Abstract
The 2015 Treatment Guideline for Diabetes recommends statin therapy as the mainstay of management for dyslipidemia in order to lower low-density lipoprotein (LDL) cholesterol and thus prevent cardiovascular disease. It maintained the target LDL cholesterol level, in contrast to the 2013 American College of Cardiology/American Heart Association guideline, which did not recommend specific treatment targets as there is no well-established cardiovascular risk calculation model for the Korean population, and controversies exist regarding statin intensity. Therefore, further extensive research is needed to provide evidence for a specific treatment policy. The desirable levels of triglycerides and high-density lipoprotein cholesterol were suggested, but no specific drug treatment was recommended. Combination therapy with fibrate or niacin has been shown not to provide additional cardiovascular benefit above statin therapy alone and was not generally recommended. The addition of ezetimibe to statin therapy has been shown to provide additional cardiovascular benefit compared with statin therapy alone and so can be considered in patients with recent acute coronary syndrome.
References
1. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation. 2002; 106:3143–421.
2. American Diabetes Association. Standards of medical care in diabetes–2014. Diabetes Care. 2014; 37:S14–80.
3. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW, Eddleman KM, Jarrett NM, LaBresh K, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, Smith SC Jr, Tomaselli GF. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014; 129:S1–45.
4. Committee for Guidelines for Management of Dyslipidemia. 2015 Korean guidelines for management of dyslipidemia. J Lipid Atheroscler. 2015; 4:61–92.
5. Arai H, Sasaki J, Teramoto T. Comment on the new guidelines in USA by the JAS guidelines committee. J Atheroscler Thromb. 2014; 21:79–81.
6. Vaucher J, Marques-Vidal P, Preisig M, Waeber G, Vollenweider P. Population and economic impact of the 2013 ACC/AHA guidelines compared with European guidelines to prevent cardiovascular disease. Eur Heart J. 2014; 35:958–9.
7. European Association for Cardiovascular Prevention & Rehabilitation. Reiner Z, Catapano AL, De Backer G, Graham I, Taskinen MR, Wiklund O, Agewall S, Alegria E, Chapman MJ, Durrington P, Erdine S, Halcox J, Hobbs R, Kjekshus J, Filardi PP, Riccardi G, Storey RF, Wood D. ESC Committee for Practice Guidelines (CPG) 2008–2010 and 2010–2012 Committees. ESC/EAS guidelines for the management of dyslipidaemias: the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J. 2011; 32:1769–818.
8. Triglyceride Coronary Disease Genetics Consortium and Emerging Risk Factors Collaboration. Sarwar N, Sandhu MS, Ricketts SL, Butterworth AS, Di Angelantonio E, Boekholdt SM, Ouwehand W, Watkins H, Samani NJ, Saleheen D, Lawlor D, Reilly MP, Hingorani AD, Talmud PJ, Danesh J. Triglyceride-mediated pathways and coronary disease: collaborative analysis of 101 studies. Lancet. 2010; 375:1634–9.
9. Studer M, Briel M, Leimenstoll B, Glass TR, Bucher HC. Effect of different antilipidemic agents and diets on mortality: a systematic review. Arch Intern Med. 2005; 165:725–30.
10. Jun M, Foote C, Lv J, Neal B, Patel A, Nicholls SJ, Grobbee DE, Cass A, Chalmers J, Perkovic V. Effects of fibrates on cardiovascular outcomes: a systematic review and metaanalysis. Lancet. 2010; 375:1875–84.
11. Cooney MT, Dudina A, De Bacquer D, Wilhelmsen L, Sans S, Menotti A, De Backer G, Jousilahti P, Keil U, Thomsen T, Whincup P, Graham IM. SCORE investigators. HDL cholesterol protects against cardiovascular disease in both genders, at all ages and at all levels of risk. Atherosclerosis. 2009; 206:611–6.
12. Chapman MJ, Ginsberg HN, Amarenco P, Andreotti F, Borén J, Catapano AL, Descamps OS, Fisher E, Kovanen PT, Kuivenhoven JA, Lesnik P, Masana L, Nordestgaard BG, Ray KK, Reiner Z, Taskinen MR, Tokgözoglu L, Tybjærg-Hansen A, Watts GF. European Atherosclerosis Society Consensus Panel. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management. Eur Heart J. 2011; 32:1345–61.
13. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998; 97:1837–47.
14. Bays HE, Jones PH, Brown WV, Jacobson TA. National Lipid Association. National Lipid Association annual summary of clinical lipidology 2015. J Clin Lipidol. 2014; 8:S1–36.
16. Ha KH, Kwon HS, Kim DJ. Epidemiologic characteristics of dyslipidemia in Korea. J Lipid Atheroscler. 2015; 4:93–9.
17. Moon JH, Koo BK, Moon MK. Optimal high-density lipoprotein cholesterol cutoff for predicting cardiovascular disease: comparison of the Korean and US National Health and Nutrition Examination Surveys. J Clin Lipidol. 2015; 9:334–42.
18. ACCORD Study Group. Ginsberg HN, Elam MB, Lovato LC, Crouse JR 3rd, Leiter LA, Linz P, Friedewald WT, Buse JB, Gerstein HC, Probstfield J, Grimm RH, IsmailBeigi F, Bigger JT, Goff DC Jr, Cushman WC, Simons-Morton DG, Byington RP. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med. 2010; 362:1563–74.
19. AIM-HIGH Investigators, Boden WE, Probstfield JL, Anderson T, Chaitman BR, Desvignes-Nickens P, Koprowicz K, McBride R, Teo K, Weintraub W. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med. 2011; 365:2255–67.
20. Cannon CP, Blazing MA, Giugliano RP, McCagg A, White JA, Theroux P, Darius H, Lewis BS, Ophuis TO, Jukema JW, De Ferrari GM, Ruzyllo W, De Lucca P, Im K, Bohula EA, Reist C, Wiviott SD, Tershakovec AM, Musliner TA, Braunwald E, Califf RM. IMPROVE-IT Investigators. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015; 372:2387–97.