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Lipid Management in Korean People With Type 2 Diabetes Mellitus: Korean Diabetes Association and Korean Society of Lipid and Atherosclerosis Consensus Statement

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Dyslipidemia in patients with diabetes is an important treatment target as a modifiable risk factor for cardiovascular disease (CVD). Although the primary treatment goal for dyslipidemia is to control low-density lipoprotein cholesterol (LDL-C), achieving this goal remains suboptimal according to recent studies. It is important to set the target goal for LDL-C control based on an accurate risk assessment for CVD. Here, we summarize the latest evidence on lipid management in patients with diabetes and present a consensus of the Korean Diabetes Association and Korean Society of Lipid and Atherosclerosis on the treatment goals of LDL-C according to the duration of diabetes, presence of CVD, target organ damage, or major cardiovascular risk factors. In patients with type 2 diabetes mellitus (T2DM) and CVD, an LDL-C goal of <55 mg/dL and a reduction in LDL-C level by 50% or more from the baseline is recommended. For the primary prevention of CVD in patients with T2DM with a duration of diabetes ≥10 years, major cardiovascular risk factors, or target organ damage, an LDL-C goal of <70 mg/dL is recommended. In patients with T2DM with a duration of diabetes <10 years and no major cardiovascular risk factors, an LDL-C goal of <100 mg/dL is recommended.

Abstract

Dyslipidemia in patients with diabetes is an important treatment target as a modifiable risk factor for cardiovascular disease (CVD). Although the primary treatment goal for dyslipidemia is to control low-density lipoprotein cholesterol (LDL-C), achieving this goal remains suboptimal according to recent studies. It is important to set the target goal for LDL-C control based on an accurate risk assessment for CVD. Here, we summarize the latest evidence on lipid management in patients with diabetes and present a consensus of the Korean Diabetes Association and Korean Society of Lipid and Atherosclerosis on the treatment goals of LDL-C according to the duration of diabetes, presence of CVD, target organ damage, or major cardiovascular risk factors. In patients with type 2 diabetes mellitus (T2DM) and CVD, an LDL-C goal of <55 mg/dL and a reduction in LDL-C level by 50% or more from the baseline is recommended. For the primary prevention of CVD in patients with T2DM with a duration of diabetes ≥10 years, major cardiovascular risk factors, or target organ damage, an LDL-C goal of <70 mg/dL is recommended. In patients with T2DM with a duration of diabetes <10 years and no major cardiovascular risk factors, an LDL-C goal of <100 mg/dL is recommended.

참고문헌 (58)

