Cited by 205Diabetes, Cardiovascular Risks, and LipoproteinsLipoproteins and Cardiovascular HealthLipid metabolism and disorders

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Lipoprotein abnormalities and their consequences for patients with Type 2 diabetes

Krentz, Andrew J·2003·Diabetes Obesity and Metabolism

DOI 10.1046/j.1462-8902.2003.0310.x

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Abstract

Dyslipidaemia is common in patients with Type 2 diabetes and is held to be responsible for considerable CVD-related morbidity and mortality. Patients with Type 2 diabetes are at high risk from complications associated with atherosclerosis and should therefore receive preventive interventions. At the level of the adipocyte, impaired insulin action leads to increased rates of intracellular hydrolysis of triglycerides with the release of NEFA. The rise in NEFA provides substrate for the liver that, in the presence of impaired insulin action and relative insulin deficiency, is associated with complex alterations in plasma lipids: * Plasma VLDL levels are raised. (i). Increased VLDL levels are associated with post-prandial hyperlipidaemia that is compounded by impaired LPL activity. The latter may be independently associated with CAD. (ii). Remnant particles can deliver more cholesterol to macrophages than LDL-C particles. Thrombogenic alterations in the coagulation system also ensue from hypertriglyceridaemia. * Plasma HDL-C levels are reduced. (i). The reduction in cardioprotective HDL-C means a reduction of cholesterol efflux from the tissues--the first step in reverse cholesterol transport to the liver from peripheral tissues. (ii). The antioxidant and antiatherogenic activities of HDL-C are reduced when circulating levels are low. * LDL-C particles become small and dense. Small, dense LDL-C particles are held to be more atherogenic than their larger, buoyant counterparts because they (a) are more liable to oxidation and (b) may more readily adhere to and subsequently invade the arterial wall. The atherogenicity of LDL-C may also be enhanced by nonenzymatic glycation. Metabolic and lipid abnormalities can often be improved with lifestyle changes, including dietary modification, weight loss, smoking cessation and increased exercise. Although attainment of better glycaemic control may improve diabetic dyslipidaemia, pharmacological intervention is usually required. Several large-scale clinical trials, including 4S and more recently HPS, have clearly demonstrated the benefits of statins in reducing cardiovascular events. By virtue of their high absolute risk of CVD, many patients with Type 2 diabetes may achieve a greater risk reduction than their non-diabetic counterparts. For example, in 4S there was a 43% reduction in total mortality risk among patients with diabetes compared with 29% for non-diabetics and a reduced risk of MI by 55% vs. 32% for diabetic and non-diabetics, respectively. In the diabetic subgroup in HPS, there were reductions of approximately 25-30% in the risk of first major vascular events. More recently, the lipid-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) was halted early because of a significant reduction in cardiovascular events compared with placebo. Surprisingly an analysis of subgroups failed to show significance among the diabetic population, although the sample size, shortened follow-up period and higher drop-in statin use among diabetics on placebo may have affected results. The Collaborative Atorvastatin Diabetes Study (CARDS), involving 2800 patients with Type 2 diabetes, was halted 2 years early in June 2003 because patients allocated atorvastatin had significant reductions in MI, stroke and surgical procedures compared with those receiving placebo. The UKPDS demonstrated that the appearance and progression of certain microvascular complications of Type 2 diabetes could be reduced by treatment directed at hyperglycaemia and hypertension. In addition, correction of dyslipidaemia in patients with diabetes is important in reducing the high toll from macrovascular disease. The subjects in the HPS had similar lipid profiles to the participants in UKPDS, suggesting that additional benefit would accrue from a therapeutic assault on the main cardiovascular risk factors simultaneously. We now have firm evidence that appropriate use of statins in patients with Type 2 diabetes can significantly reduce cardiovascular morbidity and mortality.

