Biomedical subjects

M Laakso

Publications and source records attributed to M Laakso.

At least 199 records · Page 11Linked to original sources

PubMed1996

Prevalence of ageing-associated cognitive decline in an elderly population.

Different diagnostic definitions have been proposed for use in the characterization of mild cognitive disorders associated with ageing. Previously, we reported a high (38.4%) prevalence of age-associated memory impairment (AAMI) using the National Institute of Mental Health criteria in an elderly population. Recently, a work group of the International Psychogeriatric Association proposed criteria for 'ageing-associated cognitive decline' (AACD). The objective of this study was to evaluate the prevalence of AACD in an elderly population. We examined 403 randomly selected subjects (68-78 years of age) with tests of memory, cognitive processing, attention, verbal and visuoconstructive functions and with a structured questionnaire for health status and subjective complaints of cognitive decline. In all, 26.6% of the subjects (24.4% of women, 30. 1% or men) fulfilled the AACD criteria. The prevalence was slightly related to age and education. The rate was lowest in the oldest age of 75 - 78 years (20.5%) and highest in the age of 71 -74 years (30%). Subjects with less than 4 years of education had the lowest (14.3%) and subjects with more than 6 years of education had the highest rate (29.4%) for AACD. However, the differences between these subgroups were not statistically significant. These results suggest that the prevalence of AACD is lower than that of AAMI. As AAMI tends to identify a very heterogeneous subject group, the AACD diagnosis, which takes into account age and education specific norms in its inclusion criteria, might prove superior to AAMI in differentiating a meaningful subgroup from an elderly population both for research purposes and in clinical settings.

Aged↗

PubMed1996

Association of Chlamydia pneumoniae and acute coronary heart disease events in non-insulin dependent diabetic and non-diabetic subjects in Finland.

OBJECTIVE: It has been suggested that Chlamydia pneumoniae, a Gram-negative intracellular bacterium, is a risk factor for both myocardial infarction and chronic coronary heart disease. Previous studies have been done predominantly in non-diabetic subjects and thus the effect of diabetes on the association between C. pneumoniae antibodies and coronary heart disease has not been analysed. The aim of our study was to investigate the association between prior chlamydial infection and the risk of serious coronary heart disease events (myocardial infarction or coronary death) in a 7-year prospective study of cohorts of diabetic and non-diabetic subjects in two areas of Finland. RESULTS: It was found that the prevalence of elevated chlamydial antibodies at baseline was higher in nondiabetic subjects who had serious coronary heart disease events during the follow-up than in subjects without coronary heart disease events (32 vs 15%, relative risk 2.56, P = 0.013) in East Finland. In non-diabetic subjects living in West Finland we did not find this association. The association between the C. pneumoniae antibodies and coronary heart disease events did not markedly change after controlling for other risk factors for coronary heart disease (OR 2.44, P = 0.055) in non-diabetic subjects living in eastern Finland. In diabetic patients we did not find any association between chlamydial antibodies and coronary heart disease events. CONCLUSION: We found an association between C. pneumoniae antibodies and coronary heart disease events in non-diabetics living in eastern Finland. This association remained strong even after controlling for the other risk factors for coronary heart disease. In diabetic patients with high risk for coronary heart disease, C. pneumoniae was not a risk factor for coronary heart disease.

Acute Disease↗

PubMed1996

Relationship of plasma insulin concentration and insulin sensitivity to blood pressure. Is it modified by obesity?

OBJECTIVE: To investigate the relationship between insulin level, insulin sensitivity and blood pressure in normoglycaemic men (n = 51) and women (n = 64) aged 53-61 years who were not receiving blood pressure medication and were participants in a previous population-based study. METHODS: Insulin sensitivity was estimated by the minimal model from a frequently sampled intravenous glucose tolerance test. RESULTS: Systolic blood pressure (SBP) did not correlated significantly with fasting insulin level, 2 h insulin level or insulin sensitivity. Diastolic blood pressure (DBP) correlated positively with fasting insulin level but not with 2 h insulin level or insulin sensitivity. However, the positive association between fasting insulin level and DBP was not significant after adjustment for obesity and age. The relationship between high fasting insulin concentration and high DBP was stronger in lean than in obese subjects. The positive correlation between fasting insulin level and DBP was significant in lean but not in obese subjects. CONCLUSIONS: The relationships between decreased insulin sensitivity and compensatory hyperinsulinaemia and blood pressure were rather weak. It is possible that different mechanisms may control blood pressure in lean and obese subjects, with a weaker association between insulin level and blood pressure in obese subjects. Alternatively, in obese subjects long-standing hyperinsulinaemia might increase blood pressure by mechanisms such as sympathetic activation and effects of vasculature, which may mask the underlying contribution of hyperinsulinaemia.

