Target HDL/TGs in diabetes Should HDL and TGs be targeted in diabetes?

‘There is a high incidence of dyslipidaemia in the diabetic population’ Dr Peter Lansberg (Amsterdam, Netherlands) reminded delegates. The MR FIT study showed cholesterol levels were directly proportional to CVD mortality in male patients with diabetes. Low levels of HDL and high levels of triglycerides and LDL is a pattern commonly seen in diabetic patients. Lipids levels appear to have an increased effect on CVD mortality in diabetic compared to non-diabetic patients. The UKPDS study showed LDL-C was a strong predictor of coronary heart disease. Patients with diabetes have an accelerated pattern of atherosclerosis which may be due to smaller LDL particles which are more easily taken up by the vascular wall. Increased ApoB levels are also seen as apart of the metabolic syndrome. A range of guidance for lipid lowering is seen in different countries. American and Canadian guidelines include ApoB targets. Statins reduce lipid levels but there is likely to be a residual risk. There has been renewed interest in drugs such as nicotinic acid which can increase HDL levels. ‘It is likely that we will be using a combination of drugs to achieve lower lipid levels in the future’, said Dr Lansberg. Weight loss and exercise can also reduce triglycerides. Dr Lansberg completed his talk with an inspiring story of a patient with diabetes who took a four month back packing trip which led to a dramatic improvement in his lipid profile and glycemic control.

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