[Diabetic dyslipidemia and pathogenesis of ischemic heart disease]

Type II diabetes is associated with high risk of ischemic heart disease (IHD), diabetes and IHD have similar risk factors, abdominal obesity as well as interrelated disturbances of lipid and carbohydrate metabolism play important roles in pathogenesis of both diseases.

To elucidate characteristics of metabolism and transport of lipids and carbohydrates in patients with type II diabetes and IHD with normal and excessive body mass with abdominal type of fat distribution.

Parameters of carbohydrate metabolism, blood serum levels of free fatty acids, lipid and apoprotein (apo-) parameters of lipoprotein spectrum were evaluated in subjects without diabetes or IHD (group 1), patients with IHD and normal body mass (group 2), patients with IHD combined with diabetes with normal body mass (group 3), patients with IHD, diabetes and abdominal obesity (group 4).

Patients with combination of diabetes and IHD compared with those of groups 1 and 2 in addition to higher blood glucose had lower growth hormone, higher triglycerides, lower high density lipoprotein cholesterol (CH) and apo-A1, higher low/high density lipoprotein CH and apo-B/apo-A1 ratios. These atherogenic changes were more pronounced in patients of group 4 who had highest levels of insulin, free fatty acids, low density lipoprotein CH and apo-B and lowest glucose/insulin ratio and level of apo-A1.

Insulin resistance and hyperinsulinemia are most important features of disturbed carbohydrate and lipid metabolism. Insulin resistance and hyperinsulinemia are most pronounced in subjects with abdominal obesity in whom they create conditions for impaired glucose utilization, development of atherogenic dyslipidemia and eventually emergence of IHD.