Microsoft word - editors note_lipoproteins and cvd in diabetes.doc
The Review of Diabetic Studies Cardiovascular Disease, Lipids, and Diabetes
Herewith, I cordially invite you participating in the Special Issue Project for The Review of Diabetic Studies (http://www.the-rds.org) on Cardiovascular Disease, Lipids, and Diabetes. There are many controversies and unanswered questions
relating to the care of diabetic patients with dyslipidemia. The cardiovascular and
renal protective effects of current lipid-lowering agents in diabetic patients is very
confusing, and many recent review articles have discussed the dilemma.
Based on an extended collection of clinical observation data and meta-analyses
of research results, statin treatment is supposed to offer beneficial effects in the
primary and secondary prevention of cardiovascular and kidney disease
(http://www.ncbi.nlm.nih.gov/pubmed/20934984). However, the decrease in the
incidence of macrovascular disease is not well correlated to the degree of LDL-C
reduction, and many patients remain at high risk even when their level of LDL-C has
been reduced by aggressive treatment with statins. Recent papers have suggested a
role for HDL-C in the pathogenesis of diabetes cardiovascular disease, which cannot
be treated by current medication. HDL-C has attracted attention for a long period of
time, but study results have all been disappointing, especially the results from the
ACCORD-LIPID study (http://www.ncbi.nlm.nih.gov/pubmed/20228404).
We have all experienced that many patients with diabetes have a paradoxical
HDL-C reduction in response to statin treatment, which was also observed in the
CARDS study (http://www.ncbi.nlm.nih.gov/pubmed/15325833). A recent review by
de Lorgeril and colleagues have pointed out this situation (Rev Recent Clin Trials,
2012, 7(2):150-7, title: “Is the use of cholesterol-lowering drugs for the prevention of
cardiovascular complications in type 2 diabetics evidence-based? A systematic
review”). Their conclusion is as follows: “This review does not support the use of cholesterol-lowering drugs (such as statin and fibrate) to reduce mortality and cardiovascular complications in type 2 diabetics. Official guidelines should be re-examined and reformulated by experts independent from the pharmaceutical industry”. This is a very interesting and important conclusion, and it prompts us
scientists to develop new treatment regimens. It is one of the reasons why I initiate
this Special Issue on CVD, lipids, and treatment of diabetes cardiovascular
complications. I think that current knowledge should be reconsidered and treatment
It will be important to elucidate the different effects of statin or fenofibrate in
diabetes and non-diabetes and to explore the molecular mechanisms of impaired statin
or fenofibrate responses in patients with diabetes. Fundamental research could explain
the association of diabetes dyslipidemia with poor cardiovascular outcome and
unresponsiveness to current medications. Clarification of the molecular mechanisms
associated with diabetes dyslipidemia and response to statin or fenofibrate may be
helpful in solving this controversy. Though review articles have been published, an
integrated and comprehensive reappraisal of diabetes dyslipidemia and
cardiovascular/renal diseases is still lacking and urgently needed. I believe that further
in-depth review will have a great scientific impact.
The following topics are scheduled for the Special Edition of The Review of
1. Effects of statin and fenofibrate in patients with diabetes – local data are
2. Systemic review/meta-analysis of statin/fenofibrate treatment in diabetic
3. Pharmacogenetics and pharmacokinetics of lipid-lowering agents.
4. Systemic review/meta-analysis of the effects of statin treatment in diabetic
and non-diabetic patients with cardiovascular disease.
5. Systemic review/meta-analysis of non-pharmacologic management of
6. Should the official guidelines be re-examined and reformulated for diabetes
dyslipidemia management and for primary prevention?
8. New frontiers in the treatment of diabetes dyslipidemia.
9. Dyslipidemia and kidney disease (diabetic nephropathy) - a systemic
10. Effectiveness of statin/fibrate treatment of diabetic nephropathy/chronic
kidney disease - a systemic review and meta-analysis
11. Dyslipidemia and diabetic retinopathy.
12. Development of new guidelines for the treatment of diabetic cardiovascular
I hope my considerations on diabetes dyslipidemia may be interesting to you,
and that you join us with your contribution.
The Wild Yam – a review The Wild Yam – review of Dioscorea species . Introduction When it was decided to review the wild yam and related Dioscorea species it was probably in ignorance of the complexity of the task. This is a fascinating plant with many uses in folk lore and also in the history of the development of modern pharmacy. The number of species is quite overwhelmin
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