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Background
Dyslipidemia in Type 2 Diabetes Mellitus Patients in Benghazi, Libya
Ahmida, M., Gatish, Z., Al-Badry, S., El-Shalmani, I., & El-Deeb, O. (2015) · International Journal of Biomedical and Advance Research · doi:10.7439/ijbar.v6i10.2606 · Cited by 4
Effect of High Protein Diet Containing Fortified Bread with Fenugreek and Nigella sativa Seeds on Rats Suffering from Diabetes
Mahmoud, M. Y. (2013) · Pakistan Journal of Nutrition · doi:10.3923/pjn.2013.736.747 · Cited by 4
Clinical Significance of the Serum 3′tRF-AlaAGC, Neutrophil to High-Density Lipoprotein Ratio, and Lymphocyte-to-Monocyte Ratio in Breast Cancer with Lymph Node Metastasis
Mo, D., Zhu, Y., Mao, X., Li, C., Yang, Y., Zheng, J., & Yan, F. (2025) · Journal of Inflammation Research · doi:10.2147/jir.s518232 · Cited by 4
Associations of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio with diabetes and prediabetes among adults with hypertension: a cross-sectional study
Meng, Q., Fan, S., Zhang, L., Shen, B., Zou, C., Sun, D., Liu, X., Zhang, J., & Xu, S. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1523016 · Cited by 3
Lipid metabolism disorders in patients with hypertension and diabetes mellitus: development and current treatment options
Podzolkov, V. I., Tarzimanova, A. I., Аркадьевна, А. А., Vetluzhskaya, M. V., Medvedev, I. D., & Loriya, I. Z. (2023) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2023-3656 · Cited by 3
Clinical evaluation of dyslipidemia among type 2 diabetes and hypothyroidism patients
Koyyada, A. (2021) · Current Medicine Research and Practice · doi:10.4103/cmrp.cmrp_86_20 · Cited by 3
Antihyperglycemic and Antihyperlipidemic Evaluation of Zingiber officinale, Anethum graveolens and Citrullus colocynthis Extracts with Different Polarities in Streptozotocin-Induced Diabetic Rats
Ahmadi, A., Roghani, M., Parsianfard, M., Seyedmomeni, F.-S., Gheraati, S., & Sobhanian, S. A. (2022) · Pharmaceutical Chemistry Journal · doi:10.1007/s11094-021-02538-2 · Cited by 3
Therapeutic potential of Nigella sativa
Abdul-Rahman, N. Z., & Mohd-Zubri, N. S. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-90788-0.00017-2 · Cited by 3
ESRα Promoter Methylation May Modify the Association Between Lipid Metabolism and Type 2 Diabetes in Chinese Farmers
Zhou, G., Liu, L., Li, X., Hou, X., Wang, L., Sun, R., Huang, H., Li, Z., Li, W., Wang, C., et al. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.578134 · Cited by 3
“The concentrations of LDL-C in patients with T2DM are generally not significantly different from those in non-diabetic patients (35).”
Result
Association of APOA5 −1131T>C Polymorphism and Serum Lipid Levels in Patients with Type 2 Diabetes
Ćelap, I., Šimundić, A.-M., Nikolac, N., Kačkov, S., & Katalinić, D. (2013) · DNA and Cell Biology · doi:10.1089/dna.2013.2099 · Cited by 3
“This secondary hypertriglyceridemia is mainly caused by reduced lipoprotein lipase levels, overproduction of triglyceride-rich lipoproteins, and poor clearance of remnants (Krentz, 2003).”
Investigation of non-HDL cholesterol and C-reactive protein in diabetes patients
Hsu, W.-T., Pien, H.-C., Huang, H.-I., Tu, Y.-Y., Kuo, W., Tsai, K.-Y., & Chen, L.-M. (2013) · Biomarkers and Genomic Medicine · doi:10.1016/j.bgm.2013.08.002 · Cited by 3
Phytoconstituents evaluation and antihyperglycemic and antihyperlipidemic effects ofMahonia leschenaultiaTakeda in streptozotocin-induced diabetic rats
Palani, S., Sundararajan, R., Kumar, R. P., Sakthivel, K., Devi, K. P., & Kumar, B. K. (2010) · Toxicological & Environmental Chemistry Reviews · doi:10.1080/02772240903266140 · Cited by 3
“These lipoprotein abnormalities are held to be responsible for considerable cardiovascular disease-related morbidity and mortality (Krentz 2003).”
Background
Correlation between glycemic parameters and lipid profile in type 2 diabetic patients attending tertiary care centre in central region of Nepal
