Effects of bezafibrate and pravastatin on remnant-like lipoprotein particles and lipoprotein subclasses in type 2 diabetes

The effects of bezafibrate and pravastatin on remnant-like lipoprotein particles (RLPs) and lipoprotein subclasses were compared in type 2 diabetes. Bezafibrate (400 mg/day) and pravastatin (10 mg/day) were given to 27 Japanese diabetics in a randomized crossover design. RLP cholesterol (RLP-C) and RLP triglyceride (RLP-TG) were measured by an immunoseparation technique. LDL and HDL were separated each into three subclasses (large, medium, small) and their cholesterol (C) contents were measured by an HPLC method. RLP-C was reduced more effectively by pravastatin (bezafibrate -16.0% vs. pravastatin -40.6%, P<0.05), whereas RLP-TG was reduced more effectively by bezafibrate (-55.2% vs. -35.0%, P<0.05). Further, pravastatin decreased large and small LDL-C levels equally (large; -23.6%; medium; -17.2%, small; -21.0%), while bezafibrate produced a relatively larger reduction in small LDL-C (-12.1; -16.9; -21.5%). Whereas bezafibrate significantly decreased large HDL-C and increased medium and small HDL-C (-49.6; 34.1; 35.8%), pravastatin significantly increased only medium HDL-C (5.2; 9.4; 5.9%). Bezafibrate reduced RLP-C and RLP-TG more effectively in patients with high TG levels, whereas pravastatin's effect was not markedly influenced by the initial TG level. Thus measurements of RLP-C, RLP-TG, and HPLC subclasses revealed that bezafibrate and pravastatin differently influence the lipoprotein status in type 2 diabetes.