2.4.4 The diabetes connection

The association between diabetes and cardiovascular disease has emerged. The prevalence of, incidence of, and mortality from all forms of cardiovascular disease are two- to eight-fold higher in persons with diabetes than in those without diabetes. The pathogenesis of atherosclerosis in diabetes is complex and multifactorial, but one thing is very clear, there is an increase in lipid and lipoprotein peroxidation within the arterial wall of diabetic patients, which could result in the enhanced biosynthesis of oxLDL within the atherosclerotic lesion. Kopprasch and investigators at the Technischen Universität Dresden, Germany used the oral glucose tolerance test to distinguish between normal glucose tolerance and impaired glucose tolerance in middle-aged subjects from the RIAD cohort. They found that the metabolic situation of impaired glucose tolerance and newly diagnosed diabetes is associated with diabetic dyslipidemia that particularly affects the level of circulating oxLDL.

The presence of an atherogenic lipid profile is common in diabetic patients. Scheffer and colleagues at the VU University Medical Centre, Amsterdam, the Netherlands found that patients with higher HbA1C and higher fasting glucose levels also had higher levels of small, dense LDL. The researchers also found that the prevalence of small, dense LDL particles correlated with high circulating levels of oxLDL in Type 2 diabetic patients. Together, these data suggest that measuring oxLDL may be useful in identifying type 2 diabetic patients with accelerated atherosclerosis.

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