Type II diabetes mellitus causes A charaterlstic Dyslipidemia

Triglycerides and very low density lipoprotein cholesterol

(VLDL-C). The most common alteration of lipoprotein in type II is

hypertriglyceridemia caused by an elevation in VLDL-C. The most

important factor responsible for increased VLDL level is over

production of VLDL triglyceride probably due to increase flow of

substrates such as glucose and Free Fatty acids to the liver. In

addition individuals with type II have defect in clearance of VLDL

triglycerides. Due to decreased lipoprotein lipase activity which

parallels to the insulin resistance, thus in turn to hyperglycemia.

Low density lipoprotein-cholesterol (LDL-C):

- studies examining plasma concentration of total cholesterol and LDL-C intype II have been contradictory with some showing higher and showing lower levels in type II than in control subjects. But the recent study II of the National Health and Nutrition Examination Survey, USA, indicates that elevations of LDL-C concentrations are more common in individuals with type II DM that in the general population .

High Density lipoprotien: 

- Cholesterol (HDL-C) the individuals with type II DM have lower concentration of HDL-C as compared with control subjects because of increased clearance rate of HDL-C which is directly related with plasma glucose concentration. Since HDL-C concentration increases during lipolytic process, lipoprotein lipase activity has been shown to correlate significantly with the HDI-C concentrations in individuals with type II DM. As with LDL and VLDL particles, an increased proportion of triglyceride in HDL particles have also been observed. An increase in the ratio of cholesterol to protein in HDL particles has been reported. These compositional changes appear to correlate with the degree of stimulation of adipose tissue lipoprotein lipase. In addition, glycation of the HDL particles appears to interfere with binding to receptors. 

Apo-B concentration:

- An elevated Apo-B concentration is  another common feature of the Dyslipidemia of type II diabetes. Elevated Apo-B levels are found in almost half of normocholesterolaemic patients with type II diabetes and are frequently associated with low HDL cholesterol levels and hypertriglyceridemia. Indeed, an increased in Apo-B levels may predict CHD events better than LDLCholesterol levels .

Apo-AI Concentrations: 

- Apo-AI is the crucial structural apoprotien for HDL. An contrast to athenogenic Apo-B lipoproteins, the Apo-AI containing HDL appear to be anti atherogenic. In fact in some studies, HDL cholesterol levels are as strong an indication of protection from CHD as LDL-cholesterol levels are an indicator of risk .

Lipoprotein-a :

Lipoprotein-a IS an LDL- like particle that carries the Lpa

specific highly glucosylated protein Apo-a. Glycamic control and

insulin therapy may influence Lp-a level in patient with diabetes. There.. is no clear evidence that Lp-a contributes significantly to the increased risk of atherosclerosis in diabetes, although diabetic .nephropathy seem to be associated with high Lp-a levels. LDL cholesterol connected positively and  triglyceride negatively with Lp-a concentrations . Lipoprotein level and coronary heart disease. In the past raised LDL-cholesterol levels were held largely responsible for the increased risk of CHD. But it is now clear that other lipid abnormalities, reduced HDL-cholesterol levels and increased

triglyceride concentrations may be more important in diabetic

patients.

Dyslipidemia and Hypertension :

Hypertension is an independent risk factor for the development of CHD as well as stroke, and does not significantly affect lipid levels. There is a synergistic risk enhancement effect of concurrent dyslipidemia and hypertension. So, every hypertensive patient should be screened for dyslipidemia.