Plasma lipoproteins and renal function during simvastatin treatment in diabetic nephropathy

Abstract

The aim of this study was to assess the effect of simvastatin on plasma lipoproteins and renal function in hypercholesterolaemic Type 1 (insulin-dependent) diabetic patients with diabetic nephropathy. Twenty-six hypercholesterolaemic (total cholesterol greater than or equal to 5.5 mmol/l) Type 1 diabetic patients with nephropathy were enrolled in a double-blind randomized placebo-controlled study for 12 weeks. The active treatment group (n = 14) received simvastatin (10-20 mg/day) for 12 weeks while the remaining 12 patients received treatment with placebo. The results during simvastatin treatment (baseline vs 12 weeks): total cholesterol 6.6 vs 4.8 mmol/l (p less than 0.01), LDL-cholesterol 4.25 vs 2.57 mmol/l (p less than 0.01) and apolipoprotein B 1.37 vs 1.06 mmol/l (p less than 0.01). HDL-cholesterol, and apolipoprotein A-I remained unchanged. Total cholesterol, LDL-cholesterol, HDL-cholesterol, apolipoprotein A-I, apolipoprotein B remained unchanged during placebo treatment. Albuminuria measured during the simvastatin and the placebo treatment (baseline vs 12 weeks) (the data are logarithmically transformed before analysis because of their positively skewed transformation; geometric mean (x/divided by antilog SE) is indicated) was 458 (x/divided by 1.58) vs 393 (x/divided by 1.61) and 481 (x/divided by 1.62) vs 368 (x/divided by 1.78 micrograms/min (NS). Glomerular filtration rate during simvastatin and placebo treatment (baseline vs 12 weeks) was 64 vs 63 and 72 vs 74 ml.min-1.1.73 m-2, respectively. Two patients receiving simvastatin treatment were withdrawn, one due to gastrointestinal side effects and one due to myalgia.(ABSTRACT TRUNCATED AT 250 WORDS)

Do Statins Reduce Blood Pressure?

“…Eighteen randomized, controlled trials met the inclusion criteria and were included in the meta-analysis 9,10,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] (Figure 1). Because 2 of them, 25,26 however, were characterized by having 2 different pairs of control and treatment groups, we considered them as being split in 2 independent studies; thus, the final number of studies analyzed was actually 20.…”

“…One study 9 used probucol, a lipid-lowering drug as control, whereas in another one 26 fluvastatin plus orlistat (an inhibitor of intestinal lipid digestion) were compared with orlistat alone. Pravastatin was the statin used in 8 studies, 9,10,17,[21][22][23]25 simvastatin was used in 5, 15,19,20,24,28 fluvastatin in 2, 26 cerivastatin in 2 studies, 27,30 atorvastatin in 2 studies, 16,29 and lovastatin in 1 study. 18 The duration of treatment varied from 4 weeks 15 to 1 year.…”

“…24,26 Some studies included only hypertensive patients, 10,16,17,23,28,29 others recruited either normotensive or treated hypertensive patients in reasonably good control, 22,30 and a few studies included only normotensive individuals. 22,23,28,30 Four studies included only type 1 or only type 2 diabetic patients, 19,24,27,30 whereas 9 studies excluded patients affected by diabetes 9,10,15,17,18,20,21,23,29 (Table S3).…”

“…Ten studies gave instructions for patients' diet. 10,17,19,20,[23][24][25][26] In 1 study, the patients' previous Figure 1. Schematic representation of the procedure followed to determine the trials to be included in the meta-analysis based on predetermined inclusion/exclusion criteria.…”

The reno-protective role of AT1-receptor blockers

“…1,2 There is little evidence that treatment of dyslipidaemia will offer any protection of renal function, and the few studies that do exist are somewhat conflicting. [43][44][45][46] Obviously, treatment of dyslipidaemia is more important for the prevention of cardiac and vascular disease. 22 Only a few studies have assessed the use of lowprotein diets in diabetic patients.…”