Issue 117 Item 7 Atorvastatin Improves Lipid Profile but Not Endothelial Functio

In patients with type 2 diabetes, they found that aggressive atorvastatin monotherapy does not improve endothelial function this patient group. Dr. Michiel L. Bots from the University Medical Center Utrecht, the Netherlands, and colleagues from the Diabetes Atorvastatin Lipid Intervention study assessed the effect of atorvastatin on endothelial function in 133 patients with type 2 diabetes without cardiovascular disease. All the patients had similar endothelium vasodilation at baseline.

Treatment with cholesterol-lowering drugs can restore endothelial function in dyslipidemic patients without diabetes, Dr. Bots’ group explains. However, there are a lack of data on the effect of statins on endothelial function in diabetics.

Patients were assigned to 10 mg or 80 mg of atorvastatin for 30 weeks. Endothelial function was assessed using B-mode ultrasound of the brachial artery.

After 30 weeks, the mean flow-mediated vasodilation among patients receiving 10 mg atorvastatin was 3.20% compared with 3.41% at baseline. Mean response on sublingual nitroglycerin was 6.87% compared with 6.80% at baseline, the researchers found.

Similarly, no significant improves were seen with the higher dosage. The mean flow-mediated vasodilation among patients receiving 80 mg atorvastatin was 3.10% compared with 3.18% at baseline; and the mean response on sublingual nitroglycerin was 6.59% compared with 6.01% at baseline.

Although treatment with atorvastatin substantially reduced the patient’s lipid profile, the researchers found no improvement in endothelium-dependent vasodilation with atorvastatin therapy.

"These results suggest that one should be careful with the extrapolation of the effects of statins on endothelial function in nondiabetic patients to patients with diabetes," Dr. Bots and colleagues conclude. "Furthermore, the relevance of endothelial function improvement as a therapeutic target of statins, especially in patients with diabetes, is a matter of debate, " they add. Diabetes Care 2002;25:1198-1202,1211-1216.