The American Diabetes Association's 48th Annual Advanced Postgraduate Course.

Abstract

This article covers symposia presented at the American Diabetes Association’s 48th Annual Advanced Postgraduate Course, which was held in New York in January 2001. Topics include management of cardiovascular disease and diabetes, management of diabetes and hypertension, estrogen therapy and cardiovascular disease, and use of ACE inhibitors. At the American Diabetes Association’s 48th Annual Advanced Postgraduate Course in New York, 19–21 January 2001, much emphasis was devoted to cardiovascular disease (CVD) management in patients with diabetes. Henry Ginsberg, New York, NY, discussed diabetic dyslipidemia as a part of the hyperglycemia syndrome and, more importantly, the insulin resistance syndrome. Central to diabetic dyslipidemia is the elevation of fatty acid levels, with consequent elevated total triglycerides, reduced HDL cholesterol levels, and normal or mildly elevated levels of LDL cholesterol of abnormal composition. Thus, triglyceride levels exceed 235 mg/dl in 9 vs. 19% of nondiabetic vs. diabetic men and are >200 mg/dl in 8 vs. 17% of women. HDL cholesterol levels <31 mg/dl are seen in 12 vs. 21% of the two groups of men, and levels <41 mg/dl are seen in 10 vs. 25% of the respective groups of women. LDL cholesterol levels are similar in individuals with and without diabetes, exceeding 190 mg/dl in 11 vs. 9% and 16 vs. 15% of men and women, respectively (1). Similarly, in the U.K. Prospective Diabetes Study (UKPDS), HDL levels were lower and triglyceride levels were higher in both men and women with diabetes, although among women with diabetes, LDL cholesterol levels were higher (2). Insulin resistance is associated with a 30–40% higher free fatty acid (FFA) level because of decreased adipocyte uptake and increased release, leading to an increase in hepatic triglyceride synthesis, with increased VLDL production. In the circulation, cholesterol ester transfer protein, which resides mainly on HDL particles, transfers cholesterol from …