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Ye J, Guo K, Li J, Li X, Zhou Z, Yang L. Estimating the effect of lipid-lowering agents on novel subtypes of adult-onset diabetes. Diabetes Metab Res Rev 2024; 40:e3793. [PMID: 38661109 DOI: 10.1002/dmrr.3793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/30/2024] [Accepted: 03/05/2024] [Indexed: 04/26/2024]
Abstract
AIMS The aims of the present study were to assess the effects of lipid-lowering drugs [HMG-CoA reductase inhibitors, proprotein convertase subtilisin/kexin type 9 inhibitors, and Niemann-Pick C1-Like 1 (NPC1L1) inhibitors] on novel subtypes of adult-onset diabetes through a Mendelian randomisation study. MATERIALS AND METHODS We first inferred causal associations between lipid-related traits [including high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), apolipoproteins A-I, and apolipoproteins B] and novel subtypes of adult-onset diabetes. The expression quantitative trait loci of drug target genes for three classes of lipid-lowering drugs, as well as genetic variants within or nearby drug target genes associated with LDL-C, were then utilised as proxies for the exposure of lipid-lowering drugs. Mendelian randomisation analysis was performed using summary data from genome-wide association studies of LDL-C, severe autoimmune diabetes, severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), and mild age-related diabetes. RESULTS There was an association between HMGCR-mediated LDL-C and the risk of SIRD [odds ratio (OR) = 0.305, 95% confidence interval (CI) = 0.129-0.723; p = 0.007], and there was an association of PCSK9-mediated LDL-C with the risk of SIDD (OR = 0.253, 95% CI = 0.120-0.532; p < 0.001) and MOD (OR = 0.345, 95% CI = 0.171-0.696; p = 0.003). Moreover, NPC1L1-mediated LDL-C (OR = 0.109, 95% CI = 0.019-0.613; p = 0.012) and the increased expression of NPC1L1 gene in blood (OR = 0.727, 95% CI = 0.541-0.977; p = 0.034) both showed a significant association with SIRD. These results were further confirmed by sensitivity analyses. CONCLUSIONS In summary, the different lipid-lowering medications have a specific effect on the increased risk of different novel subtypes of adult-onset diabetes.
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Affiliation(s)
- Jianan Ye
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Keyu Guo
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jiaqi Li
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xia Li
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Lin Yang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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2
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Anelli V, Armeni E, Paschou SA, Lambrinoudaki I. Statin use and incident type 2 diabetes mellitus in women after menopause. Maturitas 2024; 181:107914. [PMID: 38245965 DOI: 10.1016/j.maturitas.2024.107914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
Menopause is associated with adverse cardiometabolic changes which increase the risk of new-onset type 2 diabetes (T2DM) and cardiovascular disease (CVD). Statins are widely used for primary and secondary CVD prevention, given their beneficial effects on the lipid profile and the vessel wall. On the other hand, statins increase the risk of T2DM. This association has been evaluated mainly in mixed-gender studies, without gender-specific evaluation. This narrative review evaluates the use of statins and the related risk of new-onset T2DM among postmenopausal women. Studies that incorporated a gender-specific analysis report a higher risk of new-onset T2DM in women than in men on treatment with statins. Fewer studies evaluated female-only samples; these confirm the observed association between statin use and new-onset T2DM. Factors influencing the association between statin use and T2DM include the type and dose of statin and the baseline metabolic status. Women may benefit from stratification of their metabolic risk before initiating a statin for CVD prevention.
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Affiliation(s)
- Valentina Anelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Eleni Armeni
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece; Royal Free Hospital NHS Trust, Medical School, University College London, London, UK
| | - Stavroula A Paschou
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Irene Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece.
