Are plasma lipoproteins responsible for the excess atherosclerosis in diabetes?

The quantitative analyses of the concentration and composition of main plasma lipoprotein fractions in diabetic patients have so far not revealed such abnormalities that they could explain any major part of the excess atherosclerotic vascular disease present in both insulin-dependent and noninsulin-dependent diabetes. In insulin-treated patients the characteristic lipoprotein profile with low VLDL, normal LDL and elevated HDL levels prevents atherosclerosis rather than promotes it. However, the pattern will change to more atherogenic direction in the presence of either poor diabetic control or obesity or renal disease. It is possible that the patients who develop manifest clinical cardiovascular disease are in fact derived from these subcategories. In noninsulin-dependent diabetic patients the most common lipoprotein abnormality is an increase of VLDL and of total triglyceride, neither of which are currently held as strong risk factors. HDL is often at low side and may contribute to atherosclerosis, but may also represent a special hypercatabolic form of hypo-HDL-emia which is less atherogenic than the usual HDL deficiency.