Journal Report
05/03/2004

Lipid-lowering drug may reduce risk of type 2 diabetes

DALLAS, May 4 – A drug used mainly to treat high triglycerides may also prevent or slow the onset of type 2 diabetes in coronary artery disease patients, according to research published in today’s rapid access issue of Circulation: Journal of the American Heart Association.

Bezafibrate, which reduces both LDL (bad) cholesterol and triglycerides, while increasing HDL (good) cholesterol, was associated with “about a 30 percent reduction in diabetes onset in patients with coronary artery disease,” said Alexander Tenenbaum, M.D., Ph.D., assistant professor of cardiology at Tel-Aviv University, from the Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hasomer, Israel.

“Bezafibrate also delayed the onset of diabetes by about one year,” he said.  “This confirms that diabetes is preventable with both lifestyle and pharmacological interventions.”

Earlier research reported that intense lifestyle modifications – such as dietary changes and regular physical activity – reduced the risk of type 2 diabetes.  Also called adult onset diabetes, it’s associated with obesity, high blood pressure and a sedentary lifestyle.

Since poor sugar metabolism is another risk factor for type 2 diabetes, drugs that improve glucose metabolism also reduce the risk for type 2 diabetes.

“This is the first study to demonstrate that improving lipid metabolism can reduce the risk of type 2 diabetes in patients with coronary artery disease,” Tenenbaum said.  “These results are very promising and warrant more study.”

The study enrolled 303 nondiabetic coronary artery disease patients ages 42 to 74.  Most were men who’d had a heart attack.  All had fasting blood glucose levels of 110 to 125 milligrams per deciliter (mg/dL), a level considered “pre-diabetes,” Tenenbaum said.  The patients received dietary advice, but weren’t closely monitored or encouraged to change their lifestyle.

Researchers gave 156 of the randomized patients 400 mg of bezafibrate daily; 147 patients got placebo.  The patients were followed for 6.2 years on average.

During followup, a significant portion in each group developed diabetes: 66 patients (42.3 percent) in the bezafibrate group and 80 patients (54.4 percent) in the placebo.  Additionally, the average time to onset of diabetes was 3.8 years in the placebo group, compared to 4.6 years in the bezafibrate group.

Tenenbaum noted that it may be possible to combine bezafibrate with other drugs to achieve even better results.  For example, angiotensin-converting enzyme inhibitors (ACE inhibitors), which are used to treat high blood pressure, and statins – another class of lipid-lowering drugs – are associated with reduced risk of diabetes or complications of coronary artery disease.  Thus, the effect of combining bezafibrate with statins and/or ACE inhibitors should be studied, he said.

Co-authors are Michael Motro, M.D.; Enrique Z. Fisman, M.D.; Ehud Schwammenthal, M.D.; Yehuda Adler, M.D.; Ilan Goldenberg, M.D.; Jonathan Leor, M.D.; Valentina Boyko, MS; Lori Mandelzweig, M.P.H.; and Solomon Behar, M.D.

Editor’s note: The American Heart Association’s program The Heart of Diabetes:  Understanding Insulin Resistance is a FREE 12-month program that educates people about the link between cardiovascular disease, diabetes and insulin resistance.  People with type 2 diabetes are encouraged to control their heart disease risk through physical activity, nutrition and cholesterol management.  People wishing to register for the program should call 1-800-AHA-USA1 or visit americanheart.org/diabetes.

NR04–1249 (Circ/Tenenbaum)

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