Differential effects of fenofibrate versus atorvastatin on the concentrations of E-selectin and vascular cellular adhesion molecule-1 in patients with type 2 diabetes mellitus and mixed hyperlipoproteinemia: a randomized cross-over trial
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vor 21 Jahren
Background: Diabetic dyslipoproteinemia is characterized by
hypertriglyceridemia, low HDL-cholesterol and often elevated
LDL-cholesterol and is a strong risk factor for atherosclerosis.
Adhesion molecule levels are elevated both in hyperlipoproteinemia
and diabetes mellitus. It is unclear whether fibrate or statin
therapy has more beneficial effects on adhesion molecule
concentrations. Methods: Atorvastatin (10 mg/d) was compared to
fenofibrate (200 mg/d) each for 6 weeks separated by a 6 week
washout period in 11 patients (6 male, 5 female; 61.8 +/- 8.2
years; body mass index 29.8 +/- 3.1 kg/m(2)) with type 2 diabetes
mellitus (HbA(1c) 7.3 +/- 1.1 %) and mixed hyperlipoproteinemia
using a randomized, cross-over design. Fasting blood glucose,
HbA(1)c, lipid parameters, E-selectin, ICAM-1, VCAM-1, and
fibrinogen concentrations were determined before and after each
drug. Results: Glucose and HbA(1)c concentrations remained
unchanged during the whole study period. LDL cholesterol was
reduced during atorvastatin therapy, triglycerides were lowered
more effectively with fenofibrate. Comparison of pre- and
postreatment concentrations of E-selectin showed a reduction during
atorvastatin (-7 %, p = 0.11) and fenofibrate (-10 %, p < 0.05)
therapy. Atorvastatin treatment reduced VCAM-1 levels by 4% (p <
0.05), while VCAM-1 concentrations remained unchanged (+1%, ns)
during fenofibate therapy. However, direct comparisons of
posttreatment levels during both forms of therapy were not of
statistical significance. ICAM-1 levels were not influenced by
either form of therapy. Conclusions: In addition to the different
beneficial effects on lipid metabolism, both drugs appear to lower
adhesion molecule plasma concentrations in a different manner in
patients with type 2 diabetes and mixed hyperlipoproteinemia. Our
observations should be confirmed in a larger cohort of such
patients.
hypertriglyceridemia, low HDL-cholesterol and often elevated
LDL-cholesterol and is a strong risk factor for atherosclerosis.
Adhesion molecule levels are elevated both in hyperlipoproteinemia
and diabetes mellitus. It is unclear whether fibrate or statin
therapy has more beneficial effects on adhesion molecule
concentrations. Methods: Atorvastatin (10 mg/d) was compared to
fenofibrate (200 mg/d) each for 6 weeks separated by a 6 week
washout period in 11 patients (6 male, 5 female; 61.8 +/- 8.2
years; body mass index 29.8 +/- 3.1 kg/m(2)) with type 2 diabetes
mellitus (HbA(1c) 7.3 +/- 1.1 %) and mixed hyperlipoproteinemia
using a randomized, cross-over design. Fasting blood glucose,
HbA(1)c, lipid parameters, E-selectin, ICAM-1, VCAM-1, and
fibrinogen concentrations were determined before and after each
drug. Results: Glucose and HbA(1)c concentrations remained
unchanged during the whole study period. LDL cholesterol was
reduced during atorvastatin therapy, triglycerides were lowered
more effectively with fenofibrate. Comparison of pre- and
postreatment concentrations of E-selectin showed a reduction during
atorvastatin (-7 %, p = 0.11) and fenofibrate (-10 %, p < 0.05)
therapy. Atorvastatin treatment reduced VCAM-1 levels by 4% (p <
0.05), while VCAM-1 concentrations remained unchanged (+1%, ns)
during fenofibate therapy. However, direct comparisons of
posttreatment levels during both forms of therapy were not of
statistical significance. ICAM-1 levels were not influenced by
either form of therapy. Conclusions: In addition to the different
beneficial effects on lipid metabolism, both drugs appear to lower
adhesion molecule plasma concentrations in a different manner in
patients with type 2 diabetes and mixed hyperlipoproteinemia. Our
observations should be confirmed in a larger cohort of such
patients.
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