EFFICACY OF SIMVASTATIN FOR LOWERING CHOLESTEROL IN NON-INSULIN-DEPENDENT DIABETIC-PATIENTS WITH HYPERCHOLESTEROLEMIA

Patients with non-insulin-dependent diabetes mellitus (NIDDM) are at h igh risk of cardiovascular disease for many reasons and especially due to the fact that dyslipidemias are more frequent in this group of pat ients. Fibrate derivatives are the drugs of choice when hypertriglycer idemia is the main lipid anomaly. When hypercholesterolemia is predomi nant, the use of resins and nicotinic acid has been advocated but thes e drugs are poorly tolerated on a long-term basis. We assessed the eff ect of simvastatin, a recent HMG-CoA reductase inhibitor in 12 NIDDM p atients with hypercholesterolemia. After 4 weeks of placebo, which did not significantly modify the lipid values, patients were given simvas tatin at increasing dosages (from 10 to a maximum of 40 mg daily) duri ng 24 weeks. Compliance and clinical tolerance were excellent. There w as no major biological side effect, but a significant deterioration of glucose control was noted at the end of the study. Simvastatin reduce d total cholesterol by 28%, LDL-cholesterol by 36% and apo B by 31%. C oncomitantly, there was an increase of HDL-cholesterol by 15%. This im provement of lipid profile-persisted during the 24 weeks of treatment. Comparing the patients with pure hypercholesterolemia to those presen ting combined hyperlipidemia, it was evident that the hypolipidemic ef fect was more marked in the diabetic subjects with combined hyperlipid emia.