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KMID : 0338420080230010022
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The Korean Journal of Internal Medicine
2008 Volume.23 No. 1 p.22 ~ p.29
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Flexible Initial Dosing of Atorvastatin Based Upon Initial Low-Density Lipoprotein Cholesterol Levels in Type 2 Diabetic Patients
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Atorvastatin Study Group in Korea
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Abstract
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Background/Aims: We used flexible starting doses and early titration of atorvastatin to determine the rate of
achievement of a low-density lipoprotein cholesterol (LDL-C) target for hyperlipidemic patients with type 2 diabetes mellitus.
Methods :This study was a multicenter, open-label, prospective trial of atorvastatin therapy in hyperlipidemic
patients with type 2 diabetes. The patients were divided into three groups according to initial LDL-C levels (130-149,
150-159 and≥160 mg/dL), and 10, 20, and 40 mg of atorvastatin was administered to each group, respectively. If
LDL-C did not reach the 100 mg/dL target level at four weeks after initiation of treatment, the doses were increased
by one step. Endothelial function tests and plasminogen activator inhibitor (PAI)-1 levels were measured in 41 patients.
Results:Groups of 62, 18, and 69 patients were started on 10, 20, and 40 mg of atorvastatin, respectively, and
91% of the patients achieved the LDL-C target after four weeks of treatment. The overall percentage of patients
achieving the LDL-C target after eight weeks of treatment was 89.3%: 87.5% in the 10 mg group, 86.4% in the 20
mg group, 93.9% in the 40 mg group, and 66.7% in the 80 mg group. A statistically significant reduction was observed
in the mean percentage change in flow-mediated endothelium-dependent dilatation after eight weeks of treatment
(p<0.0001).
Conclusions:Flexible initial dosing and early aggressive titration of atorvastatin according to LDL-C levels is an
efficient and safe strategy for achieving the target level and for improving endothelial dysfunction in hyperlipidemic
patients with type 2 diabetes.
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KEYWORD
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Atorvastatin, Low-density lipoprotein cholesterol (LDL-C), Type 2 diabetes mellitus, Flow-mediated
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