Pathophysiology of diabetic dyslipidaemia: where are we?
Open accessAbstract
Cardiovascular disease is a major cause of morbidity and mortality in patients with type 2 diabetes mellitus, with a two- to fourfold increase in cardiovascular disease risk compared with non-diabetic individuals. Abnormalities in lipid metabolism that are observed in the context of type 2 diabetes are among the major factors contributing to an increased cardiovascular risk. Diabetic dyslipidaemia includes not only quantitative lipoprotein abnormalities, but also qualitative and kinetic abnormalities that, together, result in a shift towards a more atherogenic lipid profile. The primary quantitative lipoprotein abnormalities are increased triacylglycerol (triglyceride) levels and decreased HDL-cholesterol levels. Qualitative lipoprotein abnormalities include an increase in large, very low-density lipoprotein subfraction 1 (VLDL1) and small, dense LDLs, as well as increased triacylglycerol content of LDL and HDL, glycation of apolipoproteins and increased susceptibility of LDL to oxidation. The main kinetic abnormalities are increased VLDL1 production, decreased VLDL catabolism and increased HDL catabolism. In addition, even though LDL-cholesterol levels are typically normal in patients with type 2 diabetes, LDL particles show reduced turnover, which is potentially atherogenic. Although the pathophysiology of diabetic dyslipidaemia is not fully understood, the insulin resistance and relative insulin deficiency observed in patients with type 2 diabetes are likely to contribute to these lipid changes, as insulin plays an important role in regulating lipid metabolism. In addition, some adipocytokines, such as adiponectin or retinol-binding protein 4, may also contribute to the development of dyslipidaemia in patients with type 2 diabetes.
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Typical type 2 diabetes lipid abnormalities include hypertriglyceridemia that promotes small dense LDL particles, reduced HDL cholesterol from enhanced catabolism, and a predominance of large VLDL particles from a synthesis-catabolism imbalance.
“Typical lipid anomalies in T2DM include hypertriglyceridemia, which promotes the presence of small, dense low-density lipoprotein (LDL) particles; reduced levels of high-density lipoprotein cholesterol caused by enhanced high-density lipoprotein cholesterol catabolism; and a predominance of large very LDL particles resulting from a synthesis-catabolism imbalance.100”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [100]
LDL cholesterol levels in type 2 diabetes are often similar to those without diabetes, but hypertriglyceridemia promotes LDL oxidation and hyperglycemia drives LDL glycation, making LDL more atherogenic.
“LDL cholesterol (LDL-C) levels in individuals with T2DM are often similar to those in individuals without T2DM, but the persistent hypertriglyceridemic state promotes LDL oxidation, and the concurrent hyperglycemia drives LDL glycation, all of which increase the atherogenicity of the LDL particles in T2DM.100”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [100]
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- Authors
- Vergès, B.
- Affiliations
- CHU Dijon Bourgogne (FR)
- Corresponding author
- Vergès, Bruno
- ORCID
- Vergès, Bruno
- Venue
- Diabetologia
- Published
- 2015-03-01
- Volume
- 58
- Issue
- 5
- Pages
- 886-899
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC4392164
- OpenAlex
- W2104005551
- Cited by
- 708
- References
- 12
- Citations by year
- 2026: 47 · 2025: 70 · 2024: 78 · 2023: 81 · 2022: 76 · 2021: 87 · 2020: 76 · 2019: 70 · 2018: 60 · 2017: 39 · 2016: 18 · 2015: 5
- FWCI
- 6.15
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Diabetologia (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- diabetic dyslipidemia, type 2 diabetes, cardiovascular risk, lipid metabolism, atherogenic lipid profile, HDL cholesterol, VLDL1, small dense LDL, LDL oxidation, lipoprotein kinetics, insulin resistance, adiponectin, retinol-binding protein 4, adipokines
- MeSH terms
- Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Lipids, Dyslipidemias
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