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Dugré N. Lipid-lowering therapies for cardiovascular disease prevention and management in primary care: PEER umbrella systematic review of systematic reviews. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:701-711. [PMID: 37833094 PMCID: PMC10575662 DOI: 10.46747/cfp.6910701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To assess the benefits and harms of lipid-lowering therapies used to prevent or manage cardiovascular disease including bile acid sequestrants (BAS), ezetimibe, fibrates, niacin, omega-3 supplements, proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, and statins. DATA SOURCES MEDLINE, the Cochrane Database of Systematic Reviews, and a grey literature search. STUDY SELECTION Systematic reviews of randomized controlled trials published between January 2017 and March 2022 looking at statins, ezetimibe, PCSK9 inhibitors, fibrates, BAS, niacin, and omega-3 supplements for preventing cardiovascular outcomes were selected. Outcomes of interest included major adverse cardiovascular events (MACE), cardiovascular mortality, all-cause mortality, and adverse events. SYNTHESIS A total of 76 systematic reviews were included. Four randomized controlled trials were also included for BAS because no efficacy systematic review was identified. Statins significantly reduced MACE (6 systematic reviews; median risk ratio [RR]=0.74; interquartile range [IQR]=0.71 to 0.76), cardiovascular mortality (7 systematic reviews; median RR=0.85, IQR=0.83 to 0.86), and all-cause mortality (8 systematic reviews; median RR=0.91, IQR=0.88 to 0.92). Major adverse cardiovascular events were also significantly reduced by ezetimibe (3 systematic reviews; median RR=0.93, IQR=0.93 to 0.94), PCSK9 inhibitors (14 systematic reviews; median RR=0.84, IQR=0.83 to 0.87), and fibrates (2 systematic reviews; mean RR=0.86), but these interventions had no effect on cardiovascular or all-cause mortality. Fibrates had no effect on any cardiovascular outcomes when added to a statin. Omega-3 combination supplements had no effect on MACE or all-cause mortality but significantly reduced cardiovascular mortality (5 systematic reviews; median RR=0.93, IQR=0.93 to 0.94). Eicosapentaenoic acid ethyl ester alone significantly reduced MACE (1 systematic review, RR=0.78) and cardiovascular mortality (2 systematic reviews; RRs of 0.82 and 0.82). In primary cardiovascular prevention, only statins showed consistent benefits on MACE (6 systematic reviews; median RR=0.75, IQR=0.73 to 0.78), cardiovascularall-cause mortality (7 systematic reviews, median RR=0.83, IQR=0.81 to 0.90), and all-cause mortality (8 systematic reviews; median RR=0.91, IQR=0.87 to 0.91). CONCLUSION Statins have the most consistent evidence for the prevention of cardiovascular complications with a relative risk reduction of about 25% for MACE and 10% to 15% for mortality. The addition of ezetimibe, a PCSK9 inhibitor, or eicosapentaenoic acid ethyl ester to a statin provides additional MACE risk reduction but has no effect on all-cause mortality.
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Affiliation(s)
- Nicolas Dugré
- Pharmacist at the CIUSSS du Nord-de-l’Île-de-Montréal and Clinical Associate Professor in the Faculty of Pharmacy at the University of Montréal in Quebec
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4
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Gross M, Schwartz SW, Sebastião YV, Alman A, Salemi JL, Ghimire-Aryal P, Foulis P. LDL Reduction and Risk of Diabetes in Veteran Statin Users. Ann Pharmacother 2023; 57:283-291. [PMID: 35912948 DOI: 10.1177/10600280221115816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND While statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) reduce cardiovascular morbidity and mortality, there is controversy regarding a potentially causal link with incident diabetes mellitus (DM). This association may partially be due to confounding by indication; since prescription guidelines encourage statin use among those diagnosed with DM, this may encourage their prescription among those with elevated blood glucose in the absence of DM diagnosis. OBJECTIVE The study examined the association between low-density lipoprotein (LDL) reduction following initiation of statin use and new-onset DM among veterans. METHODS We conducted a retrospective cohort study using data from the James A. Haley Veteran's Hospital in Tampa, Florida. Patients with a visit between January 2007 and December 2011 were selected from the Veterans Information Systems and Technology Architecture system. Individuals were classified into categories of statin usage based on LDL reduction percentages and frequency-matched with controls. The primary outcome of interest was incident DM. RESULTS There was a significant association between LDL reduction and DM which was higher in lower LDL reduction groups (low response hazard ratio [HR]: 2.12, 95% CI: 1.62, 2.79; moderate response HR: 1.85, 95% CI: 1.40, 2.45; high response HR: 1.24, 95% CI: 0.74, 2.07). CONCLUSION AND RELEVANCE This association may partially be explained by potential lifestyle modifications individuals may make when prescribed a statin which may reduce their risk of DM independent of the statin usage. This research has demonstrated a protective association between greater LDL reduction and DM at the individual level while reenforcing the evidence of an association between statin usage and DM.
