Is your blood sugar controlled? Not if your LDL cholesterol is higher than 70 mg/dl

Diabetes and cholesterol abnormalities commonly occur together, and much like diabetes and hypertension, confer a greater risk than either factor alone, says Dr Ambrish Mithal, Chairman of Endocrinology and Diabetes at Max Healthcare

Research has shown that people with diabetes are two to four times more likely to develop heart disease than those without diabetes. Yet, controlling sugar alone may not protect your heart. Your sugars may be well controlled and you may still be prone to heart attack or brain stroke if you don’t exercise, are overweight, smoke, have uncontrolled hypertension or very importantly, have high cholesterol levels. Unfortunately, diabetes and cholesterol abnormalities commonly occur together, and much like diabetes and hypertension, confer a greater risk than either factor alone.

It is, therefore, mandatory to check the lipid profile in people with diabetes at least once a year, and initiate appropriate therapeutic measures accordingly. Ignoring cholesterol means that your diabetes treatment is incomplete.

A lipid profile commonly measures the following:

1) Low-density lipoprotein (LDL) cholesterol or “bad” cholesterol, a high level of which is consistently associated with a higher risk for heart disease. An ideal LDL level is below 100 mg/dl.

2) High-density lipoprotein (HDL) cholesterol or “good” cholesterol is associated with a lower risk for heart disease in high levels but puts you at a higher risk of heart disease at low levels. HDL is often found to be low in Indians. Medications are not very effective in raising HDL and it is unclear if raising HDL by medication reduces the risk of heart disease.

3) Triglycerides are the most common type of fat in the body. The exact role of triglycerides in the development of heart or vascular disease remains uncertain. Very high levels of triglycerides ( > 500 mg/dl) are associated with a greater risk of pancreatitis.

How does diabetes affect cholesterol?

The most common abnormality seen in diabetes is low HDL levels and high triglycerides (diabetic dyslipidaemia), although the LDL also tends to be higher. Insulin resistance, typical of Type 2 diabetes, may be linked to the development of diabetic dyslipidaemia.

How do we manage cholesterol abnormalities in people with diabetes?

Lifestyle measures are important in reducing cardiac risk even though the impact on the chief culprit, LDL cholesterol, may be modest (10-15 per cent). Weight loss by restriction of calorie intake is associated with improvements in lipids and other cardiac risk factors. While everyone should follow lifestyle measures, most people with diabetes also require medication to bring their LDL cholesterol in target range

The most popular cholesterol-lowering drugs, statins, inhibit an enzyme that is responsible for cholesterol synthesis, and have several other cardio-protective actions. A meta-analysis of 18,686 people with diabetes demonstrated a nine per cent reduction in all-cause mortality for every 1 mmol/L (38 mg/dl) reduction in LDL-C. In individuals at high risk of heart disease, statins reduce the risk of heart attacks by about 40 per cent. The only group of people with diabetes, where one may sometimes avoid or delay statins, are those below 40 years of age, with no other risk factors and a normal LDL. In our practice, close to 90 per cent of people with diabetes are on statins.

However, at times statins may give rise to muscle pains or cramps. There is also a very slight risk of developing diabetes. However, the benefits of statins far outweigh the risks. A meta-analysis showed that four years of statin treatment in 255 patients would lead to one extra case of Type 2 diabetes while preventing 5.4 vascular events. Please take a statin if your doctor prescribes it and do not discontinue it on your own!

Other drugs that are used either as adjunct to statin or in those who are statin intolerant are Ezetemibe and the new (PCSK9) inhibitors. PCSK9 inhibitors have been shown to reduce LDL by as much as 60 per cent and also reduce cardiac events substantially. Although not studied specifically in diabetes, recent analyses suggest that PCSK9 inhibitors work as well in people with diabetes than those without. Treatment for high triglycerides includes fibrates, Omega 3 fatty acids and Saroglitazar, although the impact on cardiac outcomes is not proven.

https://indianexpress.com/article/health-wellness/blood-sugar-control-ldl-cholesterol-9008608/