Pressure and Blood Lipids discuss the evidence of tight lipid management in patients with diabetes and both recommend regular review of patients with type 2 diabetes, incorporating routine assessment of cardiovascular risk, from the time of diagnosis. The NSF further requires PCTs to ensure that regular review underpins a systematic treatment regimen for people with diabetes. NICE suggests that the vast majority of patients with type 2 diabetes are at high risk of CV disease and recommended the UKPDS risk engine for specific numerical estimation of risk. Cardiovascular risk in type 2 diabetic patients should be assessed according to NICE gui dance set out in 2008 and specific numerical cardiovascular risk should currently be assessed using the UKPDS risk calculator. Correction of dyslipidaemia produces a 5-year reduction of major coronary events, coronary revascularisation, and stroke are reduced by approximately one fifth per mmol/L reduction in LDL cholesterol. The primary thrust of treatment for dyslipidaemia is correcting lifestyle factors. Medical therapy should be initiated with low dose simvastatin once daily. Lipid levels should be re-assessed after 1-3 months of altering treatment and if satisfactory should be repeated yearly thereafter. Further treatment options if lipid control is not achieved include a graduated increase in simvastatin dose, switching to atorvastatin in the first instance if trial of a different statin is considered, or finally considering new emergent therapies in specific circumstances. At the present time opinion is that the benefits of statins currently far outweigh their risks.
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F2, Tameside Hospital NHS Foundation Trust
Consultant Physician and Senior Lecturer
Tameside Hospital NHS Foundation Trust
Ashton under Lyne, Lancashire,
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