Vascular disease and lipids in diabetes

Patients with diabetes mellitus are particularly susceptible to morbidity and mortality resulting from cardiovascular diseases, especially atherosclerosis. Diabetes and coronary heart disease share many of the same risk factors, such as disorders of lipid metabolism (hypercholesterolemia, hypertriglyceridemia, low levels of high-density lipoprotein [HDL] cholesterol) and hypertension. Although the exact mechanisms responsible for accelerated atherogenesis in patients with diabetes are not completely understood, an important role may he Flayed by increased glycosylation of lipoproteins. Other factors involved in the development of cardiovascular disease in diabetic patients include insulin resistance, endothelial dysfunction, and the presence of a small, dense low-density lipoprotein (LDL phenotype B). The management of lipid abnormalities in diabetic patients always begins with weight loss, proper diet, exercise, and glycemic control; however, it is clear that some patients will require aggressive Lipid-lowering therapy in addition to life-style measures.