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Lipid management for cardiovascular risk reduction in type 1 diabetes
Open accessAbstract
Purpose of review: To review the recent evidence for lipid management in type 1 diabetes (T1D) for cardiovascular risk reduction. Recent findings: Individuals with T1D are at increased risk for cardiovascular morbidity and mortality, with atherosclerosis beginning as early as adolescence. Elevated low-density lipoprotein cholesterol (LDL-C), triglycerides, and lipoprotein (a) are associated with increased cardiovascular risk in T1D. Although high-density lipoprotein cholesterol (HDL-C) in T1D is often normal or higher than in nondiabetic controls, HDL in T1D has structural alterations, which make it proatherogenic rather than cardioprotective. Similarly, although LDL-C is not particularly elevated in T1D, LDL still contributes to cardiovascular risk. Studies in individuals with diabetes have primarily included T2D participants, with a much smaller number of T1D participants; such studies have shown that lipid-lowering therapies, such as statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors reduce LDL-C levels and cardiovascular events in both those with and without diabetes. Individuals with T1D have increased cholesterol absorption, suggesting that ezetimibe may be particularly effective in T1D. Results of the REDUCE-IT trial show cardiovascular risk reduction from high-dose omega-3 fatty acid (Icosapent Ethyl) therapy in patients with diabetes (primarily type 2 diabetes), independent of triglyceride lowering, but similar data in T1D are currently lacking. Summary: Individuals with T1D are at high risk of cardiovascular disease, necessitating close lipid monitoring and management from adolescence through adulthood.
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One-quarter of patients with T1DM in a Finnish study had underlying hypertension and increased arterial stiffness.
“one-quarter of patients with T1DM had underlying hypertension and increased arterial stiffness.799”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [799]
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Metadata
- Authors
- Tell, S., Nadeau, K. J., & Eckel, R. H.
- Affiliations
- University of Colorado Anschutz (US)
- Division of Pediatric Endocrinology, Department of Pediatrics
- Corresponding author
- Tell, Shoshana
- Venue
- Current Opinion in Endocrinology, Diabetes & Obesity
- Published
- 2020-06-29
- Volume
- 27
- Issue
- 4
- Pages
- 207-214
- ISSN
- 1752-296X (ISSN-L)
- 1752-2978
- PMC
- PMC7585932
- OpenAlex
- W3040282929
- Cited by
- 30
- References
- 63
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 8 · 2023: 6 · 2022: 4 · 2021: 4
- FWCI
- 0.79
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Current Opinion in Endocrinology Diabetes and Obesity (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5k24hl145076-02)
- National Heart, Lung, and Blood Institute (K24-HL145076)
- National Institute of Diabetes and Digestive and Kidney Diseases (R56DK088971, P30DK116073, T32DK063687)
- National Center for Research Resources (M01RR000069, K23RR020038)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 1 diabetes, lipid control, cardiovascular risk reduction, LDL cholesterol, triglycerides, lipoprotein(a), HDL cholesterol, atherosclerosis, statins, ezetimibe, PCSK9 inhibitors, omega-3 fatty acids, icosapent ethyl, cholesterol absorption, lipid monitoring
- MeSH terms
- Adolescent, Adult, Hypolipidemic Agents, Cardiovascular Diseases, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Humans, Risk Factors, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipid Metabolism, Young Adult
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