Lipid Disorders in Diabetes

A ltered concentrations of blood plasma lipoproteins are powerful predictors of coronary heart disease (CHD) and of other manifestations of atherosclerosis. Reduction of elevated low-density lipoprotein cholesterol (LDL cholesterol) and concomitant increases in high-density lipoprotein cholesterol (HDL cholesterol) have been shown to reduce myocardial infarction and death from CHD in people with no previous history of vascular events. Other studies using angiography have demonstrated that the atherosclerotic lesions can be stabilized or caused to regress in the coronary vessels of patients who have clinically evident disease. Diabetes mellitus markedly increases the risk of death and disability from the various complications of atherosclerosis. Seventy-five to 80% of adult diabetic patients die from CHD, cerebrovascular disease, and/or peripheral vascular disease. The lipoprotein risk factors defined in the general population also occur in diabetic patients. Elevated LDL cholesterol, reduced HDL cholesterol, and hypertriglyceridemia are frequently found in insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). There is considerable evidence that higher blood triglycerides and lower HDL cholesterol may be intrinsically related to the abnormal physiology produced by insulin resistance or inadequate insulin action, with the concomitant metabolic disturbances. The significant advances in the understanding of lipoprotein structure and metabolism, as well as the large body of data illustrating the efficacy of treating lipoprotein disorders, stimulated the American Diabetes Association to examine the possibility of better defining and altering vascular disease risk associated