DYSLIPIDEMIA IN DIABETES-MELLITUS

Patients with diabetes mellitus have a higher rate of mortality than t he general population. This higher mortality may be attributed mainly to cardiovascular disease. A high prevalence of dyslipidemia in diabet ics can be one of the reasons for this. The most commonly recognized l ipid abnormality in non-insulin-dependent diabetics (NIDDM) is hypertr iglyceridemia, which is known to be an independent risk factor for cor onary heart disease in diabetics. Hypertriglyceridemia can be produced by two mechanisms, increased synthesis of very-low-density lipoprotei n (VLDL) triglyceride and removal defect of plasma triglyceride. It ha s been a matter of debate whether insulin always stimulates hepatic VL DL secretion but it is generally accepted that insulin deficiency resu lts in an impairment of plasma triglyceride clearance. Considerable at tention has recently been focused on the atherogenecity of postprandia l hyperlipidemia, remnant lipoproteins, small, dense LDL, lipoprotein (a) [Lp(a)] and isolated hypo-alphalipoproteinemia in NIDDM subjects. Several reports suggested that these atherogenic lipoprotein abnormali ties are present in NIDDMs even if they are apparently normolipidemic. Association of visceral fat obesity, insulin resistance and nephropat hy may aggravate the atherogenic lipoprotein profile. Therefore, we pr opose here that plasma lipid levels of diabetic subjects must be more strictly controlled than for the non-diabetic population in order to a void an increased risk for coronary heart disease. If they are obese o r associated with insulin resistance or nephropathy, these conditions should be carefully controlled.