Issue 97 Item 14 Type 2 Diabetes and Hypertriglyceridemic Hyper ApoB

Based on triglycerides and apoB rather than triglycerides and LDL cholesterol, more intensive therapy is required. A group of researchers led by Dr Sniderman from McGill University in Montreal, Canada, measured plasma lipoprotein levels to determine the various dyslipidemic phenotypes in patients with type 2 diabetes. Patients were divided into phenotypes by a conventional method based on triglyceride levels ³ or <1.5mmol/L and LDL cholesterol ³ or <4.0mmol/L, and a new method based on triglycerides ³ or <1.5mmol/L and apoB ³ or <120mg/dL.

The researchers showed that for the overall cohort, plasma triglycerides were elevated (2.13±1.6mmol/L), and total (5.34±1.1mmol/L) and LDL cholesterol (3.28±0.88mmol/L) were normal. Using the conventional method, 23% of the cohort had elevated LDL cholesterol levels, but almost 40% had an elevated apoB level with the new method. Combined hyperlipidemia was found in 12.8% of patients with the conventional method compared with almost 35% with the new method. In the latter group, the mean apoB level was 145mg/dL, which was in the 95th percentile of the population.

Based on triglycerides and apoB rather than triglycerides and LDL cholesterol, over 20% of patients had hypertriglyceridemic hyperapoB, which, according to the authors, justifies intensive therapy. Diabetes Care 2002;25:579-82