Do Statins Counteract the Effect of Antidiabetic Drugs?Results of the SCEAD Study

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.

Long-term effectiveness of bisoprolol in patients with angina: A real-world evidence study.

A cohort analysis using UK Clinical Practice Research Datalink (CPRD) was performed to compare the effects of bisoprolol, other ß-blockers, and drugs other than ß-blockers on the long-term risk of mortality and cardiovascular events in patients with angina. Adult patients first diagnosed with angina from 2000 to 2014, with ≥365 days of registration to first angina diagnosis and initiating monotherapies of bisoprolol, other ß-blockers, or drugs other than ß-blockers within 6 months of angina diagnosis were included. Incidence rates for each treatment cohort were compared using adjusted hazard ratio (HR) and 95% confidence intervals (CI) obtained from Cox regression analyses. Overall, 987 patients were treated with bisoprolol, 1348 with other ß-blockers and 5272 with drugs other than ß-blockers. Over the total follow-up (≤14 years), the HR of bisoprolol versus other ß-blockers and drugs other than ß-blockers for mortality was 0.45 (95% CI: 0.34-0.61) and 0.50 (95% CI: 0.38-0.66), respectively. The HR of bisoprolol versus other ß-blockers for angina was 0.58 (95% CI: 0.50-0.68) and versus drugs other than ß-blockers was 0.77 (95% CI: 0.68-0.88), respectively. For myocardial infarction, the HR of bisoprolol versus drugs other than ß-blockers up to 14 years was 0.34 (95% CI: 0.23-0.52) and versus other ß-blockers up to 5 years was 0.45 (95% CI: 0.27-0.75). At 5 years, the HR of bisoprolol versus other ß-blockers, and drugs other than ß-blockers, for arrhythmia was 0.60 (95% CI: 0.35-1.0) and 0.61 (95% CI: 0.40-0.93), respectively. In conclusion, long-term significant reduction in the risk of mortality and various cardiovascular events with bisoprolol versus other ß-blockers, and drugs other than ß-blockers, confirm treatment guidelines recommendation that bisoprolol is particularly well suited as the first-line treatment of angina in primary care.

White-Coat Hypertension: the Neglected Subgroup in Hypertension

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.

White-Coat Hypertension: the Neglected Subgroup in Hypertension

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.