Type 2 diabetes mellitus (DM) is characterised by increased oxidative stress as a result of the hyperglycaemic state, leading to decreased nitric oxide bioavailability.¹ Similarly, type 2 DM is characterised by increased levels of proatherogenic cytokines and adhesion molecules,¹ while it has been shown that the endogenous endothelial nitric oxide synthase inhibitor, asymmetrical dimethyl arginine (ADMA), is also elevated in type 2 DM.² Although ADMA synthesis is triggered by both oxidative stress and proinflammatory stimuli, the effect of antioxidant or anti-inflammatory treatment on its release is unclear.

We compared the effects of atorvastatin (which has anti-inflammatory properties in atherosclerosis) and vitamin C (a well-known antioxidant) on the inflammatory process, endothelial function and the release of ADMA in normocholesterolaemic patients with type 2 DM.

METHODS

Forty-one patients with type 2 DM and no evidence of macroangiopathy were recruited (table 1). The absence of coronary artery disease (CAD) was established by a negative exercise stress test within the last 6 months before recruitment, while peripheral artery disease was defined as an ankle brachial index <0.90. All patients had cholesterol <5.4 mmol/l at baseline, and exclusion criteria were the use of statins, insulin, antioxidant supplements, hormone replacement therapy or anti-inflammatory medication during the past year, or the presence of any chronic disease or infection. All subjects had normal renal function (normal creatinine clearance as calculated by the Cockroft-Gault formula and no macroalbuminuria). Patients were randomly allocated into groups receiving atorvastatin (10 mg/day), vitamin C (2 g/day) or no …