Sapkota, L. B., & Thapa, S. (2017) · Journal of Chitwan Medical College · doi:10.3126/jcmc.v7i1.17365 · Cited by 3
Antihyperglycemic Effect of Pimpinella Tirupatiensis Leaves in Streptozotocin-Induced Diabetic Rats
Narasimhulu, G., Mohamed, J., & Reddy, K. S. (2014) · Cited by 2
Treatment of dyslipidemia in patients with type 2
Vijayaraghavan, K. (2010) · Cited by 1
Role of Fas/Fas Ligand Pathway in a Sample of Iraqi Diabetic Foot Patients
Hussian, S. K., Al-Karawi, I. N., & Sahab, K. S. (2013) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 1
Hypoglycaemic and hypolipidemic effect of different solvents extract of unripe Carica papaya seed in streptozotocin-induced diabetic rats
Nnaemeka, U. M. (2023) · International Journal of Science and Research Archive · doi:10.30574/ijsra.2023.8.1.0328 · Cited by 1
Antidiabetic potential of sea fish mass by inhibiting di-peptidyl peptidase-IV and augmenting glucagon-like peptide-1 on high lipid diet and streptozotocin induced diabetic rats
Das, S. K., Pyne, S., Paira, M. K., Giri, D., Das, B., Bhowmick, S., Pradhan, S., & Das, K. (2024) · Pharmacological Research - Natural Products · doi:10.1016/j.prenap.2024.100082 · Cited by 2
The CKD Patient with Dyslipidemia
Batini, V., & Bianchi, S. (2014) · Springer eBooks · doi:10.1007/978-1-4939-0515-7_6 · Cited by 1
Effect of Crispy Arrowroot Flake on Waist Circumference, Fasting Glucose and Free Fatty Acid in Type 2 Diabetes Patients
Sunarti, S., Kusuma, R. J., Rubi, D. S., & Sinorita, H. (2014) · Pakistan Journal of Nutrition · doi:10.3923/pjn.2014.415.421 · Cited by 1
A Comparative Study of Lipid Profile in Pre- and Post-Menopausal Women with and without Diabetes
Ameetha Rani, V., Khan, M. S. A., Swamy, M., & Jagannatham, S. (2020) · International Journal of Biotechnology & Biochemistry · doi:10.37622/ijbb/16.2.2020.83-91 · Cited by 1
Gender based differences in lipid profile and other novel atherogenic risk factors in type-2 diabetes mellitus patients
Jaidev, A., Shah, H., & Chaturvedi, M. (2021) · International Journal of Research in Medical Sciences · doi:10.18203/2320-6012.ijrms20213940 · Cited by 1
Evaluation of Glycemic Index, Hypolipidemic and Hypoglycemic Activities of “osu une” on Alloxan Induced Diabetic Rats
Umerah, N. N., & Asouzu, A. I. (2023) · Asian Journal of Biochemistry Genetics and Molecular Biology · doi:10.9734/ajbgmb/2023/v14i2312 · Cited by 1
“Krentz [23] observed that hypertriglyceridemia, hypercholesterolemia and elevated LDL levels are the common factors that lead to the development of atherosclerosis and coronary heart disease in diabetes mellitus patients.”
Background
Toward a Mechanistic Understanding of Hepatic Insulin Action and Resistance
Cook, J. R. (2014) · doi:10.7916/d8j38r4z · Cited by 1
Dyslipidaemia, glucose intolerance and cardiovascular disease mortality and morbidity in Europeans and Asians
Zhang, L. (2010) · Työväentutkimus Vuosikirja · Cited by 1
Do People With Diabetes Need Statins?
White, J. R. (2008) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721708320919 · Cited by 1
“Triglycerides, which are major components of very low-density lipoprotein (VLDL) cholesterol and remnant lipoproteins,(21) are believed to deliver more cholesterol to macrophages than LDL cholesterol and to accelerate atherosclerotic plaque formation.(26) Decreased HDL cholesterol is also a strong independent predicto…”
Background
Introduction
Umpierrez, G. E. (2008) · Clinical cornerstone · doi:10.1016/s1098-3597(09)60020-x · Cited by 1
Hypoglycemic and Hypolipidemic Effects of Viburnum Foetidum (Linn.) Methanolic Extract in a Mice Model of Fructose Induced Type II DiabetesPreprint
Hasnin, I., Akter, S., Khatun, R., Khatune, N. A., Islum, M. M., & Rahman, A. A. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4132385 · Cited by 1
New Insights into the Assembly and Metabolism of ApoB-Containing Lipoproteins from in vivo Kinetic Studies: Results on Healthy Subjects and Patients with Chronic Kidney Disease
