Dyslipidemia in Non-Insulin-Dependent Diabetes Mellitus

IN CONTRAST to other chronic diseases, non-insulindependent diabetes mellitus (NIDDM) is increasing in prevalence in the United States (1). Of the many sequelae of this disease, one of the most significant is accelerated atherosclerotic vascular disease, the leading cause of death among patients with NIDDM (2). One of the most important factors that contribute to cardiovascular disease in NIDDM is the alterations in lipoproteins that accompany NIDDM (3). It is therefore important to understand the etiology of dyslipidemia in NIDDM and strategies for its control. This chapter will summarize the basics of lipoprotein metabolism, review the alterations in lipoprotein composition and metabolism that occur in individuals with NIDDM, and outline potential therapeutic approaches to management of these lipid disorders. II. Lipoprotein Metabolism (Fig. 1) Lipoproteins are spherical particles containing a central core of nonpolar lipids (cholesterol esters, triglycerides) and a surface monolayer of phospholipids and apoproteins. Free cholesterol is present primarily in the surface monolayer.