Strategies for the management of diabetic dyslipidaemia.

Atherosclerosis, the complication most prominently associated with type 2 diabetes and cardiovascular disease, represents a major burden for both individuals and society. Mortality rates associated with cardiovascular disease among patients with type 2 diabetes are at least 3 times those in the general population, and although 'traditional' cardiovascular risk factors affect patients with this disorder as they do other individuals, they do not account for the excess risk attached to type 2 diabetes. There is a growing body of evidence to show that hyperglycaemia and dyslipidaemia are connected with this excess cardiovascular risk: hypertriglyceridaemia has been implicated in several prospective clinical studies, and available data suggest that low density lipoprotein (LDL)-cholesterol is more atherogenic in patients with type 2 diabetes than in other individuals. It is possible that this increased atherogenicity is associated with a preponderance of small, dense LDL particles that are more prone to oxidation and glycation than larger fractions and that may be involved in endothelial dysfunction. These findings lead to the recommendation of mandatory global risk assessment, accompanied by good glycaemic control, aggressive lowering of serum levels of LDL-cholesterol and maintenance of serum levels of triglyceride at the lowest possible level in patients with type 2 diabetes.