PREVENTION OF ATHEROSCLEROSIS IN DIABETES - EMPHASIS ON TREATMENT FORTHE ABNORMAL LIPOPROTEIN METABOLISM OF DIABETES

Atherosclerosis is the principal cause of diabetic morbidity and morta lity. Diabetic dyslipidemia, obesity, and hypertension are significant contributing factors in the acceleration of the atherosclerotic proce ss. Regardless of the type of diabetes, increased levels of very-low-d ensity lipoprotein triglyceride, modified levels of low-density lipopr otein cholesterol, and decreased levels of high-density lipoprotein (H DL) cholesterol are the main lipoprotein abnormalities in diabetic pat ients. These abnormalities can be improved in part by glycemic control , but additional intervention may be needed. Diet and exercise are imp ortant elements in the management of dyslipidemia, but lipid-lowering drugs (especially fibrates and HMG-CoA reductase inhibitors) also may be necessary for the control of diabetic dyslipidemia. Based on these findings, the American Diabetes Association Consensus Panel and the re vised treatment guidelines of the National Cholesterol Education Progr am recommend treatment of hypertriglyceridemia/low HDL cholesterol as a risk factor of coronary heart disease in diabetic and nondiabetic in dividuals alike. Aggressive treatment is recommended, therefore, parti cularly in diabetic patients and in all patients with existing vascula r disease.