HDL biology
First prospective study finds insulin therapy raises CETP without atherogenic lipid changes (Ann N Y Acad Sci 2001)
Original title: Increased cholesteryl ester transfer protein and changes in lipid metabolism from initiating insulin therapy
In 40 diabetic patients, CETP amount and activity were assessed before and two weeks after starting insulin therapy. Insulin lowered total cholesterol, triglycerides, LDL-cholesterol, and remnant lipoprotein cholesterol, with no change in HDL-cholesterol, while simultaneously increasing CETP amount and activity. No significant correlation was found between the changes in CETP and changes in any lipid or apolipoprotein measure, including HDL-cholesterol. As the first prospective study to demonstrate increased CETP activity after starting insulin therapy, the authors conclude that CETP increases without accompanying atherogenic lipid changes, and that a moderate, non-excessive rise in CETP from appropriate insulin therapy is unlikely to be atherogenic in itself.
Original abstract
Insulin therapy is often necessary for glycemic control, and its effect on plasma lipids is an important issue with respect to arteriosclerosis. Previous reports suggested that increased cholesteryl ester transfer protein (CETP) appeared in diabetic patients with hyperinsulinemia or given a lot of insulin is atherogenic. We investigated whether insulin always increases CETP and whether increased CETP by insulin is always atherogenic. In 40 patients the amount and activity of CETP were assessed before and 2 weeks after initiation of insulin therapy. After starting insulin, plasma concentrations of total cholesterol, triglycerides, LDL-cholesterol, and remnant lipoprotein cholesterol decreased. No change occurred in HDL-cholesterol. Starting insulin therapy increased the amount and activity of CEIP. No significant correlation was observed between changes in CETP and in lipids including HDL-cholesterol or apolipoprotein concentrations. This is the first prospective study to show increased CETP activity after initiation of insulin therapy. After initiating insulin, CETP increases without accompanying atherogenic changes in lipid metabolism. Based on the changes observed, CETP in itself does not have atherogenicity and the increase, but no excess, of CETP by appropriate insulin therapy cannot be atherogenic.
Summary written by cetpinhibition.org from the published abstract; figures as published. Page updated 19 August 2026. Methods.