Simvastatin but not bezafibrate decreases plasma lipoprotein-associated phospholipase A2 mass in type 2 diabetes mellitus: Relevance of high sensitive C-reactive protein, lipoprotein profile and low-density lipoprotein (LDL) electronegativity

ObjectivePlasma lipoprotein-associated phospholipase A2 (Lp-PLA2) levels predict incident cardiovascular disease, impacting Lp-PLA2 as an emerging therapeutic target. We determined Lp-PLA2 responses to statin and fibrate administration in type 2 diabetes mellitus, and assessed relationships of changes in Lp-PLA2 with subclinical inflammation and lipoprotein characteristics.MethodsA placebo-controlled cross-over study (three 8-week treatment periods with simvastatin (40 mg daily), bezafibrate (400 mg daily) and their combination) was carried out in 14 male type 2 diabetic patients. Plasma Lp-PLA2 mass was measured by turbidimetric immunoassay.ResultsPlasma Lp-PLA2 decreased (− 21 ± 4%) in response to simvastatin (p < 0.05 from baseline and placebo), but was unaffected by bezafibrate (1 ± 5%). The drop in Lp-PLA2 during combined treatment (− 17 ± 3%, p < 0.05) was similar compared to that during simvastatin alone. The Lp-PLA2 changes during the 3 active lipid lowering treatment periods were related positively to baseline levels of high sensitive C-reactive protein, non-HDL cholesterol, triglycerides, the total cholesterol/HDL cholesterol ratio and less LDL electronegativity (p < 0.02 to p < 0.01), and inversely to baseline Lp-PLA2 (p < 0.01). LpPLA2 responses correlated inversely with changes in non-HDL cholesterol, triglycerides and the total cholesterol/HDL cholesterol ratio during treatment (p < 0.05 to p < 0.02).ConclusionsIn type 2 diabetes mellitus, plasma Lp-PLA2 is likely to be lowered by statin treatment only. Enhanced subclinical inflammation and more severe dyslipidemia may predict diminished LpPLA2 responses during lipid lowering treatment, which in turn appear to be quantitatively dissociated from decreases in apolipoprotein B lipoproteins. Conventional lipid lowering treatment may be insufficient for optimal LpPLA2 lowering in diabetes mellitus.