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Lipids and Lipoproteins in Patients With Type 2 Diabetes

From the Children’s Hospital Oakland Research Institute, Oakland, California

Address correspondence and reprint requests to Ronald M. Krauss, MD, 5700 Martin Luther King Jr. Way, Oakland, CA 94609. E-mail: rmkrauss{at}lbl.gov

Insulin resistance and type 2 diabetes are associated with a clustering of interrelated plasma lipid and lipoprotein abnormalities, which include reduced HDL cholesterol, a predominance of small dense LDL particles, and elevated triglyceride levels. Each of these dyslipidemic features is associated with an increased risk of cardiovascular disease. Increased hepatic secretion of large triglyceride-rich VLDL and impaired clearance of VLDL appears to be of central importance in the pathophysiology of this dyslipidemia. Small dense LDL particles arise from the intravascular processing of specific larger VLDL precursors. Typically, reduced plasma HDL levels in type 2 diabetes are manifest as reductions in the HDL_2b subspecies and relative or absolute increases in smaller denser HDL_3b and HDL_3c. Although behavioral interventions such as diet and exercise can improve diabetic dyslipidemia, for most patients, pharmacological therapy is needed to reach treatment goals. There are several classes of medications that can be used to treat lipid and lipoprotein abnormalities associated with insulin resistance and type 2 diabetes, including statins, fibrates, niacin, and thiazolidinediones. Clinical trials have shown significant improvement in coronary artery disease after diabetic dyslipidemia treatment.

Abbreviations: apo, apolipoprotein • CAD, coronary artery disease • CHD, coronary heart disease • IDL, intermediate-density lipoprotein • SCRIP, Stanford Coronary Risk Intervention Project • TZD, thiazolidinedione • VA-HIT, Department of Veteran’s Affairs HDL Intervention Trial

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