Aged↗

PubMed1996

Insulin resistance and coronary heart disease.

Insulin resistance and hyperinsulinaemia often occur with many cardiovascular risk factors. Whether hyperinsulinaemia and insulin resistance are risk factors for coronary heart disease is still a matter of debate. The information from prospective population studies, in which the relationship between hyperinsulinaemia and coronary heart disease has been investigated, is summarized. The possibility that hyperinsulinaemia and insulin resistance increase the risk for coronary heart disease will be approached from two angles. Evidence is presented of how hyperinsulinaemia and insulin resistance increase the risk for coronary heart disease indirectly through their effects on cardiovascular risk factors. Finally, evidence of how hyperinsulinaemia and insulin resistance could directly promote atherosclerosis is reviewed.

Aged↗

PubMed1996

Incidence of rheumatoid arthritis in Finland during 1980-1990.

OBJECTIVE: To obtain information on the incidence of rheumatoid arthritis and on its recent trends in Finland. METHODS: The study covered those subjects entitled to receive specially reimbursed medication for rheumatoid arthritis under the nationwide sickness insurance scheme in five out of 21 central hospital districts in Finland (population basis about one million adults) during three years: 1980, 1985, and 1990. RESULTS: The annual incidence of rheumatoid arthritis in 1980 and 1985, satisfying the American Rheumatism Association 1987 classification criteria, was 39/100,000 of the population > or = 16 years of age. The combined incidence of rheumatoid factor (RF) positive arthritis and RF negative polyarthritis was 46/100,000. A decline of approximately 40% occurred in the number of RF negative rheumatoid arthritis cases in 1990 compared with the earlier years. The declining trend was statistically significant (P = 0.008). CONCLUSION: The decline in incidence of RF negative rheumatoid arthritis in Finland may reflect changes in the environment specifically affecting the risk of RF negative disease.

Arthritis, Rheumatoid↗

PubMed1996

Medial artery calcification. A neglected harbinger of cardiovascular complications in non-insulin-dependent diabetes mellitus.

Medial artery calcification (MAC) is a nonobstructive condition leading to reduced arterial compliance that is commonly considered as a nonsignificant finding. The aim of our study was to investigate the predictive value of MAC in relation to 7-year cardiovascular mortality, coronary heart disease (CHD) events, stroke, and lower extremity amputation in 1059 patients (581 men and 478 women) with non-insulin-dependent diabetes mellitus (NIDDM). At baseline radiologically detectable MAC in femoral arteries was found in 439 patients (41.5%) and intimal-type calcification in 310 diabetic patients (29.3%). The mean fasting plasma glucose at baseline was somewhat higher in women and the duration of diabetes somewhat longer in patients with MAC than in those without, but otherwise the presence of MAC was unrelated to conventional cardiovascular risk factors. During the follow-up 305 diabetic patients died: 208 from cardiovascular disease, 158 from CHD, and 34 from stroke. Furthermore, 58 NIDDM patients underwent their first lower extremity amputation. MAC was a strong independent predictor of total (risk factor-adjusted odds ratio and 95% confidence interval: 1.6; 1.2, 2.2), cardiovascular (1.6; 1.1, 2.2), and CHD (1.5; 1.0, 2.2) mortality, and it was also a significant predictor of future CHD events (fatal or nonfatal myocardial infarction), stroke, and amputation. This relationship was observed regardless of glycemic control and known duration of NIDDM. MAC is a strong marker of future cardiovascular events in NIDDM unrelated to cardiovascular risk factors, supporting the hypothesis that reduced arterial elasticity could lead to clinical manifestations of diabetic macroangiopathy.

Blood Glucose↗

PubMed1996

Effects of losartan on insulin sensitivity in hypertensive subjects.

