Treatment of aterogenic dyslipidemia in the metabolic syndrome and in patients with type 2 diabetes

So called aterogenic dyslipidemia as a lipid disturbance is typical of metabolic syndrome and type 2 diabetes. It consists of three abnormalities, including hypertriglicerydemia, low level of HDL-cholesterol and presence of abnormaly formed LDL particles in serum, which are called small dense LDL. Their concentration in blood is not to be evaluated in clinical practice, but it is known that simultaneously with the increase of triglicerydes concentration above 130 mg/dl the percentage of these pathological lipoproteins increases in serum and normal LDL molecules particles decreases in concentration. Small dense LDL is directly linked to atherosclerosis.
The main lipid goal objective of metabolic syndrome and type 2 diabetes treatment is the reduction of LDL-cholesterol concentrations to target values <115 mg/dl (3.0 mmol/l) or <100 mg/dl (2.5 mmol/dl) dependent on the risk of death from cardiovascular diseases during 10 years. Effort should also be made to lower the triglicerydes concentration below 150 mg/dl (1.7 mmol/l) and to increase the HDL-cholesterol above 40 mg/dl (1.0 mmol/l) in males and 50 mg/dl (1.3 mmol/l) in females.
The reduction of body weight and the increase in physical activity are highly effective in the treatment of these specific lipids disturbances. Above mentioned methods cause the inversion of insulin resistance or its reduction, what is well known to be the basic pathway of aterogenic dyslipidemia. The Mediterranean diet has special therapeutic value in metabolic syndrome and type 2 diabetes.
When dietetic and physical activity change is insufficient in patients with metabolic syndrome to reach target concentrations of lipids, after 3 months of therapy pharmacological agent(i) should be added. But in patients who have high risk (diabetes) or very high risk (diabetes or metabolic syndrome with concurrent cardiovascular disease) pharmacotherapy should be initiated at the same time with dietetic treatment. Statins are the agents of choice in the reduction of LDL-cholesterol and fibrates in the reduction of triglycerides and increase of HDL-cholesterol. A part of patients with combined lipid disturbances could need so called combined pharmacotherapy with statins and fibrates.