Hyperlipidemia: Pathogenesis and Management in Diabetes Mellitus
Aside from acute complications, care for people with diabetes mellitus requires measures to prevent the secondary complications of this disease. Although hyperglycemia is directly linked to microvascular disease of the eye and kidneys, several lines of evidence suggest that the relationship between macrovascular disease and hyperglycemia is not direct. These data include animal studies of the effects of hyperglycemia on the development and/or progression of atherosclerotic lesions in animals, epidemiological correlations of risk factors and vascular disease, and experimental interventions in humans.1,2 In most animals, hyperglycemia alone or in the setting of an atherosclerotic lipoprotein profile created by ingestion of a high fat/high cholesterol diet or by genetic manipulation does not increase atherosclerosis unless the diabetes also worsens the lipid abnormalities. In the rabbit alloxan-induced diabetes will actually prevent atherosclerosis; while the rabbits develop hyperglycemia there is also a shift of the lipoprotein profile towards the presence of large particles that are too big to enter the arterial wal1.3 In human populations, multifactorial analysis correlates lipid abnormalities such as elevated LDL and reduced HDL with coronary heart disease (CHD).4 These lipid parameters are more strongly related to disease development than is fasting glucose or glycosylated hemoglobin. Most important, several intervention trials have clearly demonstrated that reductions in plasma lipoproteins decrease CHD in patients with diabetes.5 In contrast, intervention trials that have shown a reduction in microvascular disease with better glycemic control have, in general, shown less effect on CHD.
KeywordsCholesteryl Ester Transfer Protein Coronary Heart Disease Event Hepatic Lipase Hormone Sensitive Lipase Lecithin Cholesterol Acyl Transferase
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