Dyslipoproteinemias in diabetes.

The risk of macrovascular disease in those with diabetes is several-fold greater than that in the general population. One of the many groups of factors that might contribute to this is the dyslipoproteinemias. Among the dyslipoproteinemias in diabetes, the most frequently observed abnormality is hypertriglyceridemia. Levels of low-density lipoprotein (LDL) and of plasma cholesterol in those with diabetes are similar to those observed in people without diabetes. However, in diabetes there may be qualitative modifications in LDL (as well as in other lipoproteins) that increase their atherogenicity. At present there is one study, the Diabetes Atherosclerosis Intervention Study (DAIS), specifically designed to examine whether correcting the dyslipoproteinemia of diabetes will reduce the angiographic progression of coronary artery disease. Until results are available from studies that are designed to investigate the lipid hypothesis in those with diabetes, recommendations for the treatment of dyslipoproteinemias in diabetes will be based on pathophysiologic reasoning and on extrapolation from interventions studies conducted in nondiabetic individuals.