Mazanderani, A. B. et al. Apolipoprotein B levels in adults with type 1 diabetes not receiving lipid-lowering therapy. Clin. Biochem. 42, 1218–1221 (2009).

Reduction of cardiovascular complications as a result of dyslipidemia in patients with diabetes mellitus is achieved through tight glycemic control and the use of lipid-lowering therapies. A new study of cardiovascular disease (CVD) risk and response to lipid-lowering therapy suggests that apolipoprotein B is a more appropriate indicator than LDL cholesterol.

Mazanderani et al. examined lipid parameters, such as apolipoprotein B, HDL cholesterol, LDL cholesterol and triglycerides, as well as HbA1c of 169 adult patients with type 1 diabetes mellitus (T1DM). Patients who had received lipid-lowering therapy or had a history of CVD were not included in the analysis.

The investigators found that lipid profiles of patients with T1DM were normal or even protective compared with healthy individuals. Mean HbA1c concentrations indicated intermediate to well-controlled glucose levels, and lipid levels and HbA1c were not correlated. These results suggest that cardiovascular complications in patients with T1DM might be a result of poor glycemic control or differences in lipid phenotypes rather than dyslipidemia per se.

The study also revealed a substantial difference in the number of patients classified as high risk for CVD according to their apolipoprotein B or LDL cholesterol levels; 62% of male and 66% of female patients with T1DM who exhibited high LDL cholesterol levels did not have elevated mean apolipoprotein B concentrations. “Guidelines are increasingly geared towards recommending LDL cholesterol level as an indicator of CVD risk and need for initiation of lipid-lowering therapy,” warns lead author Mazanderani. In other words, if LDL cholesterol alone is used to determine the need for lipid-lowering therapy, patients with T1DM might be prescribed lipid-lowering therapy unnecessarily.