Effects of Atorvastatin versus Fenofibrate on lipoprotein profiles, low-density lipoprotein subfraction distribution, and hemorheologic parameters intype 2 diabetes mellitus with mixed hyperlipoproteinemia

Diabetic dyslipoproteinemia characterized by hypertriglyceridemia, low high -density lipoprotein (HDL) cholesterol, and often elevated low-density lipo protein (LDL) cholesterol with predominance of small, dense LDL is a strong risk factor for atherosclerosis. It is unclear whether fibrate or statin t herapy is more effective in these patients. We compared atorvastatin (10 mg /day) with fenofibrate (200 mg/day), each for 6 weeks separated by a 6-week washout period in 13 patients (5 men and 8 women; mean age 60.0 +/- 6.8 ye ars; body mass index 30.0 +/- 3.0 kg/m(2)) with type 2 diabetes mellitus (h emoglobin A(1c) 7.3 +/- 1.1%) and mixed hyperlipoproteinemia (LDL cholester ol 164.0 +/- 37.8 mg/dl, triglycerides 259.7 +/- 107 mg/dl, HDL cholesterol 48.7 +/- 11.0 mg/dl) using a randomized, crossover design. Lipid profiles, LDL subfraction distribution, fasting plasma viscosity, red cell aggregati on, and fibrinogen concentrations were determined before and after each dru g. Atorvastatin decreased all LDL subfractions (LDL cholesterol, -29%; p <0 .01) including small, dense LDL. Fenofibrate predominantly decreased trigly ceride concentrations (triglycerides, -39%; p <0.005) and induced a shift, in LDL subtype distribution from small, dense LDL (-31%) to intermediate-de nse LDL (+36%). The concentration of small, dense LDL was comparable during therapy to both drugs (atorvastatin 62.8 +/- 19.5 mg/dl, fenofibrate 63.0 +/- 18.1 mg/dl). Both drugs induced an increase in HDL cholesterol (atorvas tatin +10%, p <0.05; fenofibrate +11%, p = 0.06). In addition, fenofibrate decreased fibrinogen concentration (-15%, p <0.01) associated with a decrea se in plasma viscosity by 3% (p <0.01) and improved red cell aggregation by 15% (p <0.05), whereas atorvastatin did not affect any hemorheologic param eter. We conclude that atorvastatin and fenofibrate con improve lipoprotein metabolism in type 2 diabetes. However, the medications affect different a spects of lipoprotein metabolism. (C) 2001 by Excerpta Medico, Inc.