[Hyperlipidemia during diabetes mellitus. Recent developments].

Abstract

Patients with diabetes mellitus are at increased risk of coronary, cerebral, and peripheral vascular disease, and frequently have abnormal plasma lipid levels. Glycaemic control, environmental factors and inherent genetic potential may affect lipoprotein metabolism. Quantitative alterations in the concentrations of major lipids and lipoproteins have been extensively studied in both insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus. However several recent findings indicate the possible presence of structural and functional abnormalities that may impair the lipid metabolism transport system in diabetic patients. These include glycation of several major or minor apolipoproteins, apo E phenotype frequency, free cholesterol or triglyceride enrichment of VLDL and LDL. Moreover lipoprotein (a) which is an independent risk factor for coronary heart disease may be increased in diabetic patients with poor glycaemic control or with microproteinuria. Patients with microalbuminuria or chronic renal failure show atherogenic changes of lipoprotein pattern. New epidemiological evidence indicates that hypertriglyceridaemia is an important predictor of coronary heart disease mortality in subjects with impaired glucose tolerance or diabetes. Postprandial lipaemia can increase the risk of cardiovascular disease potentially by low triglyceride metabolic capacity. The role of insulin must also be considered. Some lipoprotein abnormalities could be attributed to peripheral hyperinsulinaemia, insulin resistance or type of insulin infusion for insulin-dependent diabetes mellitus patients. In diabetes lipids and lipoproteins are potentially atherogenic although their concentrations may be strictly normal. The achievement of optimum lipid and lipoprotein levels as a goal of treatment for diabetic patients would reduce the current rates of morbidity and mortality from vascular disease.