Diagnostic and therapeutic procedures in lipid disorders in patients with diabetes – practical indications for physicians

Lipid disorders affect more than 50% of patients diagnosed with type 1 and type 2 diabetes. They are often associated with atherogenic dyslipidaemia with characteristic coexistence of elevated triglycerides, the presence of small, dense, low-density lipoprotein (LDL) molecules, and low concentration of high-density (HDL) cholesterol in the serum. Cholesterol disorders are an important risk factor for cardiovascular events. Statin monotherapy is often insufficient to effectively correct the lipidogram. Even though the target LDL cholesterol level is reached, the residual cardiovascular risk remains significant. Therefore, current guidelines, as well as lowering LDL, also indicate the need to adjust the serum concentration of non-HDL cholesterol, which determines the total number of atherogenic molecules in plasma and better reflects cardiovascular risk. The optimal way to correct non-HDL cholesterol is by using combined treatment with statins and fenofibrate. The paper presents the latest 2019 European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) guidelines regarding the treatment of lipid disorders, and the algorithm that facilitates the selection of diagnostic and therapeutic procedures.