Diabetic Dyslipidaemia

Abstract

Diabetic dyslipidaemia plays an important role in the increased cardiovascular risk of type 2 diabetes. It encompasses not only quantitative lipoprotein abnormalities, but also qualitative and kinetic abnormalities that, together, result in a shift toward a more atherogenic lipid profile. The principal quantitative lipoprotein abnormalities are increased triglyceride levels and decreased high-density lipoprotein (HDL) cholesterol levels. Qualitative lipoprotein abnormalities include increases in large, very low-density lipoprotein subfraction 1 (VLDL1) and small, dense low-density lipoproteins (LDLs), increased triglyceride content of LDLs and HDLs, glycation of apolipoproteins, and increased susceptibility of LDLs to oxidation. Moreover, HDLs from diabetic patients are dysfunctional, having severely reduced antiatherogenic properties. Statin use is recommended in most patients with T2DM because of the cardiovascular benefit demonstrated in many trials. Some post-hoc analyses of trials with fenofibrate suggest a potential CVD reduction in diabetic patients with triglycerides ≥2.6 mmol/L and low HDL cholesterol.