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Atherosclerosis and Dyslipidemia:Diabetic-Lifestyle:"The importance of treating dyslipidemia in type 2 diabetics is linked to an associated two to fourfold excess risk of coronary heart disease. There are also findings that the increased cardiovascular risk factors exist before the onset of type 2 diabetes. The most common pattern of dyslipidemia in type 2 diabetes is elevated triglycerides and decreased HDL levels. Diabetics may also have elevated levels of LDL and VLDL; however, type 2 diabetic patients typically have more smaller, denser LDL particles, which possibly increases atherogenicity, even if the absolute concentration of LDL is not significantly increased. There are few studies of lipids and lipoproteins as predictors of CHD in type 2 diabetics with somewhat contradictory results, but in observational studies HDL may be the best predictor of CHD in type 2 diabetes followed by triglycerides and total cholesterol. Furthermore, the results from clinical trials and observational studies in diabetic subjects are somewhat inconsistent in that LDL lowering has been beneficial in clinical trials but not a significant predictor in observational studies."
publishers@diabetic-lifestyle.com
http://www.diabetic-lifestyle.com/articles/apr99_whats_1.htm

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Diabetes and Hyperlipidemia:National Pharmacy Cholesterol Council:"Initial treatment for hyperlipidemias in diabetes involves lifestyle changes and optimizing glucose control. Weight reduction is recommended in overweight patients and is associated with improvements in insulin sensitivity, glucose control, and lipid levels. A NCEP Step-One diet is suggested initially with less than 30% of calories from fat, less than 10% of total calories from saturated fat, and a cholesterol intake of less than 300 mg/dl.(11) If the desired outcomes are not achieved, the NCEP Step-Two diet can be implemented with a further reduction in saturated fat to less than 7% of total calories and less than 200 mg of cholesterol daily. Generally, complex carbohydrates are substituted for the fat calories. There is some controversy surrounding this issue, though, since a high carbohydrate diet can cause an elevation in triglycerides and lower HDL cholesterol. As an alternative, monounsaturated fats can be used to replace some of the carbohydrate.(12) Exercise is also important to facilitate weight loss and improve lipid levels with the plan individualized for the patient. Optimizing blood glucose control will help to improve the lipid profile but may not normalize it completely."
National Pharmacy Cholesterol Council
Health Tech Solutions
4455 Duncan, Suite 101
St. Louis, MO 63110-1088
http://www.npccnet.org/NPCC/fatfacts/fat3n5.html

What are the Complications of Diabetes?:diabetes-tests.com:"Diabetes increases the risk for atherosclerotic vascular disease. This risk is greatest in people who have other known risk factors, such as dyslipidemia, hypertension, smoking, and obesity. Furthermore, in type 2 diabetes there is an additional increased risk for obesity and lipid abnormalities independent of the level of glycemic control. A common abnormal lipid pattern in such patients is an elevation of VLDL, a reduction in HDL, and an LDL fraction that contains a greater proportion of small, dense LDL particles. Recent studies have shown Lp(a) to be a significant independent risk factor for assessing CHD."
http://www.diabetes-tests.com/Complications.html

Dyslipidemia in type 1 diabetes:medforum:"This study was undertaken with the purpose of identifying an important risk factor for atherosclerotic complications in people with type 1 diabetes mellitus, namely dyslipidemia. Dyslipidemia has been widely discussed in type 2 diabetes but very little information has been published in type 1. The study also attempted to elucidate epidemiological data on the prevalence of dyslipidemia as well as its phenotypical distribution in type 1 diabetes. Since previous studies have primarily emphasized only the total cholesterol and total triglyceride concentrations with regard to dyslipidemia, this study aimed to assess the effects of improving glycemic control on the prevalence of dyslipidemia and on LDL and HDL cholesterol concentrations in type 1 diabetic patients compared with a non-diabetic control group."
http://www.medforum.nl/idm/dyslipidemiaintype1diabetes.htm

Management of dyslipidemia in adults with diabetes:National Guideline Clearinghouse:"Modification of Lipoproteins by Nutritional Therapy and Physical Activity Diabetic patients who are overweight should be given a prescription for medical nutrition therapy (MNT) and for increased physical activity. The proportion of saturated fat in the meal plan should be reduced. The American Diabetes Association (ADA) suggests either an increase in carbohydrate or monounsaturated fat to compensate for the reduction in saturated fat. Some (but not all) studies suggest that a high-monounsaturated-fat diet may have better metabolic effects than a high-carbohydrate diet, although other experts have suggested that such a dietary modification may make weight loss more difficult in obese diabetic patients."
info@guideline.gov
http://www.guideline.gov/VIEWS/summary.asp?guideline=2358&summary_type=brief_summary&view=brief_summary&sSearch_string=

