Dyslipidemia and diabetes: a personal view

Cardiovascular disease, the main cause of morbidity and mortality in patients with diabetes, justifies an aggressive approach to the reduction of modifiable risk factors. Lipid values are generally normal in patients with insulin-dependent diabetes mellitus, but hypertriglyceridemia and low levels of high-density lipoprotein (HDL) cholesterol are frequently associated with non-insulin-dependent diabetes mellitus (NIDDM). Recommendations for screening and treatment of patients without diabetes do not apply to those with NIDDM. Screening should be done annually and should include fasting total cholesterol, triglycerides, and HDL cholesterol. Therapeutic recommendations based solely on the low-density lipoprotein cholesterol level are inappropriate. Hypertriglyceridemia cannot be ignored in patients with NIDDM. Therapy should first be directed toward improved control of the diabetes through diet, exercise, and insulin or sulfonylureas. Therapeutic goals are selected on the basis of individual risk assessment and are strongly influenced by the presence of preexisting vascular disease. When the goals are not achieved through improved control of diabetes, lipid-lowering drug therapy, based on the specific profile of the lipid abnormalities, should be initiated.