Effects of patient-tailored atorvastatin therapy on ameliorating the levels of atherogenic lipids and inflammation beyond lowering low-density lipoprotein cholesterol in patients with type 2 diabetes

Jang Won Son, Dong Jun Kim, Chang Beom Lee, Seungjoon Oh, Kee-Ho Song, Chan Hee Jung, Ji Oh Mok, Jong Hwa Kim, Min Kyong Moon, Kyung Mook Choi, Jae Hyoung Cho, Sung Hee Choi, Soo Kyung Kim, Kang Seo Park, Hye Soon Kim, In Joo Kim, Young Il Kim, Hae Jin Kim, Sang Yong Kim, Sungrae Kim, Jang Won Son, Dong Jun Kim, Chang Beom Lee, Seungjoon Oh, Kee-Ho Song, Chan Hee Jung, Ji Oh Mok, Jong Hwa Kim, Min Kyong Moon, Kyung Mook Choi, Jae Hyoung Cho, Sung Hee Choi, Soo Kyung Kim, Kang Seo Park, Hye Soon Kim, In Joo Kim, Young Il Kim, Hae Jin Kim, Sang Yong Kim, Sungrae Kim

Abstract

Aims/introduction: Recently, patient-tailored statin therapy was proven effective for achieving target low-density lipoprotein (LDL) cholesterol levels. It is unclear, however, whether this therapeutic modality would be effective for atherogenic lipid profiles and inflammation in patients with type 2 diabetes.

Materials and methods: The present study was an 8-week, multicenter, single-step titration trial of patient-tailored atorvastatin therapy (10, 20 and 40 mg) according to baseline LDL cholesterol levels in 440 patients with type 2 diabetes. We measured the LDL particle size by polyacrylamide gel electrophoresis, and used high-sensitivity C-reactive protein (hsCRP) and adiponectin as surrogate markers of inflammation.

Results: In the intention-to-treat analysis, 91% of the patients achieved their LDL cholesterol targets (<2.6 mmol/L) at week 8. There were significant reductions at week 8 in total cholesterol, triglycerides, non-high-density lipoprotein cholesterol (HDL) cholesterol, and the total cholesterol:HDL cholesterol ratio compared with the baseline values for all of the doses. The mean LDL particle size was significantly increased, and the small, dense LDL cholesterol levels were decreased in a dose-dependent manner over the study period. In addition, the hsCRP levels were decreased in those high-risk patients with baseline hsCRP levels over 3 mg/L (P < 0.001), and the adiponectin levels tended to increase with all of the doses (P = 0.004) at 8 weeks.

Conclusions: Patient-tailored atorvastatin therapy based on LDL cholesterol at baseline was effective in ameliorating atherogenic LDL particle size and inflammation, in addition to achieving the target LDL cholesterol level without an undesirable effect on glycemic control in patients with type 2 diabetes. This trial was registered with ClinicalTrials.gov (no. NCT01239849).

Keywords: Atorvastatin; Low‐density lipoprotein cholesterol; Type 2 diabetes mellitus.

Figures

Figure 1
Figure 1
Flow diagram. AE, adverse events.
Figure 2
Figure 2
The change from the baseline values for the small, dense low‐density lipoprotein (sd‐LDL) levels over the study period. Separate lines are plotted for the groups with 10 mg of atorvastatin (dashed‐dot line), 20 mg of atorvastatin (dashed line) and 40 mg of atorvastatin (solid line). The bars indicate standard errors, and *P < 0.05.
Figure 3
Figure 3
The change from the baseline values for the (a) high‐sensitivity C‐reactive protein (hsCRP), stratified according to the (b) baseline hsCRP category and (c) adiponectin levels. Separate lines are plotted for the groups with 10 mg of atorvastatin (dashed‐dot line), 20 mg of atorvastatin (dashed line) and 40 mg of atorvastatin (solid line). The bars indicate standard errors, and *P < 0.05.

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