Elsevier

Mayo Clinic Proceedings

Volume 73, Issue 10, October 1998, Pages 969-976
Mayo Clinic Proceedings

Subspecialty Clinics: Endocrinology, Metabolism, and Nutrition
Hyperlipidemia and Diabetes Mellitus

https://doi.org/10.4065/73.10.969Get rights and content

The increased risk of coronary artery disease in subjects with diabetes mellitus can be partially explained by the lipoprotein abnormalities associated with diabetes mellitus. Hypertriglyceridemia and low levels of high-density lipoprotein are the most common lipid abnormalities. In type 1 diabetes mellitus, these abnormalities can usually be reversed with glycemic control. In contrast, in type 2 diabetes mellitus, although lipid values improve, abnormalities commonly persist even after optimal glycemic control has been achieved. Screening for dyslipidemia is recommended in subjects with diabetes mellitus. Agoal of low-density lipoprotein cholesterol of less than 130 mg/dL and triglycerides lower than 200 mg/dL should be sought. Several secondary prevention trials, which included subjects with diabetes, have demonstrated the effectiveness of lowering low-density lipoprotein cholesterol in preventing death from coronary artery disease. The benefit of lowering triglycerides is less clear. Initial approaches to lowering the levels of lipids in subjects with diabetes mellitus should include glycemic control, diet, weight loss, and exercise. When goals are not met, the most common drugs used are hydroxymethylglutaryl coenzyme A reductase inhibitors or fibrates.

Section snippets

Type 1 Diabetes Mellitus

Lipoprotein abnormalities differ in type 1 and type 2 diabetes mellitus (Table 1). Type 1 diabetes mellitus results from a cellular-mediated autoimmune destruction of the pcells of the pancreas. Subjects with type 2 diabetes mellitus have insulin resistance, and they usually have relative (rather than absolute) insulin deficiency.7 Lipid abnormalities in type I diabetes mellitus are largely related to poor glycemic control, and the most common abnormality is hypertriglyceridemia.8 Glycemic

Screening for Lipid Abnormalities in Diabetes Mellitus

Screening for lipid abnormalities in adults with diabetes mellitus should be performed annually. In contrast to screening recommendations for nondiabetics, screening in those with diabetes should consist of total cholesterol, HDL-C, and triglyceride measurements. Triglycerides are included because of their importance in diabetes mellitus. LDL-C levels should be calculated as follows: LDL-C = total cholesterol- (HDL-C + triglycerides/5).

Desirable Lipid Levels

On the basis of recommendations by the American Diabetes Association (ADA), an acceptable LDL-C level is less than 130 mg/dL, and triglyceride levels should ideally be less than 200 mg/dL. In subjects with diabetes and vascular disease, LDL-C levels should be less than 100 mg/dL. According to the National Cholesterol Education Program (NCEP) recommendations,36 LDL-C should be kept lower than 130 mg/dL in male subjects with one additional risk factor and in female subjects with two additional

Lipid-Lowering Trials in Diabetes Mellitus for the Prevention of Coronary Heart Disease

No data are available from trials specifically designed to study the lipid-lowering effects on the risk of CAD in patients with diabetes mellitus. To date, all the available data are from subgroup analyses in patients with diabetes who are participating in larger CAD prevention studies, the Helsinki Heart Study, the Scandinavian Simvastatin Survival Study (4S), and the Cholesterol and Recurrent Events (CARE) study.

The Helsinki Heart Study is a primary prevention trial of 4,081 men, 135 of whom

Summary

Hyperlipidemia is common in patients with diabetes mellitus and is partly responsible for the increased vascular disease seen in these patients. Effective drugs are now available for its treatment. More attention must be given to hypertriglyceridemia and reduced HDL-C levels in such patients. Hypertriglyceridemia should be aggressively managed, and a goal of 100 mg/dL for LDL-C may be warranted. Finally, all adults with diabetes, regardless of sex, should have an annual fasting lipoprotein

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