Aggressive
Lipid Lowering Does Not Improve Endothelial Function in Type 2
Diabetes
The
Diabetes Atorvastatin Lipid Intervention (DALI) Study: a randomized,
double-blind, placebo-controlled trial
Endothelial
dysfunction is considered an important early marker of
atherosclerosis and cardiovascular risk and is currently
used as a surrogate end point for cardiovascular risk in
clinical trials. Type 2 diabetic patients show a characteristic dyslipidemia.
Aggressive lipid lowering might be an effective method to
improve endothelial function in these patients.
To
show that aggressive lipid lowering could be an effective way to
improve endothelial function in type 2 diabetic patients , a
randomized, double-blind, placebo-controlled trial was
completed to study the effect of 30 weeks’ administration
of atorvastatin 10 mg and 80 mg on endothelial function, as
assessed by B-mode ultrasound of the brachial artery, in
133 patients with type 2 diabetes without a history of
cardiovascular disease.
The
results of the study showed that patients with diabetes and diabetic
dyslipidemia had considerable endothelium-dependent and
endothelium-independent dysfunction; mean flow-mediated
vasodilation (SD) was 3.16% (3.56), and mean response on
sublingual nitroglycerin was 6.58% (6.04). Despite
substantial lowering of all atherogenic lipid parameters, no
improvement of endothelium-dependent vasodilatation was
found (P > 0.8).
The
study showed considerable baseline endothelium-dependent and
endothelium-independent dysfunction in patients with diabetes and
diabetic dyslipidemia without a history of cardiovascular disease.
It
was concluded from the results that aggressive lipid lowering by
administration of atorvastatin, resulting in substantial
improvement of the lipid profile, did not reverse
endothelial dysfunction. Diabetes
Care 25:1223-1228, 2002
