Diabetes and atherosclerosis. Metabolic links

Atherosclerosis is the most frequent complication of diabetes. Two of the many factors that may contribute to this are dyslipoproteinaemias and hyperinsulinaemia. The most frequent dyslipoproteinaemia in diabetics is hypertriglyceridaemia. This probably reflects an increase in intermediate density lipoprotein (IDL) concentration. Plasma levels of triglyceride and insulin are often correlated. This partly reflects a vicious circle in which hypertriglyceridaemia itself can cause insulin resistance and compensatory hyperinsulinaemia. The chronic hyperinsulinaemic state in vivo is, in turn, associated with an increase in the rate of production of very low density lipoprotein (VLDL) triglyceride. Such a vicious circle is of potential importance in atherogenesis in view of the association of both hypertriglyceridaemia and hyperinsulinaemia with early macrovascular disease.