Lipoprotein disorders associated with type 2 diabetes mellitus and insulin resistance.

Type 2 diabetes is associated with a marked increase in coronary artery disease (CAD). In subjects with type 2 diabetes, the characteristic lipoprotein abnormality is increased triglycerides, increased small, dense low-density lipoprotein (LDL) particles, and decreased concentrations of high-density lipoprotein (HDL) cholesterol but relatively normal absolute concentrations of LDL cholesterol. In observational studies, both increased LDL and decreased HDL cholesterol predict the development of CAD. In clinical trials, both fibric acids and statins have been shown to reduce CAD in subjects with diabetes. An interesting future clinical trial would be to assess whether fibric acids make an additional contribution to reduce CAD in patients already on statin therapy.