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REFLECTIONS
Dyslipidaemia
Dyslipidaemia Global Newsletter #7 2024

With regards to the effect of anti-obesity medication (AOMs) and bariatric surgery on lipid levels, the authors note that the reported
effects do not necessarily reflect efficacy in patients with specific dyslipidaemia. In addition, independent studies have varying Dyslipidaemia
duration with different protocol designs, different baseline lipid levels, different dose ranges, and that measure efficacy at different
time points. While somewhat variable depending on the analysis, the overall message is that AOMs generally have the greatest effect
on lowering blood triglyceride levels, with neutral to increases in HDL-C, and marginal decreases in blood LDL-C levels. Bariatric
surgery generally results in greater weight reduction and greater improvements in lipid profiles than current monotherapy AOMs.

The clinical take-aways from this joint expert review by the OMA and NLA are that:

• An increase in adiposity is generally associated with an atherogenic lipid profile, as well as other cardiometabolic risk factors,
all that likely contribute to increased CVD risk.
• Among patients with obesity, interventions that reduce body weight
and improve CVD outcomes are generally associated with reduced
blood triglyceride levels and increased blood HDL-C levels, often with
only mild-to-modest improvements in blood LDL-C levels.

• In patients with, or at risk for ASCVD, a dual priority includes early
lifestyle and/or pharmacologic intervention to treat both excess
adiposity and elevated levels of atherogenic cholesterol (i.e., LDL-C
and/or non-HDL-C).

“This joint expert review examines basic connections between obesity medicine and clinical lipidology,
representing content I probably should have known 30 years ago. I suspect many do not fully recognize the
foundational relationship between lipids and obesity; a natural integration exists between these two disciplines”
Dr. Harold E. Bays, lead author.
Harold E. Bays

CLICK HERE
FOR THE LINK TO FULL ARTICLE

Lipid-lowering in diabetes: An update.
Chait A, et al. Atherosclerosis. 2023 Oct 6:117313. doi: 10.1016/j.atherosclerosis.2023.117313. Online ahead of print.

Atherosclerotic CVD is accelerated in people with diabetes. This article focuses on the pathogenesis, prevention, and treatment
of lipid and lipoprotein disorders related to ASCVD in people living with diabetes, including a review of the value of international
guidelines, and touching on newer approaches to therapy that are under development.

The strongest evidence to explain increased ASCVD in both people with metabolic syndrome (MetS) and Type 2 diabetes (T2DM) is
dyslipidaemia, characterized by hypertriglyceridaemia, low levels of HDL-C, normal to slightly elevated levels of LDL-C, with high apo
B levels and accumulation of small, dense LDL particles. In Type 1 diabetes there are other unique factors like arterial stiffness and
glucose variability that cause the accelerated atherosclerosis.

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