Long-term (18-month) efficacy of atorvastatin therapy in type 2 diabetics at cardiovascular risk

M Velussi
Nutrition, Metabolism, and Cardiovascular Diseases: NMCD 2002, 12 (1): 29-35

BACKGROUND AND AIM: Dyslipidemia (increased triglyceride and low high-density lipoprotein [HDL] levels, with normal or slightly increased total cholesterol levels) is a common characteristic of type 2 diabetics and a major risk factor for cardiovascular diseases. The aim of this study was to evaluate the long-term efficacy of atorvastatin in a cohort of type 2 diabetics.

METHODS AND RESULTS: Participants were divided into 3 groups on the basis of whether they had evidence of myocardial infarction or coronary lesions (group A), a family history of hypercholesterolemia (and/or cardiovascular diseases) and total cholesterol levels constantly above 270 mg/dL in blood samples taken at regular 4-month intervals and previously never at target level (group B), or clinical and/or instrumental (electrocardiogram) evidence of cardiovascular risk (group C). Their mean age was 64 +/- 7 years, known disease duration 0.5 +/- 3 years, body mass index (BMI) 27.7 +/- 1.3 Kg/m2, and haemoglobin A1c 8 +/- 0.6%. Total cholesterol was 256 +/- 24 mg/dL in group A, 298 +/- 25 mg/dL in group B and 244 +/- 31 mg/dL in group C (p < 0.05: group B vs groups A and C). HDL-cholesterol (HDL-C) was 45 +/- 7 mg/dL, triglycerides 225 +/- 20 mg/dL, systolic and diastolic blood pressure (DBP) respectively 144 +/- 7 and 85 +/- 8 mmHg, fibrinogen 330 +/- 23 mg/dL and microalbuminuria 58 +/- 9 mg/L. Eighteen months' atorvastatin treatment (10 mg/day in 106 subjects, 20 mg in 14 subjects, 30 mg in 5 subjects, and 40 mg in 30 subjects) led to a significant decrease in total and low-density lipoprotein (LDL)-cholesterol and triglyceride levels (p < 0.01), with about 86% of the patients achieving target levels, and a significant (p < 0.05) increase in HDL-C. There was a significant decrease in fibrinogen, microalbuminuria and DBP (p < 0.01), without any change in diet, BMI, physical activity or antihypertensive treatment. No new cardiovascular events or hospital admissions due to cardiovascular diseases were recorded during the 18 months of the study.

CONCLUSIONS: These long-term treatment findings confirm and validate previous medium-term results, and suggest that atorvastatin therapy is effective and safe in the primary and secondary prevention of cardiovascular complications in type 2 diabetes.

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