Pravastatin compared to bezafibrate in the treatment of dyslipidemia in insulin-treated patients with Type 2 diabetes mellitus

Background Both HMG-CoA reductase inhibitors and fibric acid derivates are used for the treatment of dyslipidemia in Type 2 diabetes patients. The aim of this study was to compare the lipid lowering effect of 40 mg pravastati n, a HMG-CoA reductase inhibitor, and 400 mg bezafibrate, a fibric acid der ivate, on serum lipids, lipoproteins and lipoprotein composition in 45 (22 men and 23 women) dyslipidemic, insulin-treated Type 2 diabetes patients. Method The study used a double-blind, cross-over design. Results Pravastatin treatment was more effective in reducing total choleste rol, LDL-cholesterol, LDL-triglycerides, LDL-ApoB and LDL/HDL-cholesterol r atio (all p<0.001 between groups) and total/HDL-cholesterol and ApoA1/LDL-A poB ratios (both p<0.01) and always induced a decrease in LDL-cholesterol c oncentrations and LDL/HDL-cholesterol ratio irrespective of baseline trigly ceride concentration. Bezafibrate was more effective in increasing HDL-chol esterol (p<0.01 between groups), ApoA1 lipoprotein and decreasing triglycer ides (both p<0.001 between groups) but induced an increase in LDL-cholester ol concentration particularly in patients with baseline triglyceride concen trations exceeding 2.0 mmol/l. With bezafibrate treatment the LDL-cholester ol/LDL-ApoB ratio showed a tendency to rise, suggesting a change in the LDL particle composition to a less small and dense form, while pravastatin tre atment induced a decrease in this ratio suggesting a change in the LDL part icle to a more dense form. With pravastatin treatment a small rise in HbA(1 c) was observed. Conclusion Pravastatin treatment is superior in lowering cholesterol-enrich ed lipoprotein subpopulations and improving cardiovascular risk factors. Be zafibrate is more effective in raising HDL-cholesterol and alters LDL parti cle composition to a more favorable form. Copyright (C) 2000 John Wiley & S ons, Ltd.