Losartan, the first specific and orally available angiotensin II receptor antagonist, is a potent antihypertensive drug with a low incidence of side effects in humans. However, the effects of losartan on insulin sensitivity and glucose metabolism have not been investigated in detail. Therefore, we carried out a randomized, double-blind study to compare the effects of losartan (50 mg QD) and metoprolol (95 mg QD) on insulin sensitivity, insulin secretion, glucose tolerance, and lipids and lipoproteins in 20 hyperinsulinemic subjects with essential hypertension. The fall in blood pressure was greater with losartan than with metoprolol. Insulin sensitivity evaluated by the euglycemic clamp technique did not change in either group after 12 weeks of treatment. Similarly, glucose oxidation (losartan: 17.0 +/- 0.9 versus 16.9 +/- 1.0 mumol/kg per minute [before versus after, P = NS]; metoprolol: 17.9 +/- 1.3 versus 16.8 +/- 1.6 [P = NS]) and nonoxidation (losartan: 22.3 +/- 4.0 versus 23.5 +/- 3.4 mumol/kg per minute [P = NS]; metoprolol: 23.3 +/- 3.2 versus 25.6 +/- 4.7 [P = NS]) remained unchanged during the last 30 minutes of the 3-hour euglycemic clamp. Losartan and metoprolol did not have any significant adverse effects on insulin secretion, glucose tolerance, or lipids and lipoproteins. In conclusion, losartan is metabolically neutral, without any significant adverse effect on glucose and lipid metabolism.

Antihypertensive Agents↗

PubMed1996

Predictors of stroke in middle-aged patients with non-insulin-dependent diabetes.

BACKGROUND AND PURPOSE: The risk of stroke is known to be markedly elevated in patients with non-insulin-dependent diabetes mellitus (NIDDM), but the information on risk factors predicting stroke events in middle-aged NIDDM patients is limited. Therefore, we evaluated the significance of different cardiovascular risk factors with respect to the incidence of stroke in middle-aged NIDDM patients. METHODS: Levels of cardiovascular risk factors were determined at baseline in 1059 NIDDM patients (581 men, 478 women) and 1373 nondiabetic control subjects (638 men, 735 women), aged from 45 to 64 years, in eastern and western Finland. These patients were followed up for 7 years with respect to stroke events. RESULTS: Altogether, 34 NIDDM patients (13 men, 21 women) and 5 nondiabetic subjects (4 men, 1 woman) died from stroke, and 125 NIDDM patients (61 men, 64 women) and 30 (18 men, 12 women) nondiabetic subjects had a fatal or nonfatal stroke. The risk of stroke in NIDDM men was about threefold and in NIDDM women fivefold higher than that in corresponding nondiabetic subjects. Previous history of stroke increased the risk of a new stroke event by threefold. Patients with hyperglycemia (plasma glucose > 13.4 mmol/L) and high hemoglobin A1 (> 10.7%) had about a twofold higher risk of stroke than patients with better glycemic control. Low levels of high-density lipoprotein cholesterol (< 0.90 mmol/L), high levels of total triglyceride (> 2.30 mmol/L), and the presence of hypertension were associated with a twofold increase in the risk of stroke mortality or morbidity. CONCLUSIONS: Our prospective population-based study gives evidence that previous history of stroke, hypertension, hyperglycemia, and dyslipidemia are strong predictors of stroke in middle-aged patients with NIDDM.

Blood Glucose↗

PubMed1996

Proteinuria predicts stroke and other atherosclerotic vascular disease events in nondiabetic and non-insulin-dependent diabetic subjects.

BACKGROUND AND PURPOSE: Increased urinary albumin and protein excretion is associated with cardiovascular disease mortality independent of other cardiovascular risk factors in subjects with non-insulin-dependent diabetes mellitus (NIDDM). We assessed the relationship between the different degrees of proteinuria at baseline and the incidence of stroke, as well as other atherosclerotic vascular disease events, in a prospective study of nondiabetic and NIDDM subjects. METHODS: Our study was based on the 7-year follow-up of cohorts of nondiabetic (n = 1375) and NIDDM (n = 1056) subjects in Finland. The urinary protein concentration at baseline was stratified into three categories: no proteinuria (< 150 mg/L), borderline (150 to 300 mg/L), and clinical proteinuria (> 300 mg/L). RESULTS: The association between the different degrees of proteinuria and the atherosclerotic vascular events was similar in nondiabetic and NIDDM subjects. Cardiovascular disease mortality was higher both in nondiabetic and NIDDM subjects with clinical proteinuria than in those without proteinuria. The incidence of stroke was 1.6% in nondiabetic subjects without proteinuria, 3.2% in subjects with borderline proteinuria, and 8.5% in subjects with clinical proteinuria (P < .001 for trend). In NIDDM patients, the corresponding rates were 7.2%, 11.1%, and 23.0%, respectively (P < .001 for trend). The association between clinical proteinuria and the incidence of stroke remained significant both in nondiabetic and in NIDDM subjects after adjustment for other cardiovascular risk factors. Clinical proteinuria was also associated with the incidence of coronary heart disease events and that of lower-extremity amputation. NIDDM independently increased the risk of atherosclerotic vascular disease events regardless of the proteinuria status. CONCLUSIONS: Clinical proteinuria significantly predicted stroke and other atherosclerotic vascular disease events independent of other cardiovascular risk factors. This finding is compatible with the view that increased urinary protein excretion rate may be associated with widespread vascular damage.