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Cardiac Implications Diabetic Dyslipidemia:Diabetes Care:"Three large-scale studies with fibric acid drugs have included diabetic patients: The Helsinki Heart Study, the Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial (VA HIT), and the Diabetes Atherosclerosis Intervention Study (DAIS). The Helsinki Heart Study This study measured the effect of treatment with gemfibrozil versus placebo in men with an average total cholesterol level of about 290 mg/dL and a triglyceride level of approximately 175 mg/dl. The study included 135 patients with type 2 diabetes. The Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial (VA HIT) Investigators compared gemfibrozil versus placebo in 2531 men with CHD whose primary lipid abnormality was a low HDLlevel.Diabetes Atherosclerosis Intervention Study (DAIS) This was a 3-year, multinational, angiographic, double-blind, placebo-controlled study, in which subjects received 200 mg micronized fenofibrate or placebo. The primary objective was to determine if long-term correction of dyslipoproteinemia with fenofibrate decreased progression, or caused regression, of preexisting coronary atherosclerosis."
http://www.diabetes-tests.com/Cardiac_Implications.html

Defeating dyslipidemia in the diabetic patient:Power Pak:"Elevation of triglyceride levels and reduction in HDL levels are common in type 2 diabetic patients. While LDL levels are not usually elevated in type 2 diabetes, the LDL component in these patients is typically made up of smaller and denser particles than those seen in nondiabetic populations, and this specific difference tends to facilitate plaque formation. This highlights the importance of detecting and treating any dyslipidemia in the diabetic patient, since he bears not only a heightened risk of developing dyslipidemia but also a heightened risk of macrovascular complications in response to the resulting atherosclerosis and consequently a higher mortality rate once coronary heart disease develops."
http://www.powerpak.com/PowerGraphs/1999/aug/Defeating.cfm

The Role of Lipid Lowering Agents In The Diabetic Patient:St Paul's Hopital:"The American Diabetes Association has recently recommended new guidelines for the treatment of diabetic dyslipidemia. A brief summary follows: The first priority for therapy is lowering of LDL cholesterol. The primary therapy for LDL lowering is HMG-CoA reductase inhibitors. The first treatment for elevated triglycerides is improved glycemic control. The LDL goal (and initiation level for pharmacological therapy) for diabetic subjects with CHD is a 100 mg/dl. For diabetic subjects without preexisting CHD, the LDL goal (and initiation level) is 130 mg/dl. However, in a footnote to the table (because of controversy among the committee), it was suggested that diabetic subjects without prevalent CHD but with other CHD risk factors (smoking, hypertension, family history of CHD, low HDL, microalbuminuria, and/or proteinuria) might be treated to an LDL goal of less than 100 mg/dl. Most diabetic subjects are expected to have at least one other CHD risk factor."
St Paul's Hopital
B180-1081 Burrard St.
Vancouver, BC V6Z 1Y6.
Phone: 604-631-5591
http://www.healthyheart.org/Education/Conferences/980620/AbHaffner.htm

ADVANCES IN THE STUDY OF LIPIDS AND DIABETES:diabetes forum:"The characteristic diabetic dyslipidemia is that of low HDL cholesterol, hypertriglyceridemia, and highly atherogenic small and dense LDL particles. The etiology of accelerated atherosclerosis in individuals with diabetes is clearly multifactor, but dyslipidemia has been shown to play an important role in this process.There is now abundant clinical evidence that the typical dyslipidemia associated with insulin-resistant states and diabetes is highly atherogenic, and plays a major role in the pathogenesis of the most important clinical problem to affect individuals with these conditions. Although lipid-lowering therapy and treatment of the underlying insulin resistance are promising areas of research, solid clinical trial evidence proving the safely and efficacy of these methods is currently lacking. Until such evidence becomes available it is recommended that patients with insulin resistance and diabetes be treated very aggressively for risk-factor modification."
Mr. K.Janaki Raman.
Chief Diabetologist
23-B Ramakrishna Road,
Salem 636 007, TamilNadu. India
feedback@diabetesforum.net
http://www.diabetesforum.net/eng_treat_lipids-diabetes.htm

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There is more than one type of dyslipidemia in diabetes:healthyheart.org:"There are 5 classes of lipoproteins: chylomicrons, very low density lipoproteins (VLDL), intermediate density lipoproteins (IDL), low density lipoproteins (LDL) and high density lipoproteins (HDL). Any of these lipoproteins can be affected, singly or in combination, in dyslipidemias in diabetes.The type of diabetes and the quality of glucose control determine which lipoprotein class is abnormal. The changes int he lipoprotein profile are shown in Table 2."
http://www.healthyheart.org/Education/dyslip/dyslip04.html

Slide program for management of dyslipidemia in diabetic patients:Cariological Society of India:"This slide program is intended for physicians and pharmacists interested in the incidence, causes, and management of dyslipidemia in patients with diabetes The purpose of this slide program is to review the additional risk of cardiovascular disease faced by patients with type 2 diabetes, discuss the causes of this increased risk, especially dyslipidemia, and describe how physicians can manage cardiovascular risk factors with diet, exercise, and pharmacotherapy, based on data from clinical trials.CHD is the leading cause of death among patients with type 2 diabetes. Patients with type 2 diabetes frequently have dyslipidemia, which may contribute significantly to accelerated coronary atherosclerosis. Because risk factors for heart disease are believed to be additive (even multiplicative), mild degrees of dyslipidemia may increase CHD risk. Therefore, controlling dyslipidemia should be given equal emphasis as controlling hyperglycemia when developing strategies for managing type 2 diabetes."
http://csitn.org/june_diabetic.htm



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