HYPERLIPEMIA IN DIABETES - RECENT DEVELOP MENTS

Patients with diabetes mellitus are at increased risk of coronary, cer ebral, and peripheral vascular disease, and frequently have abnormal p lasma lipid levels. Glycaemic control, environmental factors and inher ent genetic potential may affect lipoprotein metabolism. Quantitative alterations in the concentrations of major lipids and lipoproteins hav e been extensively studied in both insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus. However several recent f indings indicate the possible presence of structural and functional ab normalities that may impair the lipid metabolism transport system in d iabetic patients. These include glycation of several major or minor ap olipoproteins, apo E phenotype frequency, free cholesterol or triglyce ride enrichment of VLDL and LDL. Moreover lipoprotein (a) which is an independent risk factor for coronary heart disease may be increased in diabetic patients with poor glycaemic control or with microproteinuri a. Patients with microalbuminuria or chronic renal failure show athero genic changes of lipoprotein pattern. New epidemiological evidence ind icates that hypertriglyceridaemia is an important predictor of coronar y heart disease mortality in subjects with impaired glucose tolerance or diabetes. Postprandial lipaemia can increase the risk of cardiovasc ular disease potentially by low triglyceride metabolic capacity. The r ole of insulin must also be considered. Some lipoprotein abnormalities could be attributed to peripheral hyperinsulinaemia, insulin resistan ce or type of insulin infusion for insulin-dependent diabetes mellitus patients. In diabetes lipids and lipoproteins are potentially atherog enic although their concentrations may be strictly normal. The achieve ment of optimum lipid and lipoprotein levels as a goal of treatment fo r diabetic patients would reduce the current rates of morbidity and mo rtality from vascular disease.