Cholesterol-lowering therapy may retard the progression of diabetic nephropathy

Diabetologia. 1995 May;38(5):604-9. doi: 10.1007/BF00400731.

Abstract

There is experimental evidence to suggest that hypercholesterolaemia may play a pathogenetic role in progressive glomerular injury. We investigated the effect of cholesterol-lowering therapy on the progression of diabetic nephropathy in 34 patients with non-insulin-dependent diabetes mellitus. Patients were randomly assigned in a single-blind fashion to treatment with either lovastatin, an HMG CoA reductase inhibitor (n = 16; mean dose 30.0 +/- 12.6 mg/day) or placebo (n = 18) for 2 years. Renal function was assessed by serially measuring the serum creatinine, glomerular filtration rate (using Cr51-EDTA), and 24-h urinary protein excretion. Lovastatin treatment was associated with significant reductions in total cholesterol (p < 0.001), LDL-cholesterol (p < 0.001) and apo B (p < 0.01), the reductions at 24 months being 26, 30 and 18%, respectively. Beneficial effects on serum triglyceride, HDL-cholesterol and apo A1 levels were also observed. Lp(a) showed no significant change in both groups. Glomerular filtration rate deteriorated significantly in the placebo group after 24 months (p < 0.025) but showed no significant change in the lovastatin-treated patients. The increase in serum creatinine was statistically significant (p < 0.02) in placebo-treated patients at 12 and 24 months, and in the lovastatin group after 24 months. Twenty-four hour urinary protein excretion increased in both groups (p < 0.05). Lovastatin treatment was not associated with significant elevations in liver or muscle enzymes. We conclude that effective normalisation of hypercholesterolaemia may retard the progression of diabetic nephropathy.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Anticholesteremic Agents / therapeutic use*
  • Apolipoprotein A-I / blood
  • Apolipoproteins / blood
  • Apolipoproteins B / blood
  • Apoprotein(a)
  • Blood Pressure / drug effects
  • Body Mass Index
  • Cholesterol / blood
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Creatinine / blood
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / physiopathology*
  • Diabetic Nephropathies / prevention & control*
  • Diet, Diabetic
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate / drug effects*
  • Glycated Hemoglobin A / analysis
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Lipoprotein(a)*
  • Lovastatin / therapeutic use*
  • Male
  • Middle Aged
  • Placebos
  • Single-Blind Method
  • Time Factors
  • Triglycerides / blood

Substances

  • Anticholesteremic Agents
  • Apolipoprotein A-I
  • Apolipoproteins
  • Apolipoproteins B
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Glycated Hemoglobin A
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Lipoprotein(a)
  • Placebos
  • Triglycerides
  • Cholesterol
  • Lovastatin
  • Creatinine
  • Apoprotein(a)