Cholesterol-lowering therapy may retard the progression of diabetic nephropathy

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.

Intrarenal arteriosclerosis and impairment of kidney function in NIDDM subjects

“…Recently, Lam et al [10] demonstrated that cholesterol-lowering therapy retarded the progression of nephropathy in NIDDM, reducing the rate of impairment of kidney function, without affecting the albumin excretion rate [10]. This finding can also be interpreted as evidence for a major role for macroangiopathy in the evolution towards ESRF in NIDDM.…”

Microalbuminuria and Associated Factors in Bahraini Patients with Type 2 Diabetes Mellitus

“…While abnormalities of serum lipids are common in patients with type 2 diabetes and persistent albuminuria, some recent prospective studies document an association of high baseline level of serum cholesterol with an increased risk of developing incipient or overt nephropathy in patients with type 2 DM. 20,23 Moreover, Lam et al 24 have reported that lovastatin, a cholesterol-lowering drug, slows the progression of nephropathy in type 2 DM. If larger studies confirm these results, hypercholesterolemia should also be treated aggressively in patients with type 2 DM and microalbuminuria.…”

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.…”