Management of hyperlipidemia in women with diabetes

To review gender-related factors in coronary artery disease, possible mechanisms for increased atherogenesis in women with diabetes, and potential therapeutic strategies for hyperlipidemia.

Pertinent published studies and personal experiences are discussed, and lipoprotein profiles are outlined.

In the normal population, the increase in atherosclerotic vascular disease with aging in women lags behind that in men by 10 to 15 years. With the presence of diabetes, however, the atherosclerotic changes are similar in men and women. Several studies have substantiated that triglyceride levels are a stronger risk factor than cholesterol in men and women with diabetes who have coronary artery disease. In general, hypertriglyceridemia is a stronger risk factor for cardiovascular disease in women than in men. Gender differences in lipid levels can be explained physiologically by the presence of estrogen in female patients, which accelerates the rate of metabolism of lipoproteins and, in a setting of insulin deficiency, induces hypertriglyceridemia. Dietary measures and various classes of drugs, including reductase inhibitors, are used alone or in combination for management of the combined hyperlipidemia typically found in subjects with insulin resistance, diabetes, or both.

Gender-related differences in lipoprotein-associated cardiovascular risk should be considered in choosing treatment options for patients with diabetes and hyperlipidemia.