Pathogenic role of triglycerides in the cardiovascular disease of type 2 diabetes mellitus

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Coronary artery disease is the most common cause of death in diabetes mellitus. The increased risk is due in part to lipid abnormalities such as hypertriglyceridemia, low high density lipoprotein cholesterol, increased low density lipoprotein density, and glycoxidation of lipoprotein particles. Postprandial hypertriglyceridemia, insulin resistance, and clotting abnormalities may also play a role. This constellation of abnormalities is often found in association with central obesity and hypertriglyceridemia. Plasma triglycerides may increase the risk of atherogenesis via a direct effect of triglyceride-rich lipoproteins or indirectly via associations with the other abnormalities listed. There are no clinical trials of the effect of lowering triglycerides on coronary artery disease in diabetes mellitus. Recently, however, post hoc analyses of diabetic subjects in two large secondary prevention trials have demonstrated a benefit from cholesterol lowering with the use of statins. In these trials, subjects with significant hypertriglyceridemia were excluded, which may limit the relevance to diabetic subjects with mild hypertriglyceridemia.

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