Abnormalities in apo B-containing lipoproteins in diabetes and atherosclerosis

Atherosclerosis is the major cause of death in patients with diabetes. Low- density lipoprotein (LDL) being the most important cholesterol-carrying lip oprotein has been studied extensively in both diabetes and non-diabetes. Th is paper reviews the literature but also focuses on the precursors of LDL a nd in particular the postprandial apo B-containing lipoproteins. Abnormalit ies in the postprandial lipoproteins and alteration in chylomicron assembly and clearance are discussed and the evidence presented suggesting the impo rtance of dysregulation of these lipoproteins in atherosclerotic progressio n. The relationship between chylomicron production in the intestine and hep atic release of very low-density lipoproteins (VLDL) is explored, as is the interrelationship between clearance rates of these lipoproteins. The size of LDL influences its atherogenicity. VLDL composition and size in relation to its influence on LDL is discussed. The effect of diet on the compositio n of lipoproteins and the relationship between fatty acid composition and c learance is reviewed. Evidence that diabetic control beneficially alters li poprotein composition is presented suggesting how improved diabetic control may reduce atherosclerosis. The review concludes with a discussion on the effect of the apo B-containing lipoproteins and their modification through glycation and oxidation on macrophage and endothelial function. Copyright ( C) 2001 John Wiley & Sons, Ltd.