Atorvastatin or fenofibrate on post-prandial lipaemia in type 2 diabetic patients with hyperlipidaemia

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Abstract

Background

Post-prandial lipid abnormalities might contribute to the excess of cardiovascular risk typical of type 2 diabetic patients. The study evaluated the effects of atorvastatin (20 mg d−1) vs. fenofibrate (200 mg d−1) on post-prandial lipids in type 2 diabetic patients with mixed hyperlipidaemia.

Materials and methods

Eight type 2 diabetic patients, male/female (M/F) 6/2, age 58 ± 5 years, body mass index (BMI) 28 ± 3 kg m−2 with cholesterol of low-density lipoprotein (LDL) between 100–160 mg dL−1 and triglycerides between 150–400 mg dL−1, participated in a randomized, cross-over study (3 months on atorvastatin and 3 months on fenofibrate). At baseline and at the end of the two treatments, the patients were given a standard fat meal; blood samples were taken before the meal and every 2 h after for the assay of cholesterol, triglycerides, apoB-48 and apoB-100 (determined by sodium dodecyl sulphate-polyacrylamide gel electrophoresis) in plasma lipoproteins and very low-density lipoprotein (VLDL) subfractions (large and small VLDL), separated by density gradient ultracentrifugation.

Results

Data on fasting lipids confirmed that atorvastatin was more effective on the reduction of LDL-cholesterol, whereas fenofibrate was a better triglyceride-lowering agent. Concerning the post-prandial phase, the incremental areas under the curve (IAUC) for chylomicrons and large VLDL were reduced after both treatments, reaching statistical significance for cholesterol, triglyceride and apoB-100 content of chylomicrons only after fenofibrate administration [IAUC, (5·2 ± 4·6 vs. 10·7 ± 9·3) mg dL−1 h−1, P = 0·03; (131·3 ± 95·1 vs. 259·1 ± 201·5) mg dL−1 h−1, P = 0·02; (0·46 ± 1 vs. 3 ± 3·7) mg dL−1 h−1, P = 0·025, all respectively].

Conclusion

During the post-prandial state fenofibrate appeared to be more effective than atorvastatin in reducing the chylomicron response.

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