ABSTRACT
Purpose@#Diabetes and dyslipidemia are leading causes of mortality and morbidity. According to international guidelines, statins are the cornerstone of treatment in patients with diabetes and/or dyslipidemia. However, statins and antidiabetic agents have opposite pharmacological effects, because statins, particularly atorvastatin and rosuvastatin, impair glucose homeostasis, increasing the risk of new-onset diabetes, whereas antidiabetic drugs improve glycemic homeostasis. The aim of this study was to investigate the effect of atorvastatin, rosuvastatin, and pitavastatin on glucose homeostasis in patients with type 2 diabetes mellitus (T2DM) and dyslipidemia during stable treatment with hypoglycemic drugs. @*Materials and Methods@#The study was conducted as a pilot, prospective, randomized, open label, parallel group with blindedendpoints (PROBE) study. Of 180 recruited patients with T2DM and dyslipidemia, 131 were randomized to atorvastatin (n=44), rosuvastatin (n=45), and pitavastatin (n=42) and treated for 6 months. @*Results@#Fasting plasma glucose (FPG) marginally decreased in patients assigned to atorvastatin (-3.5 mg/dL, p=0.42) and rosuvastatin (-6.5 mg/dL, p=0.17), while it decreased much more in patients treated with pitavastatin (-19.0 mg /dL, p<0.001). Mean glycated hemoglobin A1c (HbA1c ) values remained unchanged during treatment with atorvastatin (-0.10%, p=0.53) and rosuvastatin (0.20%, p=0.40), but were significantly reduced with pitavastatin (-0.75%, p=0.01). Atorvastatin, rosuvastatin, and pitavastatin significantly lowered (p<0.001) plasma levels of total cholesterol, low-density lipoprotein-cholesterol, and triglycerides, while highdensity lipoprotein-cholesterol (HDL-C) levels increased significantly (p=0.04) only in the pitavastatin group. @*Conclusion@#The results of the present study suggest that pitavastatin affects FPG and HbA1c less than atorvastatin and rosuvastatin in patients with T2DM and concomitant dyslipidemia. Lipid-lowering efficacies were not significantly different among the three statins, with the exception of HDL-C, which increased significantly with pitavastatin. Although the pharmacological mechanism of pitavastatin on glucose homeostasis in patients with T2DM during stable antidiabetic therapy is not known, it can be assumed that pitavastatin has less drug interaction with hypoglycemic agents or that it increases plasma levels of adiponectin.
ABSTRACT
The clinical prognostic importance of white coat hypertension (WCH), that is, the clinical condition characterized by an increase of office but a normal ambulatory or home blood pressure (BP) is since a long time matter of considerable debate. WCH accounts for a consistent portion of hypertensive patients (up to 30–40%), particularly when hypertension is mild or age is more advanced. Although scanty and inconsistent information is available on the response of office and out-office BP to antihypertensive treatment and the cardiovascular (CV) protection provided by treatment, an increasing body of evidence focusing on the association of WCH with CV risk factors, subclinical cardiac and extra-cardiac organ damage and, more importantly, with CV events indicates that the risk entailed by this condition is intermediate between true normotension and sustained hypertension. This review will address a number of issues concerning WCH with particular attention to prevalence and clinical correlates, relation with subclinical target organ damage and CV morbidity/mortality, therapeutic perspectives. Several topics covered in this review are based on data acquired over the past 20 years by the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, a longitudinal survey performed by our group on the general population living in the surroundings of Milan area in the north part of Italy.
ABSTRACT
The clinical prognostic importance of white coat hypertension (WCH), that is, the clinical condition characterized by an increase of office but a normal ambulatory or home blood pressure (BP) is since a long time matter of considerable debate. WCH accounts for a consistent portion of hypertensive patients (up to 30–40%), particularly when hypertension is mild or age is more advanced. Although scanty and inconsistent information is available on the response of office and out-office BP to antihypertensive treatment and the cardiovascular (CV) protection provided by treatment, an increasing body of evidence focusing on the association of WCH with CV risk factors, subclinical cardiac and extra-cardiac organ damage and, more importantly, with CV events indicates that the risk entailed by this condition is intermediate between true normotension and sustained hypertension. This review will address a number of issues concerning WCH with particular attention to prevalence and clinical correlates, relation with subclinical target organ damage and CV morbidity/mortality, therapeutic perspectives. Several topics covered in this review are based on data acquired over the past 20 years by the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, a longitudinal survey performed by our group on the general population living in the surroundings of Milan area in the north part of Italy.