Diabetic dyslipidaemias

Type 2 diabetic patients are at high risk of premature coronary heart disea se (CHD) morbidity and mortality. Dyslipidaemia is an important risk factor in these patients and is open to therapeutic intervention. Total cholester ol was strongly related to CHD mortality in the 12-year follow-up of men sc reened for the Multiple Risk Factor intervention Trial. However, for any gi ven cholesterol concentration, CHD risk was threefold higher among diabetic s than non-diabetics. The reason for this remains unclear, but it is likely that hyperglycaemia, thrombotic and coagulation factors, endothelial dysfu nction and dyslipidaemia all play a role. For example, in type 2 diabetes l ow density lipoprotein undergoes qualitative changes in size, density and g lycation, which make it more atherogenic. Also, hypertriglyceridaemia cause s significant and undesirable alterations in important lipoprotein species, and plasma triglyceride levels correlate positively with key coagulation a bnormalities, increasing the risk of thrombus formation. The parameters of diabetic dyslipidaemia are strongly related to both insulin resistance and insulin precursor molecules. A hypothesis to explain the various components of diabetic dyslipidaemia and their relationships to insulin resistance wi ll be discussed. These abnormalities often persist after best efforts direc ted to the control of hyperglycaemia, and therefore demand specific therape utic interventions.