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Affiliation(s)
- Michaela Gross
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Skai W Schwartz
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Yuri V Sebastião
- Division of Global Women's Health, School of Medicine, The University of North Carolina at Chapel Hill North, Chapel Hill, NC, USA
| | - Amy Alman
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Jason L Salemi
- College of Public Health, University of South Florida, Tampa, FL, USA
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5
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Dong W, Yang Z. Trends in lipid profile and lipid control among survivors of stroke or myocardial infarction among US adults, 2001-2018. Front Endocrinol (Lausanne) 2023; 14:1128878. [PMID: 36967759 PMCID: PMC10031105 DOI: 10.3389/fendo.2023.1128878] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND We aim to analyze the change in lipid profile and lipid control among survivors of stroke and/or myocardial infarction among US adults from 2001-2018. METHODS In total, 3,736 survivors of stroke and/or myocardial infarction from the 2001-2018 National Health and Nutrition Examination Surveys were included in this study, representing a weighted total population of 110,005,898. Trends for lipid concentration and lipid control rate over time were detected via general linear regression analysis and lipid control was compared by sex and race via survey-weighted logistic regression analysis. RESULTS The total cholesterol, LDL, and triglyceride concentrations were significantly decreased in survivors from the 2001-2002 survey cycle to the 2017-2018 survey cycle (p for trend < 0.01). Lipid control was defined as total cholesterol < 200 mg/dL. Among survivors, the lipid control rate increased from 56.2% (95% CI: 43.9%, 67.7%) in the 2001-2002 survey cycle to 73.2% (95% CI: 64.8%, 80.2%) in the 2017-2018 survey cycle (p for trend < 0.01). Women had a higher lipid concentration and were more likely have poor lipid control compared to men. Non-Hispanic White survivors possessed better lipid control than other races survivors. CONCLUSIONS Lipid concentrations decreased and lipid control improved in stroke and/or myocardial infarction survivors from 2001 to 2018, with heterogeneity observed according to sex and race.
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Affiliation(s)
- Weiwei Dong
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhiyong Yang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Zhiyong Yang,
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Andronie-Cioară FL, Jurcău A, Jurcău MC, Nistor-Cseppentö DC, Simion A. Cholesterol Management in Neurology: Time for Revised Strategies? J Pers Med 2022; 12:jpm12121981. [PMID: 36556202 PMCID: PMC9784893 DOI: 10.3390/jpm12121981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Statin therapy has been extensively evaluated and shown to reduce the incidence of new or recurrent vascular events, ischemic stroke included. As a consequence, each published guideline pushes for lower low-density cholesterol levels in the population at large, recommending increased statin doses and/or adding new cholesterol-lowering molecules. Neurologists find it sometimes difficult to apply these guidelines, having to confront situations such as (1) ischemic strokes, mainly cardioembolic ones, in patients with already low LDL-cholesterol levels; (2) myasthenic patients, whose lifespan has been extended by available treatment, and whose age and cholesterol levels put them at risk for ischemic stroke; (3) patients with myotonic dystrophy, whose disease often associates diabetes mellitus and heart conduction defects, and in whom blood cholesterol management is also not settled. As such, further trials are needed to address these issues.
