The American Journal of Cardiology
Original ArticlesDiabetic dyslipidemia
Section snippets
Lipid abnormalities in diabetes mellitus
Virtually every lipid and lipoprotein is affected by insulin resistance and diabetes mellitus.1, 4 Chylomicron and very-low-density lipoprotein (VLDL) remnants accumulate, leading to high levels of potentially atherogenic particles; in addition, there is triglyceride enrichment of both HDL and low-density lipoprotein (LDL). Triglyceride enrichment of these particles leads to decreased levels of HDL and small, dense LDL particles. When hyperglycemia occurs, there may be further impairment in
Dyslipidemia and atherogenesis in insulin resistance syndrome and type 2 diabetes
Controversy exists over whether hypertriglyceridemia is a risk factor for coronary artery disease. This, in part, reflects the high biologic variability in triglyceride measurement (Table II)12 and the fact that many studies have used only a single triglyceride measurement, which may not have been a fasting sample.
Hypertriglyceridemia is associated with atherosclerosis for multiple reasons. Hypertriglyceridemia is a marker for insulin resistance and the constellation of atherogenic metabolic
Lipid reduction and coronary artery disease in type 2 diabetes mellitus
There are no published studies that specifically evaluate the effects of lipid-lowering therapy on the development of coronary artery disease in patients with type 2 diabetes mellitus. However, a small number of diabetic patients were included in the Helsinki Heart Study, a primary prevention trial, and in the Scandinavian Simvastatin Survival Study (4S) and Cholesterol and Recurrent Events (CARE) study, secondary prevention trials. The Helsinki Heart Study included 135 patients with type 2
Role of lipid-lowering therapy in preventing macrovascular disease
Studies indicate that patients with type 2 diabetes mellitus who have no history of coronary artery disease have the same risk for cardiac events as do nondiabetic patients with preexisting coronary artery disease (Figure 5; S. M. Haffner, personal communication). This emphasizes the extensive but silent nature of coronary artery disease in patients with diabetes mellitus. Diabetic patients have more diffuse and more nonocclusive coronary artery disease lesions; the latter predispose to acute
Does improving glycemic control decrease coronary artery disease events in patients with type 2 diabetes mellitus?
The data relating glycemic control to coronary artery disease are primarily observational and a correlation is weak at best. In the Wisconsin Retinopathy Study, a 1% increment in hemoglobin A1c increased the risk of retinopathy by 50% but the risk of coronary artery disease by only 5–10% (Figure 6 ).28 In the variable insulin group of the University Group Diabetes Program, better glycemic control was not associated with decreased coronary artery disease events. In fairness, however, the degree
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