Adult↗

PubMed1996

Low levels of sex hormone-binding globulin and testosterone are associated with smaller, denser low density lipoprotein in normoglycemic men.

Recently, the phenotype with a preponderance of small, dense low density lipoprotein (LDL) has been associated with increased coronary heart disease. Although previous data indicated that decreased sex hormone-binding globulin (SHBG) and testosterone concentrations are associated with increased triglyceride and decreased high density lipoprotein (HDL) cholesterol levels in men, no data are available on the relationship of LDL composition to sex hormones. Therefore, we examined the relationship of SHBG, total and free testosterone, estradiol, and dehydroepiandrosterone sulfate to LDL size (as determined by gradient gel electrophoresis) in 87 normoglycemic men. LDL size was significantly positively related to SHBG (r = 0.354) and total testosterone (r = 0.313) and inversely related to dehydroepiandrosterone sulfate (r = -0.247), but not to free testosterone or estradiol concentrations. After adjustment for age, waist circumference, overall glucose disposal, fasting glucose, triglyceride, and HDL cholesterol, LDL size remained significantly associated with SHBG (r = 0.312) and total testosterone (r = 0.269). The relationship between LDL size and total testosterone and SHBG tended to be stronger in nonobese subjects. We conclude that SHBG and total testosterone concentrations are significantly associated with LDL size in men, and these relationships appear to be independent of known confounding variables, such as triglyceride and HDL cholesterol levels. Our data suggest that endogenous sex hormones may have an independent modifying effect on LDL composition in men.

Adult↗

PubMed1996

Severity of hippocampal atrophy correlates with the prolongation of MRI T2 relaxation time in temporal lobe epilepsy but not in Alzheimer's disease.

We analyzed hippocampal volumes and T2 relaxation times by MRI from 78 control subjects, 24 patients with temporal lobe epilepsy, and 55 patients with Alzheimer's disease (AD). In the epilepsy group, the hippocampal volumes were 27% smaller than in control subjects (p < 0.001). The T2 relaxation times were prolonged (8 to 20 ms compared with control subjects) in the head, body, and tail portions of the hippocampus on the focal side (p < 0.01) and also on the contralateral side (p < 0.05) compared with control subjects. In the epilepsy group, the prolongation of T2 relaxation time correlated inversely with the hippocampal volume (p < 0.05). In the AD group, the hippocampal volumes were 35% smaller than in control subjects (p < 0.01). The T2 relaxation times were slightly prolonged (5 to 6 ms) in the head and tail portions of the right hippocampus (p < 0.01), but the T2 relaxation times did not correlate with the hippocampal volumes. These data show that the degree of prolongation of T2 relaxation time is associated with severity of hippocampal atrophy in temporal lobe epilepsy but not in AD.

Adult↗

PubMed1996

Insulin action and age. European Group for the Study of Insulin Resistance (EGIR).

Evidence that age is associated with insulin resistance is discordant. We analyzed euglycemic insulin clamp (1 mU x min(-1) x kg(-1)) data collected at 20 centers throughout Europe from 1,146 men and women with normal glucose tolerance, ranging in age from 18 to 85 years. In the whole group, insulin action (as the M value) declined slightly with age (at a rate of 0.9 micromol x min(-1)-kg(-1) per decade of life, 95% CI = 0.4-1.3, P = 0.0002). When adjusted for BMI, this relationship was no longer statistically significant. The same result was obtained whether insulin action was expressed per kilogram of body weight or per kilogram of fat-free mass, expressed as the M:I ratio, or estimated from fasting plasma insulin concentrations. Subgroup analysis showed that a significant BMI-adjusted decrease in insulin action with age was present only in lean (BMI <25 kg/m2) women (a rate of 1.6 micromol x min(-1) x kg(-1) per decade, 95% CI = 0.6-2.5, P = 0.001), in whom percentage fat mass also increased with age (by 0.38% body weight per decade, P = 0.0007). Insulin action was positively associated with insulin suppression of circulating free fatty acids (FFAs) (+1.5 micromol x min(-1) x kg(-1) for each 10% increase in FFA suppression, P < 0.0001) in a multivariate model accounting for sex, BMI, age, and fasting FFA levels. Furthermore, insulin suppression of FFAs improved with age in men (2% per decade, P < 0.0001) but not in women. In the subgroup of lean women in whom insulin action declined with age, adding FFA suppression to a multiple regression equation canceled the association between age and insulin action. Thus, the small effect of age on insulin action could be adequately explained on the basis of age-related changes in body composition and substrate competition. We conclude that in healthy Europeans, age per se is not a significant cause of insulin resistance of glucose metabolism or lipolysis.

