Abnormalities of lipids are associated with increased risk of coronary artery disease (CAD) in
patients with DM. This risk can be reduced by intensive treatment of lipid abnormalities. The usual
pattern of lipid abnormalities in type 2 DM is elevated triglycerides, decreased HDL cholesterol and
higher proportion of small, dense LDL particles. Cholesterol is a lipid found in all cell membranes
and in blood plasma. It is an essential component of the cell membranes, and is necessary for
synthesis of steroid hormones, and for the formation of bile acids. Cholesterol is synthesized by
the liver and many other organs, and is also ingested in the diet. Triglycerides are lipids in which
three long-chain fatty acids are attached to glycerol. They are present in dietary fat and also
synthesized by liver and adipose tissue.
Newer treatment goals and statin initiation thresholds based on the risk categories proposed by
Lipid Association of India in 2020.
|
Risk Category
|
Treatment Goal
|
Consider Therapy
|
|
LDL Cholesterol
(LDL-C) (Mg/dl)
|
Non-HDL Cholesterol
(Non HDL-C) (Mg/dl)
|
LDL cholesterol
(LDL-C) (Mg/dl)
|
Non- HDL Cholesterol
(Non HDL-C) (Mg/dl)
|
|
Extreme Risk Group Category A
|
< 50
(Optional Goal<=30)
|
<80
(Optional Goal<=60)
|
>=50
|
>=80
|
|
Extreme Risk Group Category A
|
<=30
|
<=60
|
>30
|
>60
|
|
Very High
|
<50
|
<80
|
>=50
|
>=80
|
|
High
|
<70
|
<100
|
>=70
|
>=100
|
|
Moderate
|
<100
|
<130
|
>=100
|
>=130
|
|
Low
|
<100
|
<130
|
>=130*
|
>=160*
|
*In low risk patient, consider therapy after an initial non-pharmacological intervention for at
least 3 months.