In this review article published in the International Journal of Cardiology, Pastromas et al. described the possible effects of a disturbed postprandial lipemia on atherosclerosis risk in patients with type 2 diabetes. The paper focussed on the altered plasma concentrations and physicochemical properties of lipoproteins in individuals with delayed postprandial lipemia and on the mechanisms underlying each lipoprotein abnormality. For instance, an increase in triglyceride-rich lipoproteins such as VLDL and chylomicrons is caused by increased insulin resistance and free fatty acid delivery to the liver and a decreased lipoprotein lipase (LPL) activity leading to decreased clearance of these triglyceride-risk lipoproteins. As for the high levels of both small LDL and HDL particles observed in individuals with delayed postprandial lipemia, decreased LPL activity as well as an increase in hepatic lipase and cholesteryl ester transfer protein activities/concentrations are some of the mechanisms involved. Management of this diabetic dyslipidemia is another important consideration addressed in the review, which also describes pharmacological (lipid-lowering drugs such as statins, fibric acid derivatives, and nicotinic acid) and non-pharmacological interventions.
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