There is an increased incidence of cardiovascular disease (CVD) in people with diabetes. There is also a greater mortality in people with diabetes following a heart attack. This strongly suggests that the role of preventive lipid lowering therapy, in people with diabetes, is of great importance compared to those who don’t have diabetes.

What are lipids?
Lipids is a term used to describe a wide range of fat soluble substances including lipoproteins. These lipoproteins are the body’s transporters of cholesterol. They take the cholesterol from the liver, where cholesterol is made, to the tissues where it is needed for the formation of cell membranes and hormones. There are a number of types of lipids that have different roles to play in managing your bodies cholesterol level.

What are the different types of lipids?
Lipids are divided into four main groups, each with a different proportion of cholesterol and triglyceride:

• Chylomicrons – Transport triglycerides from the intestine to tissues in the body where they are needed as a source of energy

• VLDL (very low density lipoproteins) – Transport triglycerides from the liver to adipose tissues and muscle where they are used for storage and energy. High blood plasma levels of VLDL are found in people with familial hypertriglyceridaemia, diabetes mellitus, underactive thyroid and in people with a high alcohol intake

• LDL (low density lipoproteins) – Transport cholesterol from the liver to the tissues in the body. About 70% of blood plasma cholesterol occurs in this form. When LDL cannot be cleared efficiently from the blood, due to a defect in, or lack of LDL receptors, LDL accumulates. This is the case in inherited disorders such as Familial Hypercholesterolaemia. High levels of LDL in the blood are associated with an increased risk of coronary heart disease (CHD)

• HDL (high density lipoproteins) – Transport surplus cholesterol from tissues (including the arterial wall) back to the liver for disposal. HDL is commonly known as the good cholesterol.  Low levels of HDL cholesterol are predictive of high risk of CHD

How does diabetes affect cholesterol levels?
Diabetes tends to lower HDL ‘good’ cholesterol, and raise triglyceride and LDL ‘bad’ cholesterol levels, which increases the risk for heart disease and stroke. This condition is called diabetic dyslipidemia.

Why should people with diabetes aim for a lower cholesterol level?
Having diabetes puts that person at a much higher risk of CHD. People with diabetes have a 2-5 fold risk of developing heart disease. Having diabetes puts a person at the same risk of developing heart disease as a person who has had a heart attack but who doesn’t have diabetes.5 A person with diabetes who lowers their LDL cholesterol can reduce cardiovascular complications by 20-50%.

Should all patients aim for a total cholesterol level of 5mmol/l?
For certain patients (listed below), the recommended cholesterol level by the Joint British Society Guidelines is for a total cholesterol of no higher than 4mmol/l and an LDL cholesterol of below 2mmol/l:

• Patients with established CHD

• Patients with other major atherosclerotic disease

• Patients with hypertension, dyslipidaemias, diabetes, family history of premature CHD, or a combination of these risk factors, which puts them at high risk of developing CHD or other atherosclerotic disease

References:
1. Georg, P. Ludvik B. Lipids and Diabetes. Journal of Clinical Basic Cardiology 2000; 3: 159
2. H.E.A.R.T UK. Cholesterol and Lipoproteins. Available at http://www.heartuk.org.uk/images/uploads/
healthylivingpdfs/HUKcfs_A_Cholesterol_and_Lipoproteins.pdf  (Accessed January 2009)
3. Wood D., Joint British Society. JBS2: Joint British Societies’ Guidelines on Prevention of Cardiovascular Disease in Clinical Practice in HEART. December 2005:91(suppl V); v44
4. H.E.A.R.T UK. Risk Factors for CHD. Available at http://www.heartuk.org.uk/images/
uploads/healthylivingpdfs/HUKcfs_I_Risk_Factors.pdf  (Accessed January 2009)
5. American Heart Association. Diabetes and Cholesterol. Available at http://www.americanheart.org/presenter.jhtml?identifier=3044764  (Accessed January 2009)
 

Advertising Feature