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Title: Regional evidence and international recommendations to guide lipid management in Asian patients with type 2 diabetes with special reference to renal dysfunction
Authors: Lau, T.W.L
Tan, K.E.K
Choo, J.C.J 
Ng, T.-G
Tavintharan, S
Chan, J.C.N
Keywords: atorvastatin
creatine kinase
ezetimibe plus simvastatin
hydroxymethylglutaryl coenzyme A reductase inhibitor
low density lipoprotein cholesterol
antilipemic agent
acute kidney failure
antioxidant activity
cardiovascular disease
cardiovascular risk
chronic kidney failure
clinical practice
coronary artery atherosclerosis
creatine kinase blood level
diabetic nephropathy
disease association
disease burden
dose response
drug clearance
drug efficacy
drug megadose
drug use
end stage renal disease
ethnic difference
kidney disease
kidney dysfunction
lifestyle modification
liver dysfunction
non insulin dependent diabetes mellitus
practice guideline
primary prevention
priority journal
risk assessment
secondary prevention
side effect
Asian continental ancestry group
cardiovascular disease
chronic kidney failure
non insulin dependent diabetes mellitus
statistics and numerical data
Asian Continental Ancestry Group
Cardiovascular Diseases
Diabetes Mellitus, Type 2
Hypolipidemic Agents
Practice Guidelines as Topic
Renal Insufficiency, Chronic
Issue Date: 2018
Citation: Lau, T.W.L, Tan, K.E.K, Choo, J.C.J, Ng, T.-G, Tavintharan, S, Chan, J.C.N (2018). Regional evidence and international recommendations to guide lipid management in Asian patients with type 2 diabetes with special reference to renal dysfunction. Journal of Diabetes 10 (3) : 200-212. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: The anticipated increase in the prevalence and incidence of type 2 diabetes in Asia, and its associated cardiovascular–renal complications, will place a significant burden on patients, caregivers, and society. Despite the proven effectiveness of lipid management in reducing these complications, there are major treatment gaps, especially in Asian patients with young-onset diabetes and chronic kidney disease (CKD). Recent international guidelines recommended the adoption of absolute risk estimation of atherosclerosis and cardiovascular disease to guide treatment intensity. These recommendations replaced the previous strategy of using low-density lipoprotein cholesterol targets to guide initiation and intensification of lipid lowering, albeit still widely practiced in Asia. The latest guidelines also highlight the high risk of atherosclerosis and cardiovascular disease (ASCVD) for people with diabetes, who should be protected with statins, except for young patients without other risk factors, who will need yearly monitoring of blood lipid levels. Given the propensity of Asian patients with diabetes to develop CKD and the amplifying effect of CKD on ASCVD, the use of statins in Asian patients is particularly important. Due to interethnic differences in drug metabolism, rosuvastatin, which is largely cleared by the kidney, should be prescribed in low dosages (5–10 mg daily) in Asian populations. Conversely, epidemiological and experimental data confirm pleotropic and organ-protective effects of atorvastatin, with proven safety in Asian populations within a daily dose range of 10–40 mg. Thus, there is a need for Asian countries to review and align their lipid-lowering treatment guidelines to reduce the substantial burden of diabetes in the Asian region. © 2017 The Authors. Journal of Diabetes published by John Wiley & Sons Australia, Ltd and Ruijin Hospital, Shanghai Jiaotong University School of Medicine.
Source Title: Journal of Diabetes
ISSN: 17530393
DOI: 10.1111/1753-0407.12610
Rights: Attribution 4.0 International
Appears in Collections:Staff Publications

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