LIPID DISORDERS IN DIABETES

An increased frequency of lipid disorders is believed to be responsibl e, in part, for the increased prevalence of cardiovascular disease ass ociated with diabetes. Decreased insulin action, attributable to insul in deficiency or insulin resistance, is the primary cause. Increased t riglyceride and decreased high density lipoprotein (HDL) levels often associated with small, dense, low density lipoprotein (LDL) (dyslipide mia) are found more commonly than in nondiabetic patients, and elevate d LDL values occur with equal frequency in overweight, elderly diabeti c, and nondiabetic individuals. In addition, compositional abnormaliti es increase the atherogenicity of lipoproteins. These abnormalities ar e largely reversed by administration of high dosages of insulin in typ e 1 diabetic patients; in patients with type 2 diabetes, a dyslipidemi c pattern frequently persists despite treatment with oral agents or in sulin. Hypertriglyceridemia and low HDL are predictive of coronary hea rt disease (CHD) risk in diabetes, although hypertriglyceridemia loses its predictive power in patients with normal LDL levels or after corr ection for low HDL. Cut points for diagnosis and goals for treatment s hould be set lower for diabetic patients than for the general populati on. Weight reduction and increased physical activity are useful initia l approaches to therapy. Recent evidence in diabetic patients with CHD that lowering LDL using statin drugs is associated with at least the same relative degree of benefit as in nondiabetic patients provides th e rationale for aggressive LDL lowering in diabetic individuals, given their excess rate of CHD. Pharmacotherapy for hypertriglyceridemia is more controversial except in patients with severe abnormalities.