IN BRIEF Diabetes is associated with a high risk of cardiovascular disease (CVD). The management of diabetic dyslipidemia, a well-recognized and modifiable risk factor, is a key element in the multifactorial approach to prevent CVD in individuals with type 2 diabetes.

Diabetes is associated with a high risk of cardiovascular disease. The management of dyslipidemia, a well-recognized and modifiable risk factor among patients with type 2 diabetes, is an important element in the multifactorial approach to prevent coronary heart disease. Diabetic dyslipidemia typically consists of elevated triglyceride, low high-density lipoprotein cholesterol (HDL-C), and the predominance of small dense low-density lipoprotein (LDL) particles. LDL cholesterol (LDL-C) levels in patients with diabetes are similar to those found in the rest of the population. During the past few years, clinical trials have provided evidence that lipid-lowering therapy has a similar beneficial effect on cardiovascular outcomes in diabetic and nondiabetic individuals. According to current guidelines, the primary lipid target is an LDL-C <100 mg/dL (<70 mg/dL in very high-risk patients) and, to this end, statins are the agents of choice. The appropriate management of dyslipidemia in patients with diabetes, particularly in individuals with low LDL-C, remains controversial. To achieve lipid targets, attention should be directed first toward nonpharmacologic therapeutic interventions to control dyslipidemia, such as diet, exercise, smoking cessation, weight loss, and glycemic control. Statin therapy is recommended for most subjects but, frequently, a combination of lipid-lowering agents is required. A number of combinations are possible, and several factors should be considered to improve the safety of this strategy.

OBJECTIVE:To compare plasma plasminogen activator inhibitor type 1 (PAI-1) levels and to examine the association of PAI-1 with visceral adiposity and other components of the metabolic syndrome in overweight and obese premenopausal African-American (AA) and Caucasian (CC) women. DESIGN: Cross-sectional study. SUBJECTS: 33 CC and 23 AA healthy, overweight and obese, premenopausal women (age 19 -53 y, body mass index 28.1 -48.9 kg=m 2 ). MEASUREMENTS: Body mass index, sagittal diameter, waist circumference, percentage body fat, visceral and subcutaneous adipose tissue (by anthropometry, magnetic resonance imaging (MRI), and bioelectric impedance techniques), PAI-1, leptin, lipids, glucose, insulin, and insulin resistance (by HOMA IR). RESULTS: AA women had lower triglyceride levels and less visceral adipose tissue (VAT) volume than CC despite similar BMI. PAI-1 levels were not significantly different in the two groups. Insulin resistance was associated with PAI-1 in both groups but only in CC women were VAT, triglyceride, HDL cholesterol and blood pressure related to plasma PAI-1 levels. Multiple regression analysis showed that VAT in CC and insulin resistance in AA were independent predictors of PAI-1. CONCLUSION: VAT is significantly associated with circulating PAI-1 levels in overweight and obese CC but not AA premenopausal women.

Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis in central obesity has been demonstrated in women. We studied the corticotropin (ACTH) and cortisol response to ovine corticotropin releasing hormone (oCRH) and its association to parameters of adiposity and insulin resistance in a group of 19 healthy obese (BMI > 25 kg/m2) and 9 non-obese men. Relative insulin resistance was assessed by the homeostatic model assessment (HOMA IR). Baseline ACTH was similar, while cortisol was lower in the obese group. The ACTH response to oCRH was significantly higher in the obese group. ACTH incremental area under the curve (iAUC) correlated with age, HOMA IR, and sagittal diameter but not with leptin. In multiple regression analysis, only HOMA IR was an independent predictor of ACTH iAUC. In conclusion, obese men have hyperactivity of the HPA axis at the pituitary level, which appears to be linked to insulin resistance.

Background: Assessment of hypothalamic-pituitary-adrenal (HPA) axis function in stress-related health problems in humans is frequently carried out as a dynamic test by measuring the profile of increment in adrenocortical hormone (ACTH) and/or cortisol level in plasma in response to corticotropin-releasing hormone (CRH) administration. However, obtaining multiple blood samples for this type of test is not only an invasive procedure but also problematic to use in individuals with constricted or damaged veins which collapse during the blood draw such as the injecting drug users (IDUs) and HIV-1-infected individuals. Salivary cortisol measurement presents a non-invasive alternate approach to evaluate HPA axis activity in different situations. In order to validate the efficacy of salivary cortisol measurement for a dynamic test in IDUs and HIV-1-infected individuals, the present study was carried out to evaluate the cortisol profile in matched samples of plasma and saliva in healthy young men in response to ovine CRH (oCRH) administration. Methods: Cortisol levels were measured in matched samples of plasma and saliva of healthy young men at baseline and over a 90-min period after administration of a single low dose of oCRH (1 µg/kg). Results: Salivary cortisol levels were found to follow the profile similar to that of plasma, increasing significantly at each time point after oCRH administration from their respective baseline values (all Sign tests, p < 0.05). The peak level of cortisol occurred at 30 min in both fluids. Although salivary cortisol concentration was a fraction of the total plasma cortisol levels at all time points, there was a significant correlation in the values between the two fluids at baseline (r = 0.87, p < 0.02) as well as at 90 min (r = 0.70, p < 0.03). Conclusion: The findings support the earlier studies and substantiate the efficacy of using salivary free cortisol measurement for assessment of dynamic function of pituitary-adrenal axis in healthy young men and its application in individuals such as IDUs and HIV-infected individuals who may have difficulty in donating multiple blood samples.