Atorvastatin affects low density lipoprotein and non-high density lipoprotein cholesterol relations with apolipoprotein B in type 2 diabetes mellitus: modification by triglycerides and cholesteryl ester transfer protein

Abstract

Objectives: Non-HDL-cholesterol (non-HDL-C) and apolipoprotein (apo) B are proposed as treatment targets. The extent to which statin therapy affects relationships of LDL-C and non-HDL-C with apoB was examined in type 2 diabetes. Methods: Analyses were performed in 217 hypertriglyceridaemic type 2 diabetic patients (Diabetes Atorvastatin Lipid Intervention (DALI) cohort). 61 patients randomized to placebo, 70 to 10 mg atorvastatin daily and 65 – 80 mg atorvastin daily completed follow-up. Results: Baseline fasting LDL-C of 2.42 mmol/l and non-HDL-C of 3.69 mmol/l corresponded to the apoB guideline target of 0.90 g/l. During atorvastatin (10 and 80 mg daily), the LDL-C target was achieved most frequently, and lower LDL-C (2.38 and 2.29 mmol/l) and non-HDL-C (3.24 and 3.19 mmol/l) concentrations corresponded to this apoB goal. Decreases in LDL-C during atorvastatin treatment were negatively related (p < 0.001), but decreases in non-HDL-C were positively related to changes in triglycerides (p < 0.001), independently from decreases in apoB (p < 0.001 for all). Decreases in LDL-C and non-HDL-C were positively associated with decreases in cholesteryl ester transfer protein mass (p < 0.001). Conclusions: During atorvastatin lower LDL-C and non-HDL-C levels correspond to the apoB guideline target, which would favour its use as treatment target.

Keywords::

• apolipoprotein B
• atorvastatin
• cholesteryl ester transfer protein
• LDL-cholesterol
• non-HDL-cholesterol
• triglycerides

Acknowledgments

The authors wish to thank contributors to the DALI study as patient, technician, or data manager. The following is a complete list of the original DALI-study group (in alphabetical order): Erasmus Medical Centre Rotterdam, Department of Internal Medicine (I Berk-Planken, N Hoogerbrugge, H Jansen); Erasmus University Rotterdam, Departments of Biochemistry and Clinical Chemistry (H Jansen); Gaubius Laboratory TNO-KvL, Leiden (H M G Princen); Leiden University Medical Centre (M V Huisman, M A van de Ree); University Medical Centre Utrecht, Julius Center for General Practice and Patient Oriented Research (R P Stolk, F V van Venrooij); University Medical Center Utrecht, Division of Internal Medicine (J D Banga, G M Dallinga-Thie, F V van Venrooij).