Adult↗

PubMed1996

Smoking is independently associated with high plasma insulin levels in nondiabetic men.

OBJECTIVE: Studies using the euglycemic clamp technique or the insulin suppression test in relatively small numbers of subjects have suggested that smoking may cause insulin resistance. Our aim was to study the association between smoking status and fasting plasma insulin in a large nondiabetic male population. RESEARCH DESIGN AND METHODS: A total of 616 nondiabetic men aged 45-64 years were taken from a population register. Fasting plasma insulin and blood pressure were measured, and smoking history and medication were evaluated by interview. RESULTS: Age- and BMI-adjusted insulin levels were significantly higher in smokers and ex-smokers than in nonsmokers (92.4, 86.4, and 78.6 pmol/l, respectively; P = 0.009). In every BMI-tertile, smokers and ex-smokers had higher plasma insulin than nonsmokers. After adjustment for factors potentially affecting insulin sensitivity (hypertension, systolic or diastolic blood pressure, use of beta-blockers and/or diuretics, use of vasodilating antihypertensive drugs, physical exercise, alcohol use, parental history of NIDDM, coronary heart disease, and previous myocardial infarction), insulin concentrations were still highest in smokers (91.2 pmol/l), intermediate in ex-smokers (86.8 pmol/l), and lowest in nonsmokers (78.9 pmol/l, P = 0.008 between groups). CONCLUSIONS: Our results show that chronic smoking is associated with high age- and BMI-adjusted plasma insulin levels, independent of other factors known to influence insulin sensitivity. The effect of smoking may be partially reversible after quitting.

Alcohol Drinking↗

PubMed1996

Retinopathy predicts coronary heart disease events in NIDDM patients.

OBJECTIVE: Proliferative retinopathy has been shown to be associated with increased all-cause mortality in diabetic patients. We assessed the relationship between the different degrees of retinopathic changes at baseline and serious coronary heart disease (CHD) events (CHD death or nonfatal myocardial infarction) in a prospective population-based study of NIDDM patients. RESEARCH DESIGN AND METHODS: Our study is based on the 7-year follow-up cohort of 1,059 NIDDM patients in east and west Finland. Classification of retinopathic changes was based on clinical examination of fundi, and the findings were classified to three categories according to the status of the worse eye: no retinopathic changes, background retinopathy, and proliferative retinopathy. RESULTS: During the 7-year follow-up, 255 (24%) patients developed serious CHD event. In patients with proliferative retinopathy at baseline, the risk of CHD events during the follow-up was statistically significantly higher compared with patients without retinopathic changes (odds ratio [OR] 2.31, 95% CI 1.21-4.40). The association between proliferative retinopathy and CHD events remained significant when other cardiovascular risk factors were controlled for. CONCLUSIONS: Proliferative retinopathy in NIDDM patients was associated with CHD events. Our findings suggest that retinopathy and CHD may have similar pathophysiological backgrounds.

Cardiovascular Diseases↗

PubMed1996

Structure and costs of health care of diabetic patients in Finland.

