Vascular Health and Risk Management Open Access Full Text Article Dovepress open access to scientific and medical research R e V i e w Atherogenic dyslipidemia and diabetes mellitus: what’s new in the management arena? Ajoy Kumar1 Vibhuti Singh2 1Bayfront Family Medicine Residency, St Petersburg FL, USA; 2University of South Florida College of Medicine and Suncoast Cardiovascular Center, St Petersburg, FL, USA Correspondence:Ajoy Kumar Bayfront Family Medicine Residency, 700 6th Street South, St Petersburg, FL 33701 USA email ajoy.kumar@bayfront.org submit your manuscript | www.dovepress.com Dovepress 5686 Abstract: When compared with the general population, the diabetic population is at higher risk of cardiovascular disease (CVD), as predicted by the Framingham Risk Score calculations (10-year risk 20%). For this reason diabetes is considered a “coronary disease equivalent” condition, as classified by the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III. Furthermore, patients with diabetes who experience a myocardial infarction have a poorer prognosis than nondiabetic patients, which contributes to their overall higher mortality. Dyslipidemia is a major underlying risk factor contributing to the excess CVD risk, and is usually more atherogenic in the presence of diabetes. It is uniquely manifested by raised levels of triglycerides, low levels of high-density lipoprotein cholesterol, and smaller, denser, and more atherogenic low-density lipoprotein particles. Recent trials have suggested the need for more aggressive treatment of dyslipidemia in this subpopulation than the current recommen- dations by the NCEP-ATP III. This review addresses the newer developments in the diabetes arena in terms of our current understanding of atherogenic dyslipidemia in diabetes and data from the latest randomized trials addressing its management. Keywords: atherogenic dyslipidemia, diabetes mellitus Introduction The World Health Organization (WHO) defines cardiovascular disease (CVD) as “A group of disorders of the heart and blood vessels and includes coronary heart disease, cerebrovascular disease, peripheral artery disease, rheumatic heart disease, congenital heart disease, deep vein thrombosis, and pulmonary embolism”. Furthermore, WHO estimates show that mortality from CVD accounts for 29% of all deaths worldwide.1 In the US, death from CVD continues to be the leading cause of mortality.2 More specifi- cally, coronary heart disease (CHD) is the largest component of death related to CVD, both worldwide and within the US.1,2 Risk factors for CVD, both major and minor, include high blood pressure, cigarette smoking, high serum cholesterol, low levels of high-density lipoprotein cholesterol (HDL-C), high levels of low-density lipoprotein cholesterol (LDL-C), diabetes, obesity (especially central obesity), left ventricular hypertrophy, family history of premature CVD, and estrogen replacement.3 Pathophysiology CHD is caused by atherosclerosis, ie, hardening of an artery due to atheromatous plaque.4 The formation of an atheromatous plaque, known as atherogenesis, is a complex process involving both cellular and acellular elements.5 Although there is a growing body of evidence implicating inflammatory processes and the cells involved Vascular Health and Risk Management 2010:6 665–669 665 © 2010 Kumar and Singh, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.