Diabetic dyslipidaemia: the triad
St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH, UK
Correspondnig author. Tel: +44 20 7188 1256; fax: +44 20 7928 4226. E-mail address: anthony.wierzbicki{at}kcl.ac.uk
The lipid changes of diabetes and the metabolic syndrome are characterized by a biochemical lipid triad of low HDL-cholesterol, raised triglycerides, and small, dense low-density lipoprotein (LDL) particles. This triad is caused by the processes changing the size of lipoprotein particles, which result in the presence of atherogenic small, dense LDL-C and also rapidly cleared small, dense HDL-cholesterol. Low HDL-cholesterol is a powerful cardiovascular risk factor that is common in patients with diabetes. Analysis of available evidence suggests that raising HDL-cholesterol by 1% reduces cardiovascular events by 2–3%. Statin trials have shown that the excess risk associated with low HDL-cholesterol is not abrogated by the statin therapy. Fibrates, which do not alter LDL-cholesterol, can reduce cardiovascular events as can nicotinic acid, which raises HDL-cholesterol, alters lipoprotein sizes, and also lowers LDL-cholesterol. Specific interventions targeted at raising HDL-cholesterol and changing the size of lipoprotein particles are likely to have additional beneficial effects over and above reducing LDL-cholesterol.
Key Words: Diabetes • Dyslipidaemia • HDL-cholesterol • Cardiovascular risk • Coronary heart disease