The effect of atorvastatin on serum lipids, lipoproteins and NMR spectroscopy defined lipoprotein subclasses in type 2 diabetic patients with ischaemic heart disease

• Published in: Atherosclerosis Vol. 167; no. 2; pp. 243 - 255
• Main Authors: Soedamah-Muthu, S.S., Colhoun, H.M., Thomason, M.J., Betteridge, D.J., Durrington, P.N., Hitman, G.A., Fuller, J.H., Julier, K., Mackness, M.I., Neil, H.A.W.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01.04.2003; Elsevier
• Subjects: Aged; Atorvastatin; Biological and medical sciences; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Double-Blind Method; Female; General and cellular metabolism. Vitamins; Heptanoic Acids - administration & dosage; HMG-CoA reductase inhibitors; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hyperlipidemias - complications; Hyperlipidemias - diagnosis; Hyperlipidemias - drug therapy; Lipoprotein subclasses; Lipoproteins, HDL - blood; Lipoproteins, HDL - drug effects; Lipoproteins, LDL - blood; Lipoproteins, LDL - drug effects; Lipoproteins, VLDL - blood; Lipoproteins, VLDL - drug effects; Magnetic Resonance Spectroscopy; Male; Medical sciences; Middle Aged; Myocardial Ischemia - complications; Myocardial Ischemia - diagnosis; Myocardial Ischemia - drug therapy; NMR spectroscopy; Patient Compliance; Pharmacology. Drug treatments; Probability; Pyrroles - administration & dosage; Reference Values; Risk Assessment; Treatment Outcome; Diabetes; Lipoprotein subclasses; NMR spectroscopy; HMG-CoA reductase inhibitors; Endocrinopathy; Human; Cardiovascular disease; Lipids; NMR spectrometry; Statin derivative; Lipoprotein; Coronary heart disease; Myocardial disease; Non insulin dependent diabetes; Vascular disease; Concomitant disease; Ischemia; Placebo; Atorvastatin; Myocardium; Clinical trial; Subtype; Comparative study; Antilipemic agent
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/S0021-9150(02)00428-8

The effect of statin therapy on subclasses of LDL, VLDL and HDL lipoproteins is unclear. We compared changes in serum lipids, apolipoproteins and nuclear magnetic resonance (NMR) spectroscopy measured lipoprotein subclass concentration and average particle size over a minimum 6 months treatment period of atorvastatin 10 mg vs. placebo in 122 men and women. All subjects had type 2 diabetes and a modest dyslipidaemia (mean LDL-cholesterol 3.2 mmol/l and median triglycerides 1.8 mmol/l) and had a previous myocardial infarction. Compared with placebo, atorvastatin therapy was associated with a greater decrease in medium VLDL (median within person change −13.4 vs. −5.9 nmol/l, P<0.001 adjusted for baseline level), small VLDL (median change −17.8 vs. −8.1 nmol/l, P=0.002), large LDL (mean within person change −167.9 vs. −48.6 nmol/l, P<0.001) and medium LDL (median within person change −101.8 vs. −22.3 nmol/l, P=0.017). Atorvastatin therapy was also associated with a greater increase in large HDL than placebo (median change 1.40 vs. 0.80 μmol/l, P=0.02) and there was little change in small HDL so that average HDL particle size increased significantly with atorvastatin ( P=0.04). In addition to reducing levels of (enzymatically measured) triglyceride, LDL-cholesterol and apolipoprotein B in diabetic patients, atorvastatin significantly reduces NMR measured medium and small VLDL and large and medium LDL, and increases large HDL.