Dieplinger, B., & Dieplinger, H. (2012) · InTech eBooks · doi:10.5772/51865
“It involves all lipoprotein classes, shows considerable variations depending on the stage of CKD [50, 51] and is further modified by concurrent diseases such as diabetes [52] and nephrotic syndrome [53].”
Receptor scavenger BI: efeito de polimorfismos e atorvastatina na expressão gênica em indivíduos hipercolesterolêmicos
Maureira, Á. D. C. (2009) · doi:10.11606/d.9.2009.tde-06122011-115728
The liver in health and disease: relevance to diabetes and associated metabolic disorders
Krentz, A. J. (2007) · Practical Diabetes · doi:10.1002/pdi.1121
“Curr Medicinal Chemistry 2006; 13(5): 583–589.”
Treinamento físico aeróbio aumenta a capacidade antioxidante das HDL e reduz o estresse oxidativo plasmático no diabete melito tipo 2
Iborra, R. T. (2006) · doi:10.11606/d.5.2006.tde-06022007-150120
GENDER DIFFERENCES OF LIPID PROFILE IN TYPE 2 DIABETES MELLITUS
Chowta, M. N., Adhikari, P., Sivaraj, R., Chowta, N. K., Shenoy, A. K., Ramapuram, J., & Rao, S. B. (2012)
Étude des mécanismes athérogènes associés à l'insulino-résistance et l'hypercholestérolémie familiale
Hogue, J. (2008) · Corpus Université Laval (Université Laval)
Whole genome analysis of genetic susceptibility factors in psychotic disorders
Athanasiu, L. (2011) · NORA - Norwegian Open Research Archives
Transferência "in vitro" de lípides de uma nanoemulsão artificial para a fração HDL de pacientes com diabetes mellitus tipo 2
Seydell, T. M. (2008) · doi:10.11606/t.5.2008.tde-04042008-155521
Correlation between the Finnish Diabetes risk Score and the severity of coronary artery disease Meusobni odnos Finskog skora rizika od dijabetesa i stepena teine koronarne arterijske bolesti
Djuri, P., Mladenovi, Z., Grdini, A., Jovi, Z., & Spasi, M. (2014)
Managing Dyslipidemia and Global Risk in Patients with Type 2 Diabetes and Insulin Resistance Managing Dyslipidemia and Global Risk in Patients with Type 2 Diabetes and Insulin Resistance
Kendall, D. M., Buse, J. B., Ginsberg, H. N., Masoudi, F. A., & Plutzky, J. (2005)
WALKING AS AN INCOMPLETE EXERCISE FOR METABOLIC SYNDROME: PHYSIOLOGICAL AND BIOCHEMICAL OVERVIEW
Dr. Prasad’s DCRC, K., Prasad, M. V., Mohsina Hyder, K., Dr. Prasad’s DCRC, K., Benny, S., Dr. Prasad’s DCRC, K., & DineshRoy, D. (2016) · International Journal of Advanced Research · doi:10.21474/ijar01/1996
Evaluation of Pharmacological Modification of Growth Hormone Secretagogue Receptor in a Mouse Model of Non-Obese Type 2 Diabetes Mellitus
Mosa, R. (2017) · The University of Queensland · doi:10.14264/uql.2017.998
Antidiabetic properties of centella asiatica in type II diabetic rats.
Oyenihi, A. B. (2016) · ResearchSpace (University of KwaZulu-Natal)
Impact d'un traitement avec fenofibrate ou atorvastatin sur la cinétique in vivo de la protéine C-réactive
Levesque, J. (2009) · Corpus Université Laval (Université Laval)
Dyslipidemia in Newfoundland: findings from Canadian primary care sentinel surveillance network in Newfoundland and Labrador
Oake, J. D. (2019) · Memorial University Research Repository (Memorial University)
Anthropometric and Biochemical Profile of young adults of age group 20-45 years diagnosed newly with type 2 diabetes mellitus at Dr. Prabhakhar Kore Hospital and Medical Research Centre, Belagavi
Kour, H., Kothiwale, V., & Goudar, S. (2019) · BLDE University Journal of Health Sciences · doi:10.4103/bjhs.bjhs_25_19
Comparison of lipid profile in diabetic patients presenting with cardiac diseases
Johri, N., Mehra, D., Kadam, R., Chaudhary, R. R., & Sarda, M. S. (2021) · International Journal of Research in Medical Sciences · doi:10.18203/2320-6012.ijrms20210874
Auswirkungen eines zwölfmonatigen kontrollierten Trainingsprogramms auf die Leptin-, Adiponectin- und Progranulin-Serumkonzentrationen sowie Parameter des Lipidstoffwechsels bei Patienten mit Typ 2 Diabetes
Schaarschmidt, W. (2010) · Qucosa (Saxon State and University Library Dresden)

