Lipoproteins and Ischemic Stroke in Diabetes

About one out of ten US adults have diabetes mellitus (DM), and this prevalence is estimated to significantly increase in the years to come. Dyslipidemia is highly prevalent among patients with DM and plays a key role in the development of atherosclerosis. Several pathological changes occur at the cellular level in the vascular wall that are not explained by inherent hyperglycemia. The insulin resistance characteristic of DM activates inflammation, oxidation, increased thrombotic tendency, and disturbances in the metabolism of lipoproteins such as low-density lipoproteins, triglyceride-rich lipoproteins, and lipoprotein(a). This chapter discusses the pathophysiologic role of dyslipidemia in the development of atherosclerosis and ischemic stroke in patients with DM and reviews the evidence supporting the benefits of lipid-lowering therapies for ischemic stroke risk reduction.