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Affiliation(s)
- Felicia Liana Andronie-Cioară
- Department of Psycho-Neuroscience and Rehabilitation, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Anamaria Jurcău
- Department of Psycho-Neuroscience and Rehabilitation, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Maria Carolina Jurcău
- Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
- Correspondence: (M.C.J.); (D.C.N.-C.); Tel.: +40-744-600-833 (M.C.J.)
| | - Delia Carmen Nistor-Cseppentö
- Department of Psycho-Neuroscience and Rehabilitation, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
- Correspondence: (M.C.J.); (D.C.N.-C.); Tel.: +40-744-600-833 (M.C.J.)
| | - Aurel Simion
- Department of Psycho-Neuroscience and Rehabilitation, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
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Singh H, Sikarwar P, Khurana S, Sharma J. Assessing the Incidence of New-onset Diabetes Mellitus with Statin Use: A Systematic Review of the Systematic Reviews and Meta-analyses. TOUCHREVIEWS IN ENDOCRINOLOGY 2022; 18:96-101. [PMID: 36694884 PMCID: PMC9835812 DOI: 10.17925/ee.2022.18.2.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
Statin use has been linked with new-onset diabetes mellitus (NODM). In the present systematic review, we aimed to determine the incidence of NODM with statin use by assessing and summarizing the data generated by different systematic reviews and metaanalyses published on this topic. We conducted a systematic review of systematic reviews and meta-analyses using a pre-defined study protocol. Two authors independently performed a literature search using PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies reporting data on statin use and NODM incidence and screened and extracted data for the outcomes of interest. The Assessing the Methodological Auality of Systematic Reviews 2 (AMSTAR 2) checklist was used to evaluate the quality of the included systematic reviews and meta-analyses. The initial search yielded 621 potential records, and 16 relevant systematic reviews and meta-analyses were included in the present systematic review. The included studies showed an increase in the risk of NODM with statin use. In particular, rosuvastatin and atorvastatin were associated with NODM in many systematic reviews or meta-analyses; however, pravastatin and pitavastatin were found to be associated with lower or no risk. We observed a positive trend of development of NODM with statin use became more evident with advancing years as more number of studies were added. Intensive doses of statins and use in older subjects were found to be important risk factors for NODM. Finally, the quality assessment revealed that the included systematic reviews and metaanalyses were of critically low or low quality. We concluded that statin use carries a risk of causing NODM. Statins should not be discouraged in anticipation of NODM. However, glycaemic monitoring should be encouraged with the on-going statin therapy. Furthermore, clinical studies addressing the use of statins and the incidence of NODM as their primary objective should be planned.
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Affiliation(s)
- Harmanjit Singh
- These authors have contributed equally to this work and share first authorship.,Department of Pharmacology, Government Medical College and Hospital, Chandigarh, India
| | - Pallavi Sikarwar
- These authors have contributed equally to this work and share first authorship.,MBBS Student, Government Medical College and Hospital, Chandigarh, India
| | - Supreet Khurana
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Jatin Sharma
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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8
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Heterogeneity in statin responses explained by variation in the human gut microbiome. MED 2022; 3:388-405.e6. [DOI: 10.1016/j.medj.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 12/20/2022]
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9
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Xiao X, Luo Y, Peng D. Updated Understanding of the Crosstalk Between Glucose/Insulin and Cholesterol Metabolism. Front Cardiovasc Med 2022; 9:879355. [PMID: 35571202 PMCID: PMC9098828 DOI: 10.3389/fcvm.2022.879355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/07/2022] [Indexed: 12/19/2022] Open
Abstract
Glucose and cholesterol engage in almost all human physiological activities. As the primary energy substance, glucose can be assimilated and converted into diverse essential substances, including cholesterol. Cholesterol is mainly derived from de novo biosynthesis and the intestinal absorption of diets. It is evidenced that glucose/insulin promotes cholesterol biosynthesis and uptake, which have been targeted by several drugs for lipid-lowering, e.g., bempedoic acid, statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Inversely, these lipid-lowering drugs may also interfere with glucose metabolism. This review would briefly summarize the mechanisms of glucose/insulin-stimulated cholesterol biosynthesis and uptake, and discuss the effect and mechanisms of lipid-lowering drugs and genetic mutations on glucose homeostasis, aiming to help better understand the intricate relationship between glucose and cholesterol metabolism.
