Controversies in dyslipidemias: atheroprevention in diabetes and insulin resistance.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in industrialized countries. Patients with diabetes and insulin resistance are at even greater risk than the general population. Risk factors may be even more significant in predicting risk of disease when present in diabetic patients. Interaction among the elements of the metabolic syndrome/insulin resistance (MS/IR) in atherogenesis is currently the subject of much research. Efforts to understand the elements of the dyslipidemias associated with MS/IR are now beginning to pay off. An increasing number of drugs and other interventions have been shown to be effective in clinical trials in reducing risk factors and improving outcomes. The advantages and disadvantages of possible treatments of these dyslipidemias, including the risks and benefits of combination therapy, are discussed in detail. Finally, strategies for maintaining glucose control and the role of inflammation associated with MS/IR and CVD are described.