The effect of high dose atorvastatin therapy on lipids and lipoprotein subfractions in overweight patients with type 2 diabetes

Few data are available on the effects of high dose statin therapy on lipoprotein subfractions in type 2 diabetes. In a double blind randomised placebo-controlled trial we have studied the effects of 80 mg atorvastatin over 8 weeks on LDL, VLDL and HDL subfractions in 40 overweight type 2 diabetes patients. VLDL and LDL subfractions were prepared by density gradient ultracentrifugation. Triglycerides, cholesterol, total protein and phospholipids were measured and mass of subtractions calculated. HDL subfractions were prepared by precipitation. Atorvastatin 80 mg produced significant falls in LDL subfractions (LDL1 66.2 mg/dl:36.6 mg/dI, LDL2 118:56.6 mg/dI, LDL3 36.9:19.9 mg/dI all P < 0.0 1 relative to placebo) and VLDL subtractions (VLDL1 55:22.1 mg/dI, VLDL2 40.1:19.1 mg/dI, VLDL3 52.6:30 mg/dI all P < 0.01 relative to placebo). There was no change in the proportion of LDL present as LDL3. There was a reduction in the proportion of VLDL as VLDL1 and a reciprocal increase in the proportion as VLDL3. Changes in VLDL subfractions were associated with changes in lipid composition, particularly a reduction in cholesterol ester and a reduction in the cholesterol ester/triglyceride ratio. Effects on HDL subfractions were largely neutral. High dose atorvastatin produces favourable effects on lipoprotein subfractions in type 2 diabetes which may enhance antiatherogenic potential. (C) 2004 Elsevier Ireland Ltd. All rights reserved.