LIPOPROTEIN ABNORMALITIES IN NON-INSULIN-DEPENDENT DIABETIC-PATIENTS WITH IMPAIRED EXTRAHEPATIC INSULIN SENSITIVITY, HYPERTENSION, AND MICROALBUMINURIA

We investigated whether specific lipoprotein abnormalities are present in non-insulin-dependent diabetes mellitus (NIDDM) patients with hype rtension and/or microalbuminuria. Fifteen normotensive normoalbuminuri c (H-M-), 32 hypertensive normoalbuminuric (H+M-), and 22 hypertensive microalbuminuric (H+M+) NIDDM patients and 20 sex-, age-, and weight- matched nondiabetic control subjects were studied. Lipoprotein size wa s measured by nondenaturing polyacrylamide gradient gel electrophoresi s; insulin sensitivity was assessed by using a euglycemic hyperinsulin emic clamp and [6,6(2)H]glucose tracer infusion for simultaneous measu rement of hepatic glucose output and whole-body glucose utilization. T otal plasma and very-low-density lipoprotein cholesterol were higher i n H+M+ than in control subjects (5.84+/-0.98 versus 4.97+/-0.98 and 0. 57+/-0.54 Versus 0.26+/-0.21 mmol/L, mean+/-SD, P<.05). Plasma triglyc erides were higher in H+M+ than in either control or H-M- subjects (2. 17+/-1.32 versus 1.18+/-0.67 and 1.30+/-0.59 mmol/L, respectively; P<. 05). The mean low-density lipoprotein diameter was 27.2+/-0.8 in contr ol, 26.7+/-0.8 in H-M-, 26.5+/-0.8 nm in H+M- (P<.05 versus control su bjects), and 26.0+/-0.8 nm in H+M+ subjects (P<.05 Versus control subj ects). The mean cholesterol level of the large high-density lipoprotei n particles was lower in H+M- and H+M+ (0.37+/-0.14 and 0.36+/-0.16 mm ol/L) than in control and H-M- (0.54+/-0.41 and 0.54+/-0.27 mmol/L, P< .05) subjects. Whereas hepatic glucose output was less inhibited in al l diabetic patients than in control subjects, whole-body glucose dispo sal was lower in H+M+ (97+/-13 mg/m(2) per minute, mean+/-SEM, P<.05) and H+M- (69+/-12 mg/m(2) per minute, P<.05) but not in H-M- (277/-38 mg/m(2) per minute) NIDDM patients than in control subjects (263+/-45 mg/m(2) per minute). Hypertension (without or with microalbuminuria) a ppears to be associated with small low-density lipoprotein particles a nd low high-density lipoprotein cholesterol(2), while microalbuminuria (with hypertension) is associated with elevated triglycerides in NIDD M patients. Moreover, in NIDDM patients the presence of hypertension w ith or without microaIbuminuria is associated with impaired extrahepat ic insulin sensitivity. The atherogenic lipoprotein pattern might part ially explain why NIDDM patients with microalbuminuria and hypertensio n are prone to cardiovascular diseases.