[Proatherogenic lipid metabolism disturbances in impaired glucose tolerance]

The role of Impaired Glucose Tolerance (IGT) in the pathogenesis of cardiovascular complications is still underestimated. Besides proven doubled risk of diabetes mellitus, IGT patients present wide range of atherogenic disturbances such as insulin resistance, proinflammatory and procoagulant state and proatherogenic lipid changes. This paper reviews lipid metabolism disorders, such as elevation of free fatty acids and triglycerides level, structural changes of LDL (high level of "small dense" and modified LDL), HDL particles and more, as well as visceral obesity often observed in patients with IGT. Untreated IGT leads to diabetes mellitus and cardiovascular complications, consequently increasing risk of myocardial infarction and stroke. This supports the need for treatment at the stadium of IGT The therapy of Impaired Glucose Tolerance should be focused on body mass reduction, improvement of insulin sensitivity and lipid disturbances correction. The most common approach for overweight persons is a balanced-calorie diet and lifestyle change. According to several surveys the drugs reducing insulin resistance, such as biguanides or thiazolidinediones, as well as those improving lipid disorders (fibrates) seem to be efficient, but it needs to be confirmed in randomized clinical trials.