Lipid Lowering Does Not Improve Endothelial Function in Subjects With Poorly Controlled Diabetes
- Jacques Mansourati, MD1,
- Lisa G. Newman, MD2,
- Sheila H. Roman, MD, MPH2,
- Arlene Travis, RN2,
- Mohammad Rafey, MD2 and
- Robert A. Phillips, MD, PHD, FACC3
- 1Department of Cardiology, University Hospital of Brest, Brest, France
- 2Hypertension and Cardiac Health Programs and the Endocrine Division, Mount Sinai School of Medicine, New York, New York
- 3Department of Medicine, Lenox Hill Hospital, New York, New York
Cutaneous microangiopathy is suspected to play a role in the pathogenesis of diabetic foot ulcers (1). Because microcirculatory flow is regulated in part by the endothelium and prior studies of the coronary microcirculation showed significant improvement in endothelium-dependent vasodilatory responses with lipid-lowering therapy (2), we examined the effect of lipid lowering on endothelial function in cutaneous microcirculation in patients with type 2 diabetes.
Patients aged 21–80 years with diabetes and LDL cholesterol >3.4 mmol/l were randomized in a double-blind fashion to treatment with either simvastatin 40 mg daily or placebo and followed for 3 months after randomization. All patients received dietary counseling with regard to lowering LDL, but no attempt was made to alter glycemic control. The study was approved by the Institutional Review Board of the Mount Sinai School of Medicine, and informed consent was obtained before enrollment.
Cutaneous microcirculatory flow from the same site of the dorsum of the foot was measured with the Periflux System PF3 (Perimed, Järfälla, Sweden) at every visit in all patients. The flow response to heating was recorded …
