Cholesterol, Triglycerides and Diabetes

(LifeWire) - If you have diabetes, controlling your cholesterol and other blood fats (or lipids) is just as important as controlling blood sugar and blood pressure. That's because people with diabetes are at high risk for dyslipidemia -- abnormal levels of cholesterol and other blood lipids.

Dyslipidemia increases the risk of cardiovascular disease, heart attack and stroke. And according to the U.S. Centers for Disease Control and Prevention, it affects 70% to 97% of people with diabetes.

Dyslipidemia is typically characterized by a low level of high-density lipoprotein (HDL) -- the "good" cholesterol that protects against heart disease -- and elevated triglyceride levels. (Triglycerides are blood fats that increase the risk of heart attack and stroke.)

In addition, people with diabetes tend to have higher levels of low-density lipoprotein (LDL) -- the "bad" cholesterol that's associated with atherosclerosis. Moreover, their LDL cholesterol tends to have a greater proportion of smaller, denser particles, which are especially harmful to the cardiovascular system.

Dyslipidemia is one of the reasons why heart attacks and strokes are four times as common among people with diabetes and why more than 70% of people with diabetes eventually die from cardiovascular-related causes.

Despite its seriousness, dyslipidemia isn't widely recognized and, in some cases, isn't adequately treated. One survey showed that 60% of diabetics didn't regard themselves as being at high risk for cholesterol problems -- and 45% had never even discussed the issue of lowering cholesterol with their primary-care providers. Other research suggests that nearly two out of three diabetics have dangerously high LDL levels.

Ideally, cholesterol levels should be measured as soon as diabetes is diagnosed and again after blood sugar control has been achieved. Levels should continue to be measured every year (if they're not within the recommended range) and otherwise every two years.

To reduce the risk of cardiovascular disease, heart attack and stroke, the American Diabetes Association recommends maintaining LDL below 100 mg/dL, triglycerides below 150 mg/dl and HDL above 40 mg/dL (if you're a man) or above 50 mg/dL (if you're a woman).

If you have dyslipidemia, your doctor may first recommend lifestyle changes. These may include a diet low in cholesterol, saturated and trans fats; an exercise program (such as brisk walking); or both. The goal for exercise is to gradually increase your level of physical activity to about 30 minutes per day on most days of the week.

Drinking alcohol raises triglyceride levels. So if you drink, your doctor may recommend limiting yourself to two drinks per day, if you're a man, or one drink per day, if you're a woman. If you smoke -- which dramatically increases your risk for heart disease -- your doctor can recommend programs to help you quit.

Many people with diabetes are either overweight or obese. But a healthy diet and increased physical activity can bring not only weight loss but also significant increases in HDL and reductions in triglyceride levels (while modestly reducing LDL).

Sometimes, lifestyle changes alone are enough to bring dyslipidemia under control. If they aren't, your doctor will probably recommend adding one or more medications.

Statins -- such as Lipitor (atorvastatin) and Zocor (simvastatin) -- are the first-line drug therapy for dyslipidemia. Niacin and cholesterol absorption inhibitors -- such as Zetia (ezetimibe) -- are other possibilities. All these medications lower LDL and triglycerides and increase HDL.

Two other options: Fibrates -- such as Lopid (gemfibrozil) -- lower triglycerides and raise HDL but have variable effects on LDL. And bile acid sequestrants -- such as WelChol (colesevelam) -- lower LDL and raise HDL but have variable effects on triglycerides.

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