Atherogenic lipoproteins and diabetes mellitus.

The most common lipoprotein abnormality in type 2 diabetics is hypertriglyceridemia, which is known to be an independent risk factor for coronary artery disease (CAD) in diabetics. It is known that remnant lipoproteins, small, dense LDL, and isolated hypo-alphalipoproteinemia exist in diabetics even if they are apparently normolipidemic. Our previous observation revealed that type 2 diabetics had smaller LDL even if they were without hyperlipidemia. We also found that diabetics with microalbuminuria had smaller LDL than those with normoalbuminuria, indicating early nephrotoxicity of small, dense LDL. More than half of the Japanese type 2 diabetics associated with acute myocardial infarction (AMI) showed isolated hypo-alpha lipoproteinemia, indicating the clinical importance of suppressed HDL fraction without prominent hyperlipidemia in the diabetics. Finally, strict diet control and treatment of diabetics with dyslipidemias by acarbose, troglitazone, fibrates and/or statins were all successful in increasing LDL size.