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10
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Pirillo A, Catapano AL. New insights into the role of bempedoic acid and ezetimibe in the treatment of hypercholesterolemia. Curr Opin Endocrinol Diabetes Obes 2022; 29:161-166. [PMID: 34980867 PMCID: PMC8915986 DOI: 10.1097/med.0000000000000706] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW A number of new cholesterol-lowering drugs have been recently developed and approved, enriching the pharmacological armamentarium beyond and above statins. Ezetimibe, available since two decades, and bempedoic acid, a new drug inhibiting the same biosynthetic pathway targeted by statins but at an early step, represent valuable tools for the treatment of hypercholesterolemia, particularly in specific groups of patients. RECENT FINDINGS Bempedoic acid, either alone or in combination with ezetimibe, appears to reduce significantly LDL-C levels, an effect that has been observed also in patients with statin intolerance. A Mendelian randomization study has anticipated a protective cardiovascular effect of bempedoic acid; a randomized clinical trial is currently assessing whether the pharmacological control of hypercholesterolemia with bempedoic acid translates into a clinical benefit. Bempedoic acid, as well as ezetimibe, does not appear to induce adverse events in muscles; moreover, whereas statins are associated with a modest, although significant, increased risk of new-onset diabetes, bempedoic acid does not, at least based on the available evidence. SUMMARY On the basis of available data, and while awaiting the results of the outcome trial, bempedoic acid appears to represent a valuable approach for the treatment of hypercholesterolemia, either alone or in combination in ezetimibe.
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Affiliation(s)
- Angela Pirillo
- Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo
- IRCCS MultiMedica, Sesto S. Giovanni
| | - Alberico L. Catapano
- IRCCS MultiMedica, Sesto S. Giovanni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
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11
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Gao J, Liu JY, Lu PJ, Xiao JY, Gao MD, Li CP, Cui Z, Liu Y. Effects of Evolocumab Added to Moderate-Intensity Statin Therapy in Chinese Patients With Acute Coronary Syndrome: The EMSIACS Trial Study Protocol. Front Physiol 2021; 12:750872. [PMID: 34887772 PMCID: PMC8650150 DOI: 10.3389/fphys.2021.750872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Several studies have demonstrated that using a higher dose of statin can easily induce liver injury and myopathy. Low-density lipoprotein cholesterol (LDL-C) is a well-established modifiable risk factor for cardiovascular disease; however, the large majority of Chinese patients cannot meet the target level of LDL-C recommended by the Chinese expert consensus. Evolocumab has been demonstrated to reduce LDL-C by approximately 60% in many studies. Nevertheless, whether combined evolocumab and moderate-intensity statin is as effective in lowering LDL-C and decreasing incidence of MACE in Chinese patients presenting with the acute phase of acute coronary syndrome (ACS) remains unknown. Therefore, the "Evolocumab added to Moderate-Intensity Statin therapy on LDL-C lowering and cardiovascular adverse events in patients with Acute Coronary Syndrome" (EMSIACS) is conducted. Methods: The EMSIACS is a prospective, randomized, open-label, parallel-group, multicenter study involving analyzing the feasibility and efficacy of evolocumab added to moderate-intensity statin therapy on lowering LDL-C levels in adult Chinese patients hospitalized for acute phase ACS. The sample size calculation is based on the primary outcome, and 500 patients will be planned to recruit. Patients are randomized in evolocumab arm (evolocumab 140mg every 2weeks plus rosuvastatin 10mg/day or atorvastatin 20mg/day) and statin-only arm (rosuvastatin 10mg/day or atorvastatin 20mg/day). The primary outcome is the percentage change in LDL-C in weeks 4 and week 12 after treatment. The secondary outcome is the occurrence of MACE after 12weeks and 1year of treatment. Discussion: If the EMSIACS trial endpoints prove statistically significant, the evolocumab added to moderate-intensity statin therapy will have the potential to effectively lower subjects' LDL-C levels, especially for the Chinese patients with acute phase ACS. However, if the risk of MACE is not significantly different between the two groups, we may extend follow-up time for secondary outcome when the clinical trial is over. Clinical trial registration: The study is registered to ClinicalTrials.gov (NCT04100434), which retrospectively registered on November 24, 2020.
