Diabetes mellitus is, as compared with the non-diabetic population, associated with a much higher mortality of ischaemic
heart disease and other
cardiovascular diseases. In this risk participates in a major way also diabetic dylipidaemia. The latter is characterized in particular by
hypertriglyceridemia which reflects the increase of VLDL and
IDL lipoproteins. Elevated and prolonged postprandial lipaemia participates in the development of qualitative
lipoprotein changes. Highly athergenic "small dense
LDL" are formed which are liable to an oxidative modification and are then in an unregulated manner taken up in the vascular wall. Reduction of
HDL-cholesterol and a change in the different HDL sub-populations leads then to a deteriorated reverse
cholesterol transport.
Type 2 diabetes mellitus is associated with dyslipidaemia in the majority of patients even under conditions of satisfactory compensation of diabetes, in particular during the postprandial stage. On the other hand, in
type 1 diabetes the
lipid values usually become normal when the
blood sugar level becomes normal, however qualitative changes of
lipoproteins frequently persist. Increased glycation and oxidation of
lipoproteins is a common sign of both types of diabetes. For prevention of cardiovascular complications treatment of diabetic dyslipidaemia is at least equally important as efforts to achieve optimal compensation of diabetes. Successful treatment of diabetic dyslipidaemia includes efforts to achieve compensation of diabetes, optimation of
body weight, increase of physical activity, modification of diet, treatment of other secondary causes of hyperlipidaemia, and if these provisions are not successful, pharmacological hypolipidaemic treatment. The risk of macrovascular complications is so high in diabetics that according to recent knowledge it is not necessary to differentiate between primary and
secondary prevention but aggressive treatment is necessary to achiebe target values of total
cholesterol < 5.0 mmol/l and
LDL-cholesterol < 3.0 mmol/l.
Triglycerides > 2 mmol/l and
HDL-cholesterol < 1 mmol/l are signs of a high cardiovascular risk. Optimation of the whole
lipid profile is ideal.