Impact of an ACE inhibitor and calcium antagonist on microalbuminuria and lipid subfractions in type 2 diabetes: a randomised, multi-centre pilot study

Abstract

Background: Microalbuminuria (MA) is associated with increased cardiovascular risk and lipid abnormalities in people with type 2 diabetes. ACE inhibitors and calcium channel blockers (CCBs) reduce MA and are neutral on total cholesterol and triglycerides. The effect of ACE inhibitors and CCBs on lipid subfractions such as Lp(a), apolipoprotein (apo) A1, apo B, and others, however, is unclear. The current study tests the hypothesis that a fixed-dose combination of an ACE inhibitor, benazepril (B) with the dihydropyridine CCB, amlodipine (A), will further reduce arterial pressure and reduce atherogenic lipid fractions compared to either agent alone. Design: A multicentre, randomised, open-label, parallel group design was used to study 27 participants with type 2 diabetes. Measurements for total cholesterol, high-and low-density lipoprotein (HDL and LDL), triglycerides, apo A1, apo B, Lp(a), MA, arterial pressure and creatinine clearance were obtained at baseline and at 12-week intervals during the 36 week study. Results: Arterial pressure was significantly reduced at 36 weeks in all three groups (P ‫؍‬ 0.0078 for A, P ‫؍‬

Distinct effects of fixed combinations of valsartan with either amlodipine or hydrochlorothiazide on lipoprotein subfraction profile in patients with hypertension

“…Benazepril alone or in combination with amlodipine significantly increased HDL-C levels and decreased lipoprotein (a) levels compared with amlodipine monotherapy in 27 patients with type 2 diabetes after 36 weeks of treatment. 24 The increase in TG-rich lipoproteins as reflected by the increase in VLDL-C concentration may be the major mechanism to explain the redistribution of LDL-C from larger to sdLDL particles in the V --H group. Overproduction of large TG-rich VLDL particles could serve as a substrate for the production of sdLDL subfractions.…”

“…31 However, 36-week treatment with benazepril or amlodipine alone or in combination did not significantly change LDL particle size in 27 patients with type 2 diabetes. 24 Thiazides normally exhibit a neutral effect on HDL-C levels with few reports of a slight decrease. 20,32 ARBs also seem not to exert significant alterations in HDL-C levels with the exception of reports showing a mild increase.…”

“…36 Furthermore, amlodipine or benazepril as monotherapy or their combination had no significant effect on the cholesterol concentration of both HDL2 and HDL3 subfractions in 27 patients with type 2 diabetes after 36 weeks of treatment. 24 The adverse effects of antihypertensive drugs on the lipoprotein subfraction profile could be partially compensated by treatment with statins. Statins reduce the cholesterol concentration of all LDL subfractions equally.…”

The predictive role of serum triglyceride to high-density lipoprotein cholesterol ratio according to renal function in patients with acute myocardial infarction

“…As shown in Table 1, about 69% of patients were prescribed ACE inhibitors as a discharge medication. Several studies have shown a relationship between ACE inhibitors and the lipid profile, especially the atherogenic index [13]. We then, analyzed the groups of patients separately according to ACE inhibitor usage to investigate whether these drugs had an impac on Comparison between patients with low, middle, and high tertile of TG/HDL-C ratio.…”

Antihypertensive therapy in diabetes mellitus: insights from ALLHAT and the Blood Pressure-Lowering Treatment Trialists’ Collaboration meta-analysis

“…A common mediator of end-organ damage in both hypertension and DM seems to be the Renin Angiotensin Aldosterone System (RAAS), and blockade of the RAAS therefore offers protection not only for BP reduction, but also for reducing end-organ damage in subjects with DM. 14 There are also beneficial effects of combination therapy in comparison with the individual drugs alone, 15,16 and the enthusiasts would strenuously argue that ACE inhibitors have advantageous effects on the development of diabetic complications beyond their BP-lowering effects. 17,18 Indeed, combination therapy with angiotensin II receptor blockers (ARB) and an ACE inhibitor has been advocated in hypertension, not only in the presence of DM 19,20 but also in the absence of DM.…”