Dyslipidaemias are major cardiovascular risk factors, especially in people with diabetes. In this area, next-generation therapies targeting circulating lipoparticle metabolism (LDL, VLDL, chylomicrons, HDL) have recently been approved by the European and US medical agencies, including anti- proprotein convertase subtilisin/kexin 9 (PCSK9) antibodies; an siRNA targeting PCSK9; bempedoic acid, which targets ATP citrate lyase; an antisense oligonucleotide targeting apolipoprotein C-III; an anti-angiopoietin-like 3 antibody; and a purified omega-3 fatty acid, icosapent ethyl. Other therapies are in different phases of development. There are several important considerations concerning the link between these new lipid-lowering therapies and diabetes. First, since concerns were first raised in 2008 about an increased risk of new-onset diabetes mellitus (NODM) with intensive statin treatment, each new lipid-lowering therapy is being evaluated for its associated risk of NODM, particularly in individuals with prediabetes (impaired fasting glucose and/or impaired glucose tolerance). Second, people with diabetes represent a large proportion of those at high or very high cardiovascular risk in whom these lipid-lowering drugs are currently, or will be, prescribed. Thus, the efficacy of these drugs in subgroups with diabetes should also be closely considered, as well as any potential effects on glycaemic control. In this review, we describe the efficacy of next-generation therapies targeting lipoprotein metabolism in subgroups of people with diabetes and their effects on glycaemic control in individuals with diabetes and prediabetes and in normoglycaemic individuals.

Graphical Abstract

中文翻译：

---

糖尿病引起的高脂血症：下一代疗法有什么特别考虑因素吗？

血脂异常是主要的心血管危险因素，尤其是糖尿病患者。在这一领域，针对循环脂颗粒代谢（LDL、VLDL、乳糜微粒、HDL）的下一代疗法最近已获得欧洲和美国医疗机构的批准，包括抗前蛋白转化酶枯草杆菌蛋白酶/kexin 9（PCSK9）抗体；靶向 PCSK9 的 siRNA；bempedoic 酸，以 ATP 柠檬酸裂合酶为目标；靶向载脂蛋白 C-III 的反义寡核苷酸；抗血管生成素样3抗体；和纯化的 omega-3 脂肪酸，二十碳五烯酸乙酯。其他疗法正处于不同的开发阶段。关于这些新的降脂疗法与糖尿病之间的联系，有几个重要的考虑因素。首先，自 2008 年首次提出关于强化他汀类药物治疗会增加新发糖尿病 (NODM) 风险的担忧以来，正在评估每种新的降脂疗法与 NODM 相关的风险，特别是对于患有糖尿病前期（糖尿病前期受损）的个体。空腹血糖和/或糖耐量受损）。其次，糖尿病患者在心血管风险高或极高的人群中占很大比例，目前或将要使用这些降脂药物。因此，还应密切考虑这些药物在糖尿病亚组中的疗效以及对血糖控制的任何潜在影响。在这篇综述中，我们描述了针对脂蛋白代谢的下一代疗法在糖​​尿病患者亚组中的疗效及其对糖尿病和糖尿病前期患者以及血糖正常患者血糖控制的影响。

图形概要