Novel drugs in familial combined hyperlipidemia: lessons from type 2 diabetes mellitus.
OBJECTIVE
Familial combined hyperlipidemia (FCHL) and type 2 diabetes mellitus (T2DM) are prevalent entities that share many features of the metabolic syndrome. Recent findings suggest that FCHL and T2DM are less distinct than initially anticipated, which could offer new insights for their therapeutic approach.


RESULTS
Genetic association studies have provided evidence for a common genetic background (upstream transcription factor 1, activating transcription factor 6, transcription factor 7-like 2 and hepatocyte nuclear factor 4 alpha) between FCHL and T2DM. The metabolic overlap can be illustrated by the presence of ectopic fat accumulation and insulin resistance (muscle, adipose tissue and liver). We have shown that FCHL patients are at increased risk to develop T2DM. This indicates that both entities are not static, but instead the former is able to migrate to the latter as insulin resistance progresses. Given these new findings, it can be anticipated that FCHL patients could also benefit from insulin-sensitizing therapy such as pioglitazone and metformin. Indeed, pilot studies have demonstrated that pioglitazone might be advantageous in FCHL patients.


CONCLUSIONS
Recent studies suggest that FCHL patients have an increased risk to develop T2DM, which has important clinical implications. Further studies are necessary to evaluate whether FCHL patients can be protected from new-onset T2DM and premature cardiovascular events with insulin-sensitizing therapy.
Brouwers
Martijn C  G J
MC
Laboratory of Vascular Medicine and Metabolism, Department of Internal Medicine, Divisions of General Internal Medicine and Endocrinology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
de Graaf
Jacqueline
J
van Greevenbroek
Marleen M J
MM
Schaper
Nicolaas
N
Stehouwer
Coen D A
CD
Stalenhoef
Anton F H
AF
D000273:Adipose Tissue / Q000187:drug effects / Q000378:metabolism; D008078:Cholesterol, LDL / Q000235:genetics / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000235:genetics* / Q000378:metabolism; D055808:Drug Discovery; D005234:Fatty Liver / Q000235:genetics / Q000378:metabolism; D020022:Genetic Predisposition to Disease; D006801:Humans; D006950:Hyperlipidemia, Familial Combined / Q000150:complications / Q000188:drug therapy* / Q000235:genetics* / Q000378:metabolism; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance / Q000235:genetics*; D008297:Male; D024821:Metabolic Syndrome / Q000209:etiology / Q000235:genetics / Q000378:metabolism; D008687:Metformin / Q000008:administration & dosage; D008954:Models, Biological; D009765:Obesity / Q000235:genetics / Q000378:metabolism; D000077205:Pioglitazone; D012307:Risk Factors; D045162:Thiazolidinediones / Q000008:administration & dosage; D014157:Transcription Factors / Q000235:genetics / Q000378:metabolism; D014280:Triglycerides / Q000235:genetics / Q000378:metabolism
D008078:Cholesterol, LDL; D007328:Insulin; D045162:Thiazolidinediones; D014157:Transcription Factors; D014280:Triglycerides; D008687:Metformin; D000077205:Pioglitazone