Lipids and atherogenesis in diabetes mellitus

Premature cardiovascular disease is a major burden in diabetes. Increasing cholesterol is associated with increasing vascular risk in diabetes and the absolute excess risk attributable to cholesterol is higher in diabetics than in nondiabetics. Total cholesterol and low density lipoprotein (LDL) cholesterol correlated with arterial endothelial dysfunction as assessed by reduced flow-mediated brachial artery dilatation in insulin-dependent diabetic patients. In noninsulin dependent diabetic patients hypertriglyceridaemia is common and is associated with the accumulation of intermediate density lipoproteins, abnormal postprandial lipid metabolism and small dense LDL. No trials of lipid lowering therapy in the primary or secondary prevention of cardiovascular disease have been targeted specifically to the diabetic population; nevertheless, guidelines have been published for the treatment of dyslipidaemia in diabetic patients recognising the evidence of benefit in non-diabetics and the high intrinsic risk of the diabetic.