Authors: Krentz, A. J.
Affiliations: Southampton General Hospital (GB)
Corresponding author: Krentz, Andrew J
ORCID: Krentz, Andrew J
Venue: Diabetes Obesity and Metabolism
Publisher: Wiley
Published: 2003-10-22
Volume: 5
Issue: s1
Pages: S19-27
ISSN: 1462-8902 (ISSN-L)
1463-1326
DOI: 10.1046/j.1462-8902.2003.0310.x
OpenAlex: W2117545273
Cited by: 205
References: 56
Citations by year: 2025: 3 · 2024: 2 · 2023: 7 · 2022: 5 · 2021: 7 · 2020: 7 · 2019: 4 · 2018: 5 · 2017: 9 · 2016: 12 · 2015: 10 · 2014: 21 · 2013: 10 · 2012: 14
FWCI: 1.66
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Diabetes Obesity and Metabolism (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
Keywords: type 2 diabetes, dyslipidemia, cardiovascular disease, atherosclerosis, hypertriglyceridemia, small dense LDL, HDL cholesterol, remnant lipoproteins, lipoprotein lipase, VLDL, glycation, statins, lifestyle modification, reverse cholesterol transport, coronary artery disease, thrombosis
MeSH terms: Coronary Artery Disease, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Humans, Hyperlipidemias, Insulin Resistance, Cholesterol, HDL, Cholesterol, LDL, Risk Factors, Hypertriglyceridemia, Randomized Controlled Trials as Topic

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Lipoprotein abnormalities and their consequences for patients with Type 2 diabetes

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