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Original Article |
Divisions of Clinical Chemistry (K.W., M.M.H., I.F., H.W., W.M.) and Sports Medicine (M.W.B.), Department of Medicine, Albert Ludwigs-University, D-79106 Freiburg, Germany; and Medical Department (C.A.), Novartis Pharma GmbH, D-90429 Nürnberg, Germany
Address all correspondence and requests for reprints to: Karl Winkler, M.D., Department of Medicine, Hugstetter Strasse 55, D-79106 Freiburg, Germany. E-mail: kwinkler{at}ukl.uni-freiburg.de.
Abstract
The objective of this study was to determine the effect of slow-release (XL) fluvastatin on low density lipoprotein (LDL) subfractions in type 2 diabetes. A multicenter, double-blind, randomized, parallel-group comparison of fluvastatin XL 80 mg (n = 42) and placebo (n = 47), each given once-daily for 8 wk, in 89 patients with type 2 diabetes (HbA1c: 7.2 ± 1.0%, LDL cholesterol (LDL-C): 3.4 ± 0.7 mmol/liter, high density lipoprotein cholesterol: 1.1 ± 0.3 mmol/liter, and triglycerides (TG): 2.4 ± 1.4 mmol/liter). At baseline and on treatment, plasma lipoproteins were isolated and quantified. Eight weeks of fluvastatin treatment decreased total cholesterol (23.0%, P < 0.001), LDL-C (29%, P < 0.001) and TG (18%, P < 0.001), compared with placebo. At baseline, there was a preponderance of dense LDL (dLDL) (apolipoprotein B in LDL-5 plus LDL-6 > 25 mg/dl) in 79% of patients, among whom fluvastatin decreased all LDL subfractions, reductions in dLDL being greatest (28%, P = 0.001; cholesterol in dLDL 29%). In patients with low baseline dLDL (apolipoprotein B in LDL-5 plus LDL-6
25 mg/dl), but a preponderance of buoyant LDL (LDL-1 through LDL-3), fluvastatin significantly decreased only these subfractions. Fluvastatin 80 mg XL, once daily, decreased total cholesterol and total LDL-C. In patients with atherogenic dLDL, absolute changes of dLDL were most pronounced, emphasizing the value of fluvastatin treatment in type 2 diabetes. The antiatherogenic potential of fluvastatin in type 2 diabetes may thus be greater than that expected from its effects on LDL-C and TG alone.
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