Intensive glucose-lowering therapy (INT) is associated with favorable changes in lipoprotein levels and inflammatory risk factors even though it does not lower the incidence of cardiovascular events, according to a study published online ahead of print in Diabetes Care.
Juraj Koska, MD, from the Phoenix Veterans Affairs Health Care System, and colleagues analyzed standard plasma lipids, cholesterol content of lipoprotein subfractions, and plasma inflammatory and prothrombotic markers in 266 participants of the Veterans Affairs Diabetes Trial. Measurements were taken at baseline and following nine months of either INT or standard therapy.
INT significantly lowered glycated hemoglobin compared to standard treatment (median reduction 2% vs. 0.7%, respectively). INT also significantly increased BMI (4% vs.1%), total HDL (9% vs. 4%), HDL2 (14% vs. 0%), LDL2 (36% vs. 1%), and plasma adiponectin (130% vs. 80%). The study also revealed significant reductions in triglycerides (213% vs. 24%) and small, dense LDL4 (239% vs. 213%). INT had no effect on levels of plasma apolipoproteins B-100 and B-48, C-reactive protein, interleukin-6, lipoprotein-associated phospholipase A2, myeloperoxidase, fibrinogen, and plasminogen activator inhibitor 1. Each quartile increase in baseline interleukin-6, total LDL, apolipoprotein B-100, and fibrinogen was associated with a 33%, 25%, 29%, and 26% increased likelihood of incidence of macrovascular events, but not changes in any cardiovascular risk factors at nine months
“INT was associated with improved adiponectin, lipid levels, and a favorable shift in LDL and HDL subfractions after nine months,” the researchers concluded.