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.

中文翻译：

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血脂管理可降低 1 型糖尿病患者的心血管风险。

审查目的 

回顾最近在1 型糖尿病(T1D) 中进行血脂管理以降低心血管风险的证据。

最近的发现 

患有 T1D 的个体心血管发病率和死亡率的风险增加，动脉粥样硬化早在青春期就开始了。升高的低密度脂蛋白胆固醇(LDL-C)、甘油三酯和脂蛋白 (a) 与 T1D 心血管风险增加有关。虽然 1 型糖尿病患者的高密度脂蛋白胆固醇 (HDL-C) 通常正常或高于非糖尿病对照组，但 1 型糖尿病患者的 HDL 具有结构改变，这使其致动脉粥样硬化而非心脏保护。同样，虽然 LDL-C 在 T1D 中没有特别升高，但 LDL 仍然会增加心血管风险。对糖尿病患者的研究主要包括 T2D 参与者，T1D 参与者的数量要少得多；这些研究表明，脂质- 降低疗法，如他汀类药物、依折麦布和前蛋白转化酶枯草杆菌蛋白酶/kexin 9 型 (PCSK9) 抑制剂可降低糖尿病患者和非糖尿病患者的 LDL-C 水平和心血管事件。1 型糖尿病患者的胆固醇吸收增加，这表明依折麦布可能对 1 型糖尿病特别有效。REDUCE-IT 试验的结果显示，糖尿病（主要是 2 型糖尿病）患者的高剂量 omega-3 脂肪酸（Icosapent Ethyl）治疗可降低心血管风险，这与降低甘油三酯无关，但目前缺乏类似的 T1D 数据。

概括 

患有 T1D 的人患心血管疾病的风险很高，因此需要从青春期到成年期进行密切的血脂监测和管理。