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Cholesterol-lowering therapy may retard the progression of diabetic nephropathy
K S Lam1, I K Cheng, E D Janus
1Department of Medicine, University of Hong Kong, Queen Mary Hospital.
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.
Insights
Cholesterol-lowering therapy with lovastatin may slow the progression of diabetic nephropathy. In a study of patients with non-insulin-dependent diabetes mellitus, lovastatin treatment preserved glomerular filtration rate compared to placebo.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Endocrinology
Background:
- Hypercholesterolemia is implicated in progressive glomerular injury.
- Diabetic nephropathy is a common complication of diabetes mellitus.
Purpose of the Study:
- To investigate the effect of cholesterol-lowering therapy on diabetic nephropathy progression.
- To assess lovastatin's impact on renal function in patients with non-insulin-dependent diabetes mellitus.
Main Methods:
- A 2-year, single-blind, randomized controlled trial involving 34 patients.
- Patients received either lovastatin (HMG CoA reductase inhibitor) or placebo.
- Renal function was monitored via serum creatinine, glomerular filtration rate (Cr51-EDTA), and urinary protein excretion.
Main Results:
- Lovastatin significantly reduced total cholesterol, LDL-cholesterol, and apo B levels.
- Glomerular filtration rate deteriorated in the placebo group but remained stable in the lovastatin group.
- Serum creatinine increased significantly in the placebo group, with a delayed increase in the lovastatin group.
- Urinary protein excretion increased in both groups, though lovastatin showed no significant adverse effects on liver or muscle enzymes.
Conclusions:
- Effective normalization of hypercholesterolemia may retard diabetic nephropathy progression.
- Lovastatin therapy demonstrated a potential renoprotective effect in patients with diabetic nephropathy.