OBJECTIVE: The aim of the present study was to examine both the structure, including modes of drug treatment, ambulatory care, and hospital inpatient care, and the costs of health care for drug-treated diabetic patients in Finland. RESEARCH DESIGN AND METHODS: The modes of drug treatment and ambulatory care were studied with the help of a questionnaire given to all diabetic patients obtaining their medication through pharmacies in Finland during a 7-week period in 1989. The questionnaire sought information on drug treatment, site of health care, and frequency of visits to physicians. Hospital inpatient care was evaluated by linking the patient data from the Hospital Discharge Register and the Central Drug Register. The direct costs of health care were calculated by using relevant average costs. RESULTS: A total of 30,266 questionnaires were returned, representing > 70% of all drug-treated diabetic patients receiving medication in the period studied. Of the diabetic patients, 63% were treated by oral medication only, 31% by insulin only, and 6% by a combination of insulin and oral agents. Of the patients in whom diabetes was diagnosed at > or = 30 years of age, 75% were treated at health centers, whereas > 60% of those in whom diabetes was diagnosed at < 30 years of age were treated at outpatient clinics. The mean annual frequency of visits was 4.0 for patients receiving insulin treatment and 3.3 for patients receiving treatment with oral medications. The diabetic patients used 1.5 million hospital inpatient days per year, which was 13% of the total inpatient days in Finland. Of the inpatient days, 20% were for diabetes as the principal cause, 52% for diabetes-related diseases, and 28% for causes unrelated to diabetes. The direct costs of the health care of drug-treated diabetic patients in 1989 were 5.8% of the total costs of health care in Finland and were three times higher than the average costs of care for nondiabetic individuals. The direct costs were divided into inpatient care (81%), medication (9%), ambulatory care (8%), and self-care equipment (2%). CONCLUSIONS: Hospital inpatient care is the major contributor to the excess of health care expenditures for diabetic patients.

Ambulatory Care↗

PubMed1996

Risk factors predicting lower extremity amputations in patients with NIDDM.

OBJECTIVE: To examine the predictors of lower extremity amputation in patients with NIDDM. RESEARCH DESIGN AND METHODS: At baseline, risk factors for amputation were determined in 1,044 NIDDM patients (571 men, 473 women) aged 45 to 64 years. These patients were followed up to 7 years with respect to amputation. RESULTS: The incidence of amputation was 5.6% in men and 5.3% in women. High fasting plasma glucose at baseline examination and the duration of diabetes were associated with a twofold risk for amputation. Similarly, glycemic control measured at baseline by HbA1 was an important predictor of amputation. There was a dose-response relationship between plasma glucose or HbA1 and the risk for amputation. The effect of hyperglycemia on the risk of amputation was seen clearly even after the adjustment for other cardiovascular risk factors. Signs of peripheral neuropathy and bilateral absence of Achilles tendon reflexes and vibration sense were important predictors for amputation. Furthermore, absent peripheral artery pulses and femoral artery bruit on auscultation predicted amputation. CONCLUSIONS: Our 7-year follow-up study gives strong evidence that poor glycemic control is an important predictor of amputation in patients with NIDDM in addition to clinically detectable peripheral arterial disease and peripheral neuropathy.

Achilles Tendon↗

PubMed1996

Bisphosphonate therapy in multiple myeloma.

Lytic bone lesions, pathological fractures, hypercalcaemia and osteoporosis are common features in patients with multiple myeloma. Adjunctive therapeutic modalities in addition to antimyeloma therapy have been sought to ameliorate these clinical consequences of bone disease. Bisphosphonates appear to be useful in this respect. In addition to correcting hypercalcaemia, they reduce the amount of new bone lesions and pathological fractures in myeloma patients. Bisphosphonates also relieve bone pain. In placebo-controlled studies clodronate (1600-2400 mg/d orally) and pamidronate (90 mg intravenously once every month) have produced clinically significant effects in myeloma patients. Bisphosphonates are a useful adjunct therapy in patients with multiple myeloma.

Clinical Trials as Topic↗

PubMed1996

Lipids and lipoproteins as risk factors for coronary heart disease in non-insulin-dependent diabetes mellitus.

Dyslipidaemia is frequent in non-insulin-dependent diabetes mellitus (NIDDM). Lipid and lipoprotein abnormalities include particularly elevated levels of total and very-low-density lipoprotein (VLDL) triglycerides and reduced levels of high-density lipoprotein (HDL) cholesterol. The worsening of glycaemic control further deteriorates lipid and lipoprotein abnormalities and furthermore, total and low-density lipoprotein (LDL) cholesterol levels are often elevated in poor glycaemic control. Epidemiological data show that total cholesterol is as powerful risk factor for coronary heart disease (CHD) in NIDDM patients as in nondiabetic subjects. High total triglycerides and low HDL cholesterol may be even stronger risk factors for CHD in NIDDM patients than in nondiabetic individuals, but more prospective studies are needed to substantiate this view. Compositional changes in LDL and VLDL particles may further increase the risk of CHD but epidemiological data are missing to support this notion.

Clinical Trials as Topic↗