Available online 17 April 2024, 117545

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease, characterized by raised blood glucose levels and impaired lipid metabolism.

T2DM shows a plasma lipoprotein phenotype consisting in higher levels of apolipoprotein (apo) B-containing lipoproteins, hypertriglyceridemia, low levels of HDL cholesterol, elevated number of small, dense LDL, and increased non-HDL cholesterol.

This peculiar lipoprotein phenotype mainly results from an increased synthesis and impaired clearance of triglyceride rich lipoproteins and accelerates the development of the atherosclerotic cardiovascular disease (ASCVD).

The most relevant lipoprotein structural alterations are post-secretory glycation and oxidation in the extracellular matrix of vascular intima following increased ApoB-containing particle retention.

Inference of clinical intervention studies identify the number of ApoB-containing lipoproteins as a stronger driver of the pathological processes resulting in clinical outcomes than their composition in triglycerides and cholesterol.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease, characterized by raised blood glucose levels and impaired lipid metabolism resulting from insulin resistance and relative insulin deficiency. In diabetes, the peculiar plasma lipoprotein phenotype, consisting in higher levels of apolipoprotein B-containing lipoproteins, hypertriglyceridemia, low levels of HDL cholesterol, elevated number of small, dense LDL, and increased non-HDL cholesterol, results from an increased synthesis and impaired clearance of triglyceride rich lipoproteins. This condition accelerates the development of the atherosclerotic cardiovascular disease (ASCVD), the most common cause of death in T2DM patients. Here we review the alteration of structure, functions, and distribution of circulating lipoproteins and the pathophysiological mechanisms that induce these modifications in T2DM. The review analyzes the influence of diabetes-associated metabolic imbalances throughout the entire process of the atherosclerotic plaque formation, from lipoprotein synthesis to potential plaque destabilization. Addressing the different pathophysiological mechanisms, we suggest improved approaches for assessing the risk of adverse cardiovascular events and clinical strategies to reduce cardiovascular risk in T2DM and cardiometabolic diseases.

lipoproteins

Apolipoproteins

atherogenesis

diabetes

cardiometabolic disease

human

pre-clinical studies

Cholesterol

Triglycerides

© 2024 The Authors. Published by Elsevier B.V.