2 Diabetes and the Importance of Lipids at Diabetes Insight Center

There’s a lot to learn:

Overview:

Dyslipidemia is common in patients with type 2 diabetes.

High levels of HDL-C are associated with cardiovascular protection, while high levels of LDL-C are considered a risk factor of cardiovascular disease.

Some insulin resistance–reducing agents have been shown to have positive effects on HDL-C and triglyceride levels in patients with dyslipidemia.

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The importance of lipids

Dyslipidemia is common in patients with type 2 diabetes[1,2]

Insulin resistance is associated with three major characteristics of dyslipidemia:

Decreased HDL-C levels
Altered composition of LDL-C (smaller and denser)
Increased triglyceride levels

High HDL-C levels have been associated with cardiovascular
protection[3]

Prospective Cardiovascular Münster (PROCAM) showed an inverse correlation between HDL-C level and coronary heart disease (CHD) in 4,407 men.

Adapted from Assmann G, et al. Atherosclerosis. 1996;124(suppl 1):S11-S20.

There was a fourfold increased risk of CHD in men whose HDL-C levels were
<35 mg/dL than in those whose HDL-C levels were ≥35 mg/dL.
Men whose HDL-C levels were >55 mg/dL were half as likely to experience CHD than those whose HDL-C levels were 35–55 mg/dL.

Other studies have found an association between patients with elevated VLDL, low
HDL-C, and normal LDL-C levels and their chances of a cardiovascular event.[1]

LDL-C is a risk factor for cardiovascular disease[4]

Both particle size and concentration are independent risk factors for cardiovascular disease.

Lipid complications increase as risk factors remain uncontrolled

The Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial (VA-HIT) showed that elevated triglycerides and decreased HDL-C continuously increased the risk for major coronary events as time progressed.[5]

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25% of patients studied in the VA-HIT had diabetes. There was no statistically significant difference in major events in this subgroup compared with patients who were on placebo.[5]

Reducing insulin resistance can improve lipid levels

Treatment with some agents that directly reduce insulin resistance can help improve the most common dyslipidemic pattern in type 2 diabetes—elevated triglycerides and decreased HDL-C levels. Similar improvements in lipids are not seen with all agents that reduce insulin resistance.[2,6]

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References:

1. Howard BV. Insulin resistance and lipid metabolism. Am J Cardiol. 1999;84(1A):28J-32J. 2. American Diabetes Association. Dyslipidemia management in adults with diabetes. Diabetes Care. 2004;27(suppl 1):S68-S71. 3. Assmann G, Schulte H, von Eckardstein A, Huang Y. High-density lipoprotein cholesterol as a predictor of coronary heart disease risk: the PROCAM experience and pathophysiological implications for reverse cholesterol transport. Atherosclerosis. 1996;124(suppl):S11-S20. 4. Lamarche B, Tchernof A, Moorjani S, et al. Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic heart disease in men: prospective results from the Québec Cardiovascular Study. Circulation. 1997;95:69-75.
5. Rubins HB, Robins SJ, Collins D, et al. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. N Engl J Med. 1999;341:410-418.
6. Martens FMAC, Visseren FLJ, Lemay J, de Koning EJP, Rabelink TJ. Metabolic and additional vascular effects of thiazolidinediones. Drugs. 2002;62:1463-1480. 7. American Diabetes Association. Standards of medical care in diabetes–2007. Diabetes Care. 2007;30(suppl 1):S4-S41.