Pathophysiology of dyslipidemia in patients with metabolic syndrome or type 2 diabetes mellitus

Lipid abnormalities in people with Metabolic Syndrome and Type 2 diabetes are likely to play an important role in the development of atherogenesis. These lipid disorders include not only quantitative but also qualitative abnormalities of lipoproteins which are potentially atherogenic. The main quantitative abnormalities are increased triglyceride levels, related to an augmented hepatic production of VLDL and a reduction of both VLDL and IDL catabolism (in Type 2 diabetes), and decreased HDL-Cholesterol levels due to an accelerated HDL catabolism. The main qualitative abnormalities include large VLDL particles (VLDL,), relatively rich in triglycerides, small dense LDL particles, increase in triglyceride content of LDL and HDL. Moreover, glycation of apolipoproteins and increased susceptibility of LDL to oxidation are observed in Type 2 diabetes. Although plasma LDL-cholesterol level is usually normal in Type 2 diabetic patients, LDL particles show significant kinetic abnormalities, such as reduced turn over, which is potentially harmful. The pathophysiology of lipid abnormalities in Type 2 diabetes is not yet totally explained. However, insulinresistance and the relative insulin deficiency, observed in patients with Type 2 diabetes, are likely to play a crucial role since insulin has an important function in the regulation of lipid metabolism. In addition, it is not excluded that adipocytokines, such as adiponectin, could play a role in the pathophysiology of lipid abnormalities in Type 2 diabetes. (c) 2007 Elsevier Masson SAS. Tous droits reserves.