  1. 박정환, "Trends in Cardiovascular Complications and Mortality among Patients with Diabetes in South Korea", Diabetes and Metabolism Journal, 45(1), pp.120~124 (2021), 대한당뇨병학회[DOI]
  2. Haffner SM, "Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction", N Engl J Med, 339, pp.229~234 (1998)
  3. 김경진, "Ten-Year Mortality Trends for Adults with and without Diabetes Mellitus in South Korea, 2003 to 2013", Diabetes and Metabolism Journal, 42(5), pp.394~401 (2018), 대한당뇨병학회[DOI]
  4. Stevens RJ, "The UKPDS risk engine : a model for the risk of coronary heart disease in Type II diabetes(UKPDS 56)", Clin Sci(Lond), 101, pp.671~679 (2001)
  5. Nissen SE, "Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis : a randomized controlled trial", JAMA, 291, pp.1071~1080 (2004)
  6. Shepherd J, "Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes : the Treating to New Targets(TNT)study", Diabetes Care, 29, pp.1220~1226 (2006)
  7. Cholesterol Treatment Trialists’(CTT)Collaborators, "Efficacy of cholesterol-lowering therapy in 18, 686 people with diabetes in 14 randomised trials of statins : a meta-analysis", Lancet, 371, pp.117~125 (2008)
  8. Brugts JJ, "The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials", BMJ, 338, pp.b2376~ (2009)
  9. Cholesterol Treatment Trialists’(CTT)Collaboration, "Efficacy and safety of more intensive lowering of LDL cholesterol : a meta-analysis of data from 170, 000 participants in 26 randomised trials", Lancet, 376, pp.1670~1681 (2010)
  10. Heart Protection Study Collaborative Group, "MRC", BHF Heart Protection Study of cholesterol lowering with simvastatin in 20, 536 high-risk individuals : a randomised placebo-controlled trial, 2002, pp.360, 7~22
  11. Colhoun HM, "Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study(CARDS) : multicentre randomised placebo-controlled trial", Lancet, 364, pp.685~696 (2004)
  12. Ahmed S, "Acute coronary syndromes and diabetes: Is intensive lipid lowering beneficial? Results of the PROVE IT-TIMI 22 trial", Eur Heart J, 27, pp.2323~2329 (2006)
  13. Cannon CP, "Ezetimibe added to statin therapy after acute coronary syndromes", N Engl J Med, 372, pp.2387~2397 (2015)
  14. Sabatine MS, "Evolocumab and clinical outcomes in patients with cardiovascular disease", N Engl J Med, 376, pp.1713~1722 (2017)
  15. Schwartz GG, "Alirocumab and cardiovascular outcomes after acute coronary syndrome", N Engl J Med, 379, pp.2097~2107 (2018)
  16. Giugliano RP, "Benefit of adding ezetimibe to statin therapy on cardiovascular outcomes and safety in patients with versus without diabetes mellitus : results from IMPROVE-IT(Improved Reduction of Outcomes : Vytorin Efficacy International Trial)", Circulation, 137, pp.1571~1582 (2018)
  17. Sabatine MS, "Cardiovascular safety and efficacy of the PCSK9 inhibitor evolocumab in patients with and without diabetes and the effect of evolocumab on glycaemia and risk of new-onset diabetes : a prespecified analysis of the FOURIER randomised controlled trial", Lancet Diabetes Endocrinol, 5, pp.941~950 (2017)
  18. Ray KK, "Effects of alirocumab on cardiovascular and metabolic outcomes after acute coronary syndrome in patients with or without diabetes : a prespecified analysis of the ODYSSEY OUTCOMES randomised controlled trial", Lancet Diabetes Endocrinol, 7, pp.618~628 (2019)
  19. Grundy SM, "2018 AHA", ACC, AAPA, pp.ABC, ACPM[DOI]
  20. Mach F, "2019 ESC", EAS guidelines for the management of dyslipidaemias : lipid modification to reduce cardiovascular risk, 2020, pp.41, 111~188
  21. 문민경, "Cardiovascular Outcomes according to Comorbidities and Low-Density Lipoprotein Cholesterol in Korean People with Type 2 Diabetes Mellitus", Diabetes and Metabolism Journal, 47(1), pp.45~58 (2023), 대한당뇨병학회[DOI]
  22. 배재현, "Diabetes Fact Sheet in Korea 2021", Diabetes and Metabolism Journal, 46(3), pp.417~426 (2022), 대한당뇨병학회[DOI]
  23. Yun Soo Jin, "Current Status of Low-Density Lipoprotein Cholesterol Target Achievement in Patients with Type 2 Diabetes Mellitus in Korea Compared with Recent Guidelines", Diabetes and Metabolism Journal, 46(3), pp.464~475 (2022), 대한당뇨병학회[DOI]
  24. 김미경, "2019 Clinical Practice Guidelines for Type 2 Diabetes Mellitus in Korea", Diabetes and Metabolism Journal, 43(4), pp.398~406 (2019), 대한당뇨병학회[DOI]
  25. American Diabetes Association, "10. Cardiovascular disease and risk management: Standards of Medical Care in Diabetes-2019", Diabetes Care, 42, pp.S103~S123 (2019)
  26. Yang YS, "Low-density lipoprotein cholesterol goal attainment rates in high-risk patients with cardiovascular diseases and diabetes mellitus in Korea : a retrospective cohort study", Lipids Health Dis, 19, pp.5~ (2020)
  27. 양예슬, "Achievement of LDL-C Targets Defined by ESC", EAS (2011) Guidelines in Risk-Stratified Korean Patients with Dyslipidemia Receiving Lipid-Modifying Treatments, 2020, pp.35(2), 367~376[DOI]
  28. 황윤우, "Low Density Lipoprotein Cholesterol Target Goal Attainment Rate and Physician Perceptions about Target Goal Achievement in Korean Patients with Diabetes", Diabetes and Metabolism Journal, 35(6), pp.628~636 (2011), 대한당뇨병학회
  29. Charlton-Menys V, "Targets of statin therapy : LDL cholesterol, non-HDL cholesterol, and apolipoprotein B in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study(CARDS)", Clin Chem, 55, pp.473~480 (2009)
