DIABETIC DYSLIPIDEMIA AND ITS THERAPY

Patients with diabetes, including those with IDDM, NIDDM, and other ty pes, are at an increased risk for coronary heart disease (CHD). Factor s that may enhance CHD risk include hyperglycemia, hypertension, and d yslipidemia, Diabetic dyslipidemia is characterized by multiple lipopr otein defects, including moderately high serum levels of cholesterol a nd triglycerides, small LDL particles, and low levels of HDL cholester ol, The results of recent clinical trials reveal beneficial effects of cholesterol-lowering therapy in diabetic and nondiabetic patients, th us supporting increased emphasis on treatment of diabetic dyslipidemia . This need for intensive treatment of diabetic dyslipidemia was advoc ated by the recent report of the National Cholesterol Education Progra m's Adult Treatment Panel II, A three-step approach to treatment of di abetic patients with dyslipidemia can be recommended, First, life habi ts, including intakes of cholesterol and cholesterol-raising fats, tot al energy, and physical activity, should be modified appropriately, Se cond, good glycemic control, with drugs if necessary, should be achiev ed, Third, atherogenic lipoproteins should be effectively reduced,,vit h drugs if necessary, Clinical trials indicate that priority should be given to reducing atherogenic lipoproteins (LDL and VLDL), An appropr iate target of therapy is VLDL + LDL (non-HDL) cholesterol levels, Cho lesterol-lowering drugs (hydroxymethylglutaryl [HMG] CoA reductase inh ibitors [statins] and bile acid sequestrants) are first-line drug ther apy for diabetic dyslipidemia. Patients with severe hypertriglyceridem ia may require fibric acids to prevent development of acute pancreatit is. Although nicotinic acid seems to be an attractive drug for diabeti c dyslipidemia, it worsens hyperglycemia; therefore, it must be avoide d in most cases, The value of estrogen-replacement therapy in postmeno pausal women with diabetes has not been determined.