Clinical: Diabetic dyslipidaemia explained.

Understanding diabetic dyslipidaemia is key to effective treatment, says Dr Brian Crichton.

Diabetic dyslipidaemia is characterised by a predominance of small, dense LDL cholesterol (LDL-C), low HDL-C and raised triglyceride (TG) levels.

As our understanding of its complex pathophysiology has increased, it has become accepted that treating the lipid profile is an effective way of reducing the risk of cardiovascular disease (CVD) and atherosclerosis in patients with diabetic or pre-diabetic dyslipidaemia.

It is important to understand the mechanism behind diabetic dyslipidaemia in order to provide optimal treatment.

Diabetic dyslipidaemia

In the insulin-resistant state of diabetes, there is an increase in the release of free fatty acids (FFAs) from adipose tissue. This stimulates the liver to increase production of large TG-rich, very low-density lipoprotein (VLDL), which promotes hypertriglyceridaemia and activates other enzymes, leading to the creation of small, dense LDL-C and HDL-C particles.

Small, dense LDL-C is prone to oxidation and is highly atherogenic. It is taken …