Diabetes, lipoprotein metabolism and atherosclerosis.

As diabetologists in the United Kingdom we care for our patients against a background of one the highest population rates of coronary heart disease (CHD) in the world. As emerging evidence serves to confirm the pivotal role of blood cholesterol and particularly low density lipoprotein (LDL) cholesterol in the development of atherosclerosis-related disease, it is timely to consider the importance of lipid and lipoprotein disorders in diabetes. Although specific microvascular disease contributes significantly, atherosclerosis remains the most important cause of morbidity and mortality in long-standing diabetes. From epidemiological studies of different populations, particularly the Japanese, it is clear that premature CHD is not an inevitable consequence of diabetes. This provides encouragement for prevention especially given the recent impetus in the understanding of the role of blood lipids in the pathogenesis of atherosclerosis. In this short review I will highlight some recent developments in the cholesterol/heart disease story, how the diabetic state may influence lipid and lipoprotein metabolism and how hyperlipoproteinaemia in the diabetic should be managed.