Hormonal
In patients with type 2 diabetes, the characteristic dyslipidemia (low HDL, small dense LDL, elevated triglycerides) is strongly associated with increased cardiovascular disease risk, driven by insulin resistance and altered VLDL metabolism.
If you have type 2 diabetes, standard cholesterol tests might not tell the whole story. You are at higher risk for heart disease due to specific changes in your blood fats (like small, dense LDL and low HDL) driven by insulin resistance. This risk exists even if your total LDL looks normal. Managing this requires addressing the underlying insulin resistance through lifestyle changes (diet, exercise) and often medication, not just focusing on total cholesterol numbers.
Insulin resistance and type 2 diabetes are associated with a clustering of interrelated plasma lipid and lipoprotein abnormalities, which include reduced HDL cholesterol, a predominance of small dense LDL particles, and elevated triglyceride levels. Each of these dyslipidemic features is associated with an increased risk of cardiovascular disease.
Why this rating
The paper cites numerous prospective studies, meta-analyses, and clinical trials (VA-HIT, SCRIP, etc.) establishing this link.
Source
Lipids and Lipoproteins in Patients With Type 2 Diabetes
Ronald M. Krauss · Diabetes Care · 2004
DOI 10.2337/diacare.27.6.1496
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