Improvement in Endothelial Dysfunction With LDL Cholesterol Level <80 mg/dl in Type 2 Diabetic Patients

Type 2 diabetes is associated with a marked increase in the risk of coronary heart disease (CHD). Furthermore, a 7-year follow-up study showed that diabetic patients without previous myocardial infarction have as high a risk of myocardial infarction as nondiabetic patients with previous myocardial infarction (1). All of these observations indicate the importance of aggressive cholesterol lowering in diabetic patients. We have previously shown that type 2 diabetic Chinese subjects are characterized by impaired endothelial-dependent and -independent brachial arterial vasoactivity when compared with nondiabetic individuals (2). However, we failed to demonstrate that treatment with simvastatin (10 mg daily) had beneficial effects on brachial arterial vasoreactivity in type 2 diabetic subjects, despite a 26–35% reduction in LDL cholesterol levels. Because coronary angiographic trials suggested that more intensive LDL cholesterol lowering (<100 mg/dl) is associated with regression or arrest of progression of coronary lesions compared with moderate LDL cholesterol reduction (3), we tested the hypothesis that aggressive lowering of LDL cholesterol would be associated with more …