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Interview and laboratory data from the first wave of the German health interview and examination survey for adults (DEGS1) from 2008 to 2011 were used to provide current estimates of the prevalence of dyslipidemia which are representative of the population in Germany 18 to 79 years of age. A total of 56.6 % of men and 60.5 % of women 18 to 79 years have elevated serum total cholesterol concentrations in excess of the currently recommended threshold of 190 mg/dL; 17.9 % of men and 20.3 % of women have highly elevated total cholesterol concentrations ≥ 240 mg/dL. A total of 19.3 % of men and 3.6 % of women have high density lipoprotein cholesterol concentrations below 40 mg/dL. The overall prevalence of dyslipidemia (total cholesterol ≥ 190 mg/dL or medical diagnosis of dyslipidemia) is 64.5 % for men and 65.7 % for women. Of these, more than half of both men and women have previously undiagnosed dyslipidemia. Among persons with known dyslipidemia, 30.8% take lipid-lowering medication. Dyslipidemia is widely prevalent among adults in Germany. More in-depth analyses will examine time trends in the prevalence of dyslipidemia in Germany and in an international comparison. An English full-text version of this article is available at SpringerLink as supplemental.

Patients with type 2 diabetes face a high risk of cardiovascular morbidity and mortality. In these patients a whole cluster of cardiovascular risk factors is found, with insulin resistance being the most significant. Thiazolidinediones, in activating the peroxisome proliferator-activated receptor gamma, lower the insulin resistance. The two thiazolidinediones available at present, pioglitazone and rosiglitazone, do not differ in their effects on insulin resistance or glucose metabolism. They do, however, reveal very different effects on the dyslipidemia that is characteristic of diabetes, with elevated triglycerides, low high-density lipoprotein (HDL) and atherogenic small dense lipoprotein (LDL) cholesterol. Inter alia, data from a comparative study show that pioglitazone improves diabetic dyslipidemia more efficaciously than rosiglitazone. Despite similar effects on hyperglycemia (HbA1c reduction by 0.6% and 0.7%), both thiazolidinediones differ significantly in their effects on triglycerides (pioglitazone -51.9 mg/dl; rosiglitazone +13.1 mg/dl; p < 0.001), HDL cholesterol (pioglitazone +5.2 mg/dl; rosiglitazone +2.4 mg/dl; p < 0.001) and LDL cholesterol (pioglitazone +12.3 mg/dl; rosiglitazone +21.3 mg/dl; p < 0.001). LDL particle concentration was reduced with pioglitazone (n7.85%) and increased with rosiglitazone (+12%; p > 0.001). Only for pioglitazone the PROactive study, a major outcome trial, documented a significant reduction of cardiovascular outcomes. The principal secondary endpoint of death from any cause, nonfatal myocardial infarction (excluding silent myocardial infarction) or stroke was significantly reduced (16%; p = 0.027). The correlation of improved dyslipidemia, reconfirmed by PROactive, and cardiovascular prevention is yet to be resolved. However, as long as the vascular protective mechanism of pioglitazone is not conclusively resolved, findings may not be transmitted to other thiazolidinediones. For these substances, results from major outcome studies are to be required that prove a reduction of the cardiovascular risk.