LDL-cholesterol, HDL-cholesterol or triglycerides--which is the culprit?
Dyslipidaemia in patients with type 2 diabetes commonly consists of elevated triglyceride levels; normal or slightly elevated low-density lipoprotein (LDL)-cholesterol levels with a preponderance of small, dense LDL particles; and low high-density lipoprotein (HDL)-cholesterol levels with a preponderance of small, dense HDL. These abnormalities are closely connected, with prolonged residence of high levels of triglyceride-rich particles in the circulation favoring abnormalities in LDL and HDL. Each of these factors has been associated with endothelial dysfunction; each contributes directly or indirectly to atheroma formation, with small, dense LDL and triglyceride-rich remnants increasing deposition of cholesteryl ester in vessel walls. This process is facilitated by reduced reverse cholesterol transport in association with low levels of HDL-cholesterol and abnormal HDL. Lipid-lowering therapy focused on LDL-cholesterol reduction is highly successful in preventing coronary disease in diabetic patients. Additional strategies for treating the cluster of risk factors in dyslipidaemia are necessary to further reduce atherosclerotic disease in this population.
Taskinen
Marja Riitta
MR
Division of Cardiology, Department of Medicine, University of Helsinki, Biomedicum, Haartmaninkatu 8, Helsinki 00290, Finland. mataskin@helsinki.fi
D001161:Arteriosclerosis / Q000097:blood* / Q000150:complications; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D002995:Clofibric Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic; D003327:Coronary Disease / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications; D058607:Fibric Acids; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D010316:Particle Size; D012307:Risk Factors; D012737:Sex Factors; D014280:Triglycerides / Q000097:blood*
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D058607:Fibric Acids; D000960:Hypolipidemic Agents; D014280:Triglycerides; D002995:Clofibric Acid; C019304:ciprofibrate