ABSTRACT
Introduction:Statins are used with the understanding that a slightly increased risk of diabetes is outweighed by their cardiovascular benefits. However, it may be necessary to reconsider whether statin therapy really increase this risk mainly in the population with prediabetes.Methods:A multicenter, cross-sectional, observational study was conducted to assess the relationship between statin therapy and glucose metabolism in 407 patients aged 63.1 years (11SD) diagnosed with dyslipidemia and prediabetes treated in specialized lipid clinics in Spain.Results:Significant differences were found in HbA1c values among treatment groups (p=0.015). Patients treated with pitavastatin (14mg/day) showed the lowest HbA1c levels, with significant differences compared to patients treated with atorvastatin 4080mg/day (p=0.016) and simvastatin 1040mg/day (p=0.036). By contrast, patients treated with atorvastatin 4080mg/day showed the highest HbA1c levels compared to those receiving atorvastatin 1020mg/day (p=0.003), pitavastatin 14mg/day (p=0.016), pravastatin 2040mg/day (p=0.027), rosuvastatin 510mg/day (p=0.043), and no statin treatment (p=0.004). Patients treated with simvastatin 1040mg/day also had higher values than those treated with atorvastatin 1020mg/day (p=0.016) and pitavastatin 14mg/day (p=0.036) or with no statin treatment (p=0.018).Conclusions:This study suggests that there are differences in the diabetogenic effect of statins. Simvastatin and high doses of atorvastatin may be associated with greater impairment in glucose metabolism than pitavastatin and other statins with less lipid-lowering potency such as pravastatin. (AU)
Introducción:Las estatinas son utilizadas de acuerdo con el entendimiento de que el pequeño riesgo de incremento de diabetes se ve compensado por sus beneficios cardiovasculares. Sin embargo, puede resultar necesario reconsiderar si la terapia con estatinas incrementa realmente el riesgo, principalmente en la población con prediabetes.Métodos:Se realizó un estudio multicéntrico, transversal y observacional para evaluar la relación entre la terapia con estatinas y el metabolismo de la glucosa en 407 pacientes de 63,1 años (11 DE) diagnosticados de dislipidemia y prediabetes tratados en clínicas especializadas en lípidos en España.Resultados:Se encontraron diferencias significativas en los valores de HbA1c entre los grupos de tratamiento (p=0,015). Los pacientes tratados con pitavastatina (1-4mg/día) reflejaron los menores niveles de HbA1c, con diferencias significativas en comparación con los pacientes tratados con atorvastatina 40-80mg/día (p=0,016) y simvastatina 10-40mg/día (p=0,036). Por contra, los pacientes tratados con atorvastatina 40-80mg/día reflejaron los mayores niveles de HbA1c en comparación con los pacientes que recibieron atorvastatina 10-20mg/día (p=0,003), pitavastatina 1-4mg/día (p=0,016), pravastatina 20-40mg/día (p=0,027), rosuvastatina 5-10mg/día (p=0,043) y los que no recibieron estatinas (p=0,004). Los pacientes tratados con simvastatina 10-40mg/día tuvieron también valores más elevados que aquellos pacientes tratados con atorvastatina 10-20mg/día (p=0,016) y pitavastatina 1-4mg/día (p=0,036) que no recibieron estatinas (p=0,018).Conclusiones:El presente estudio sugiere que existen diferencias en cuanto al efecto diabetógeno de las estatinas. Simvastatina y las altas dosis de atorvastatina pueden guardar relación con un mayor deterioro del metabolismo de la glucosa que pitavastatina y demás estatinas con menor potencia de reducción de lípidos, tales como pravastatina. (AU)
Subject(s)
Humans , Atorvastatin/adverse effects , Diabetes Mellitus/chemically induced , Diabetes Mellitus/epidemiology , Glycated Hemoglobin , Pravastatin/adverse effects , Cross-Sectional Studies , Glucose , SpainABSTRACT
INTRODUCTION: Statins are used with the understanding that a slightly increased risk of diabetes is outweighed by their cardiovascular benefits. However, it may be necessary to reconsider whether statin therapy really increase this risk mainly in the population with prediabetes. METHODS: A multicenter, cross-sectional, observational study was conducted to assess the relationship between statin therapy and glucose metabolism in 407 patients aged 63.1 years (11SD) diagnosed with dyslipidemia and prediabetes treated in specialized lipid clinics in Spain. RESULTS: Significant differences were found in HbA1c values among treatment groups (p=0.015). Patients treated with pitavastatin (1-4mg/day) showed the lowest HbA1c levels, with significant differences compared to patients treated with atorvastatin 40-80mg/day (p=0.016) and simvastatin 10-40mg/day (p=0.036). By contrast, patients treated with atorvastatin 40-80mg/day showed the highest HbA1c levels compared to those receiving atorvastatin 10-20mg/day (p=0.003), pitavastatin 1-4mg/day (p=0.016), pravastatin 20-40mg/day (p=0.027), rosuvastatin 5-10mg/day (p=0.043), and no statin treatment (p=0.004). Patients treated with simvastatin 10-40mg/day also had higher values than those treated with atorvastatin 10-20mg/day (p=0.016) and pitavastatin 1-4mg/day (p=0.036) or with no statin treatment (p=0.018). CONCLUSIONS: This study suggests that there are differences in the diabetogenic effect of statins. Simvastatin and high doses of atorvastatin may be associated with greater impairment in glucose metabolism than pitavastatin and other statins with less lipid-lowering potency such as pravastatin.
Subject(s)
Diabetes Mellitus , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Prediabetic State , Aged , Atorvastatin/adverse effects , Cross-Sectional Studies , Diabetes Mellitus/chemically induced , Diabetes Mellitus/epidemiology , Glucose , Glycated Hemoglobin , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Middle Aged , Pravastatin/adverse effects , Prediabetic State/epidemiology , Rosuvastatin Calcium/adverse effects , Simvastatin/adverse effects , SpainABSTRACT
La American Diabetes Association define a la pre-diabetes como un estado que presentan pacientes, quienes tienen valores de glicemia enmarcados en el rango de glucosa anormal en ayuno (100-125 mg/dl) o tolerancia deteriorada a la glucosa (140-199 mg/dl), además de tener un mayor riesgo de desarrollar diabetes mellitus tipo 2 y de presentar enfermedad cardiovascular, eventos cerebrovasculares y neuropatía, que usualmente se acompaña de obesidad central, hipertensión, hipertrigliceridemia y valores bajos de HDL. La presente revisión tiene el objetivo de analizar los nuevos criterios diagnósticos de este estado y el tratamiento, que incluye cambios en el estilo de vida y varios fármacos que han demostrado su eficacia en estudios controlados con placebo, con antidiabéticos orales tales como troglitazona, acarbosa, menformina, roziglitazona y agentes antihipertensivos con el objetivo de reducir o retrasar el desarrollo de diabetes mellitus tipo 2.
The American Diabetes Association defines prediabetes as a condition presented by patients who have fasting glucose levels within normal values (100-125 mg/dl) or a deteriorated glucose tolerance (140-199 mg/dl) as well as having greater risk to develop type II diabetes mellitus and suffer cardiovascular disease, cerebrovascular conditions and neuropathy, usually accompanied by central obesity, hypertension, hypertriglyceridemia, and low values of HDL. The objective of this review is analize the new diagnostic criteria of this condition and its treatment, which includes life style changes and several drugs that has showed their effectiveness in placebo controlled studies, with oral antidiabetics such as troglitazona, acarbosa, menformine, roziglitazona and antihypertensive agents aiming to reduce or delay the development of type 2 diabetes mellitus.
