Effect of a Fibrate and a Statin on Endothelial Dysfunction

Inclusion Criteria:

• Age greater than 30 years
• Adult-onset DM (defined as fasting glucose greater than 125 mg/dl or by ongoing treatment with an oral hypoglycemic agent) or metabolic syndrome (defined as at least 3 of the following: 1. HDL less than 40 mg/dl for men or less than 50 mg/dl for women; 2. triglycerides greater than 150 mg/dl; 3. waist circumference greater than 40 inches for men and greater than 35 inches for women; 4. fasting glucose greater than 100 mg/dl).
• LDL cholesterol level less than 140 mg/dl
• Able to provide informed consent and complete study procedures

Exclusion Criteria:

• Change in therapy for glucose control or blood pressure less than 1 month before entry
• Hemoglobin A1C greater than 8.0%.
• Renal insufficiency (serum creatinine greater than 1.6 mg/dl in men or 1.5 mg/dl in women.
• Any investigational drug less than 1 month before entry.
• Pregnancy (excluded by urine pregnancy test at study entry with ongoing use of reliable form of birth control) or lactation
• Liver function tests or serum creatinine kinase (CK) greater than 3 times upper limit of normal.
• Clinically evident major illnesses or other problem that would make participation inappropriate
• Clinical history of symptomatic cholelithiasis
• Patients with coronary artery disease, peripheral arterial disease, or cerebral vascular disease will not be enrolled if they are currently taking lipid-lowering therapy
• Patients taking more than 40 mg/day of atorvastatin will be excluded. There is no "ceiling" level for patients taking fibrates.