With evidence increasing that endothelial lipase (EL) plays a major role in the metabolism of HDL and is associated with subclinical atherosclerosis, Shiu et al. tested the hypothesis that serum EL concentrations might be increased in patients with type 2 diabetes, which is often associated with chronic subclinical inflammation, and investigated the effect of insulin on EL levels. In this regard, 237 type 2 diabetic patients on oral anti-diabetic agents, 111 type 2 diabetic patients on insulin therapy, and 226 non-diabetic controls were studied. The authors reported that serum EL concentration was increased in patients with type 2 diabetes treated with oral anti-diabetic agents but not in those on insulin therapy. Those patients had EL levels similar to those of controls. The authors also showed that patients with type 2 diabetes had higher plasma C-reactive protein (CRP) levels than controls. Moreover, an association between plasma CRP levels and serum EL concentrations was found in patients with type 2 diabetes on oral anti-diabetic agents as well as in healthy controls. The latter observation suggests that inflammation stemmed from an increase in EL concentrations. The study also revealed that insulin may play a role in the regulation of serum EL concentrations and that exogenous insulin can lower serum EL concentrations in patients with type 2 diabetes.
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