Diabetic dyslipidemia.

Diabetes is associated with increased morbidity and mortality from cardiovascular disease in the absence of the major risk factors: cigarette smoking, hypertension, and serum cholesterol concentration. When these risk factors are present, the attributable risk to each factor alone and to the combination of risk factors is higher in diabetics than in nondiabetics. Thus, stringent measures to correct risk factors for cardiovascular disease have been advocated in diabetic patients. In addition to hypercholesterolemia, other lipid and lipoprotein abnormalities collectively referred to as diabetic dyslipidemia are likely to contribute to vascular risk. Hypertriglyceridemia often associated with low high-density lipoprotein cholesterol is common in non-insulin-dependent diabetes mellitus patients and is associated with insulin resistance. Recent information in diabetic patients pointing to the association of hypertriglyceridemia with accumulation of remnant particles and alterations in low-density lipoprotein subfractions helps to explain the strong relationship between hypertriglyceridemia and vascular risk in these individuals. Although there are as yet no intervention trials with lipid-lowering diets or drugs in diabetic patients to judge the impact on vascular disease, national and international bodies have furnished guidelines for the identification and treatment of lipid disorders in diabetes in the hope of reducing the huge toll of vascular disease in these patients.