Dyslipidemia: when and how to treat?

Abstract

Cardiovascular disease remains the leading cause of morbidity and mortality in individuals with type 1 diabetes mellitus (T1DM). Although optimal glycemic control continues to be a cornerstone of management, accumulating evidence has demonstrated that intensive lowering of low-density lipoprotein cholesterol (LDL-C) significantly reduces cardiovascular risk, even in patients without established atherosclerotic cardiovascular disease.

The management of dyslipidemia in T1DM should be based on an individualized cardiovascular risk assessment, taking into account age, duration of diabetes, the presence of microvascular complications, chronic kidney disease, and other associated cardiovascular risk factors. Current international guidelines recommend initiating lipidlowering therapy in most adults with T1DM who are classified as having moderate, high, or very high cardiovascular risk, with increasingly stringent LDL-C treatment targets.

Resumen charla Dr. Eduardo Osvaldo Esteban XXV Congreso Argentino de Diabetes

Statins remain the first-line lipid-lowering therapy because of their well-established efficacy in reducing cardiovascular events. When LDL-C goals are not achieved, combination therapy with ezetimibe is recommended, followed, in selected very high-risk patients, by PCSK9 inhibitors or inclisiran. Pharmacological therapy should be complemented by intensive lifestyle interventions, including a heart-healthy diet, regular physical activity, weight management, smoking cessation, and optimization of glycemic control.

This lecture will review the most recent scientific evidence, current ACC/AHA and ESC/EAS guideline recommendations, contemporary LDL-C treatment targets, and a practical algorithm to determine when lipid-lowering therapy should be initiated, which therapeutic goals should be pursued, and the most appropriate treatment strategies for patients with type 1 diabetes.