A lovastatina no tratamento da hipercolesterolemia em portadores de diabete näo dependente de insulina / Lovastatin for the Treatment of Hypercholesterolemia in Non-insulin Dependent Diabetic Patients

RESUMO

Objetivo - Avaliar os efeitos da lovastatina como agente capaz de corrigir as anormalidade do perfil lipídico do plasma em pacientes diabéticos näo dependentes de insulina (NIDDM) e portadores de hipercolesterolemia. Métodos - Foram estudados 20 pacientes NIDDM nos quais se diagnosticou hipercolesterolemia, definida como a ocorrência de níveis de LDL-colesterol superiores a 160mg/dl, em pacientes do sexo feminino, e acima de 130mg/dl em pacientes do sexo masculino, ou em mulheres portadoras de qualquer outro fator de risco para doença coronariana. Dos 20 pacientes incluídos, 18 eram hipertensos que foram admintidos no estudo após terem substituído a terapêutica com ß-bloqueadores ou diurêticos por inibidores da enzima conversora ou bloqueadores dos canais de cálcio. O tratamento consistiu na administraçäo de lovastatina por um período de 24 semanas. A dose diária inicial de 20mg era elevada para 40mg, após 6 semanas de uso da droga, caso os níveis de LDL-colesterol se mantivessem acima de 130mg/dl. Resultados - A lovastatina na dose diária de 20mg (9 pacientes) ou 40mg (11 pacientes), reduziu os níveis séricos de LDL-colesterol e do colesterol total em 30// e 21// respectivamente, enquanto os níveis de HDL-colesterol e triglicérides permaneceram inalterados. A medicaçäo foi bem tolerada e nenhum paciente apresentou alteraçöes nos níveis séricos das transaminases ou bilirrubinas. Em 9 dos pacientes estudados houve elevaçäo dos níveis séricos da fosfatase alcalina, sendo que a média do grupo todo se elevou de 109 ñ 59 para 188 ñ 60mµ (p < 0,05), sendo esta a única alteraçäo laboratorial observada, näo associada a qualquer manifestaçäo clínica. Conclusäo - Em NIDDM a lovastatina se mostrou eficiente para promover reduçöes nos níveis séricos do colesterol total e do LDL-colesterol. Embora se desconheça o real significado da elevaçäo nos níveis séricos da fosfatase alcalina, recomendamos, nessa condiçäo, a suspensäo da terapia com essa droga

ABSTRACT

Purpose- To evaluate the effects of lovastatin as an hypocholesterolemic agent in non-insulin dependent diabetic (NIDDM) patients with high cholesterol plasma levels. Methods - Twenty NIDDM patients were included in this study. Hypercholesterolemia was defined as LDL cholesterol plasma levels above 160mg/dl in female patients and above 130mg/dl in male patients or in women presenting any other risk factor for cardiovascular disease. From the 20 patients included, 18 had also high levels of arterial blood pressure. They were evaluated for admission in the study after they have substituted the antihypertensive medication for at least 6 weeks, from bblockers or diuretics to angiotensin converting enzyme inhibitors or calcium channel blockers. Lovastatin was administered in a initial daily dose of 20mg to all patients for 6 weeks. After this period this dose was increased to 40mg in 11 patients with LDL-cholesterol levels above 130mg/dl. All patients were treated for a total period of 24 weeks. Results - Lovastatin therapy for 24 weeks reduced LDL-cholesterol and total cholesterol plasma levels in 30% and 21°/, respectively, while no changes in HDL cholesterol or triglycerides plasma levels wereobserved. The medication was well tolerated and no changes in bilirrubins or transaminases plasma levels were detected. In 9 patients the serum levels of alkaline phosphatase showed an elevation and the mean level of all group increased from 109±59 to 188±60mm/ml (p< 0.05). This was an isolated abnormality without any other clinical manifestation. Conclusion - Lovastatin in NIDDM showed to be an efficient agent to reduce high levels of LDL-cholesterol and total cholesterol. However, the importance of the abnormality observed in serum alkaline phosphatase levels deserves further investigation. In this condition we recommend discontinuation of lovastatin therapy