  30. Sarwar N, "Triglyceride-mediated pathways and coronary disease: collaborative analysis of 101 studies", Lancet, 375, pp.1634~1639 (2010)
  31. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, "Executive summary of the 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)", JAMA, 285, pp.2486~2497 (2001)
  32. Grundy SM, "Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines", Circulation, 110, pp.227~239 (2004)
  33. Gordon DJ, "High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies", Circulation, 79, pp.8~15 (1989)
  34. Estruch R, "Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts", N Engl J Med, 378, pp.e34~ (2018)
  35. Franz MJ, "Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes : a systematic review and meta-analysis of randomized clinical trials", J Acad Nutr Diet, 115, pp.1447~1463 (2015)
  36. 허규연, "2021 Clinical Practice Guidelines for Diabetes Mellitus of the Korean Diabetes Association", Diabetes and Metabolism Journal, 45(4), pp.461~481 (2021), 대한당뇨병학회[DOI]
  37. 이은정, "2018 Guidelines for the Management of Dyslipidemia in Korea", 지질·동맥경화학회지, 8(2), pp.78~131 (2019), 한국지질동맥경화학회[DOI]
  38. Ben-Yehuda O, "The comparative efficacy of ezetimibe added to atorvastatin 10 mg versus uptitration to atorvastatin 40 mg in subgroups of patients aged 65 to 74 years or greater than or equal to 75 years", J Geriatr Cardiol, 8, pp.1~11 (2011)
  39. Bays HE, "Influence of age, gender, and race on the efficacy of adding ezetimibe to atorvastatin vs. atorvastatin up-titration in patients at moderately high or high risk for coronary heart disease", Int J Cardiol, 153, pp.141~147 (2011)
  40. Zhang XL, "Safety and efficacy of anti-PCSK9 antibodies : a meta-analysis of 25 randomized, controlled trials", BMC Med, 13, pp.123~ (2015)
  41. Rosenson RS, "Efficacy and safety of evolocumab in individuals with type 2 diabetes mellitus : primary results of the randomised controlled BANTING study", Diabetologia, 62, pp.948~958 (2019)
  42. Moriarty PM, "Efficacy and safety of alirocumab, a monoclonal antibody to PCSK9, in statin-intolerant patients : design and rationale of ODYSSEY ALTERNATIVE, a randomized phase 3 trial", J Clin Lipidol, 8, pp.554~561 (2014)
  43. Guedeney P, "Efficacy and safety of alirocumab and evolocumab : a systematic review and meta-analysis of randomized controlled trials", Eur Heart J, pp.ehz430~ (2019)
  44. Bhatt DL, "Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia", N Engl J Med, 380, pp.11~22 (2019)
  45. Nicholls SJ, "Effect of high-dose omega-3 fatty acids vs corn oil on major adverse cardiovascular events in patients at high cardiovascular risk : the STRENGTH randomized clinical trial", JAMA, 324, pp.2268~2280 (2020)
  46. ACCORD Study Group, "Effects of combination lipid therapy in type 2 diabetes mellitus", N Engl J Med, 362, pp.1563~1574 (2010)
  47. Scott R, "Effects of fenofibrate treatment on cardiovascular disease risk in 9, 795 individuals with type 2 diabetes and various components of the metabolic syndrome : the Fenofibrate Intervention and Event Lowering in Diabetes(FIELD)study", Diabetes Care, 32, pp.493~498 (2009)
  48. Hermans MP, "Impact of fenofibrate on type 2 diabetes patients with features of the metabolic syndrome : subgroup analysis from FIELD", Curr Cardiol Rev, 6, pp.112~118 (2010)
  49. Koopal C, "Predicting the effect of fenofibrate on cardiovascular risk for individual patients with type 2 diabetes", Diabetes Care, 41, pp.1244~1250 (2018)
  50. Kim NH, "Use of fenofibrate on cardiovascular outcomes in statin users with metabolic syndrome: propensity matched cohort study", BMJ, 366, pp.l5125~ (2019)
  51. Das Pradhan A, "Triglyceride lowering with pemafibrate to reduce cardiovascular risk", N Engl J Med, 387, pp.1923~1934 (2022)
  52. Stone NJ, "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, J Am Coll Cardiol, pp.2014, 63[DOI]
  53. Berglund L, "Evaluation and treatment of hypertriglyceridemia : an Endocrine Society clinical practice guideline", J Clin Endocrinol Metab, 97, pp.2969~2989 (2012)
  54. American Diabetes Association Professional Practice Committee, "10. Cardiovascular disease and risk management: Standards of Medical Care in Diabetes-2022", Diabetes Care, 45, pp.S144~S174 (2022)
  55. Lee KH, "Benefit of early statin therapy in patients with acute myocardial infarction who have extremely low low-density lipoprotein cholesterol", J Am Coll Cardiol, 58, pp.1664~1671 (2011)
  56. Kim MK, "Cholesterol levels and development of cardiovascular disease in Koreans with type 2 diabetes mellitus and without pre-existing cardiovascular disease", Cardiovasc Diabetol, 18, pp.139~ (2019)
  57. Huh JH, "Optimal low-density lipoprotein cholesterol levels in adults without diabetes mellitus : a nationwide population-based study including more than 4 million individuals from South Korea", Front Cardiovasc Med, 8, pp.812416~ (2022)
  58. Ahn JH, "Optimal low-density lipoprotein cholesterol target level in Korean acute myocardial infarction patients (<70 mg", dL vs. <55 mg, Int J Cardiol, pp.2022, 351[DOI]

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