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Abstract
Both risk factors and the incidence of cardiovascular disease are higher in diabetic
patients. Total serum cholesterol has the same impact on coronary heart disease (CHD)
incidence in diabetic patients as in nondiabetic individuals. Abnormal blood lipids
in diabetic patients include elevated very low-density lipoproteins (VLDL) and triglyceride
and reduced levels of high-density lipoproteins (HDL). These are associated with obesity
and precede the onset of diabetes. Diabetes increases the risk of all clinical manifestations
of CHD, has a greater impact in women, and predisposes to cardiac failure and fatal
outcome. In men, it predisposes to silent myocardial infarctions. CHD risk reduction
in the diabetic patient requires multifactorial control. In evaluating the lipid-induced
CHD risk, the level of low-density lipoprotein (LDL) cholesterol is not as valuable
as the LDL/HDL cholesterol ratio, which is the most reliable criterion. Triglyceride
levels make no independent contribution. Most CHD preventive measures, including weight
control, exercise, avoidance of cigarettes, and improvement of glucose tolerance also
increase HDL cholesterol, reduced levels of which are chiefly responsible for the
poor LDL/HDL ratio in diabetics. Weight control merits a high priority because of
its favorable influence on the lipid profile, glucose tolerance, and blood pressure.