[Diabetic dyslipoproteinemia: physiopathological bases and treatment prospects]

Dyslipoproteinemia associated with type 2 diabetes comprises hypertriglyceridemia caused by reduced insulin sensitivity, and consequently, low HDL levels and an increase in the proportion of small dense LDL particles. In addition, in both type 1 and 2 diabetes glycated LDL is formed in the presence of high plasma glucose levels. These lipoprotein disorders are all atherogenic and are responsible for the distinctly increased risk for cardiovascular disease in diabetics. Intensive glucose-lowering measures result in lower rates of micro- and macro-angiopathies in both types of diabetes. The benefit of additional lipid-lowering measures has not yet been confirmed by appropriate investigations. However, subgroup analyses from two large intervention trials do demonstrate that mortality from coronary heart disease may be substantially reduced. LDL cholesterol levels in diabetics should not exceed 115 mg/dl (3 mmol/l), and fasting triglycerides should be lower than 180 mg/dL (2 mmol/l).