HIGH-DENSITY-LIPOPROTEINS (HDL) IN DIABETES-MELLITUS

Several epidemiologic studies have demonstrated that macrovascular disease is more prevalent among patients with diabetes mellitus than among controls. Lipoprotein metabolism has been extensively studied in diabetic patients because of its close links with the development of atherosclerosis. Several anomalies have been found. Specifically, diabetics have decreased levels of high-density lipoproteins, whose protective effect against atherosclerosis is being increasingly substantiated. Furthermore, the composition of HDLs in diabetes mellitus is modified, with more triglycerides, less apo Al, glycation of apolipoproteins, peroxidation of lipids, etc. Treatment of diabetes mellitus induces improvements in lipid and lipoprotein patterns. Although we failed to prove that correction of lipid anomalies in diabetic patients is associated with a decreased risk of atherosclerosis, the close links between cardiovascular disease and lipoprotein systems demonstrated in non-diabetic individuals implies that lipid disorders should be targeted during the management of diabetes mellitus. In addition to lipoprotein anomalies, increased serum insulin levels are often found in diabetic patients. This increase and the various alterations it causes should also be borne in mind when considering the increased risk of ischemic disease in patients with diabetes mellitus.