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Affiliation(s)
- Jing Gao
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China.,Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, China
| | - Jing-Yu Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Peng-Ju Lu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jian-Yong Xiao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Ming-Dong Gao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Chang-Ping Li
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhuang Cui
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yin Liu
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China.,Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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12
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Wan S, Ding Y, Ji X, Meng R. The safety and efficacy of Ezetimibe Plus Statins on ASVD and Related Diseases. Aging Dis 2021; 12:1857-1871. [PMID: 34881073 PMCID: PMC8612613 DOI: 10.14336/ad.2021.0412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022] Open
Abstract
It is well known that atherosclerotic vascular disease (ASVD) in the elderly is a global disease with high morbidity, mortality and disability, and plasma LDL-C correction is the most important strategy for ASVD control. However, a large proportion of patients failed to achieve their ideal LDL-C goals after statins use. Ezetimibe, a newly non-statin lipid-lowering agent, is an inhibitor of exogenous cholesterol absorption. Whereby, ezetimibe plus statins may reduce LDL-C more strongly than statins alone. Differed from any other papers published previously, which only involved ezetimibe plus statins for coronary heart disease, the highlight of this paper is to summarize the efficacy and safety of ezetimibe plus statins in all kinds of ASVD subtypes and their related diseases, mainly included aortic atherosclerosis, coronary artery disease, cerebrovascular and peripheral artery diseases. Obviously, this paper is inimitable, which will provide the readers an important reference, especially in treating the elderly with multi-organs atherosclerosis.
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Affiliation(s)
- Shuling Wan
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- 2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,4Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xunming Ji
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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Bonilha I, Hajduch E, Luchiari B, Nadruz W, Le Goff W, Sposito AC. The Reciprocal Relationship between LDL Metabolism and Type 2 Diabetes Mellitus. Metabolites 2021; 11:metabo11120807. [PMID: 34940565 PMCID: PMC8708656 DOI: 10.3390/metabo11120807] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 12/14/2022] Open
Abstract
Type 2 diabetes mellitus and insulin resistance feature substantial modifications of the lipoprotein profile, including a higher proportion of smaller and denser low-density lipoprotein (LDL) particles. In addition, qualitative changes occur in the composition and structure of LDL, including changes in electrophoretic mobility, enrichment of LDL with triglycerides and ceramides, prolonged retention of modified LDL in plasma, increased uptake by macrophages, and the formation of foam cells. These modifications affect LDL functions and favor an increased risk of cardiovascular disease in diabetic individuals. In this review, we discuss the main findings regarding the structural and functional changes in LDL particles in diabetes pathophysiology and therapeutic strategies targeting LDL in patients with diabetes.
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Affiliation(s)
- Isabella Bonilha
- Cardiology Division, Atherosclerosis and Vascular Biology Laboratory (AtheroLab), State University of Campinas (Unicamp), Campinas 13083-887, Brazil; (I.B.); (B.L.)
| | - Eric Hajduch
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, F-75006 Paris, France;
| | - Beatriz Luchiari
- Cardiology Division, Atherosclerosis and Vascular Biology Laboratory (AtheroLab), State University of Campinas (Unicamp), Campinas 13083-887, Brazil; (I.B.); (B.L.)
| | - Wilson Nadruz
- Cardiology Division, Cardiovascular Pathophysiology Laboratory, State University of Campinas (Unicamp), Campinas 13083-887, Brazil;
| | - Wilfried Le Goff
- Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition, ICAN, Inserm, Sorbonne Université, F-75013 Paris, France;
| | - Andrei C. Sposito
- Cardiology Division, Atherosclerosis and Vascular Biology Laboratory (AtheroLab), State University of Campinas (Unicamp), Campinas 13083-887, Brazil; (I.B.); (B.L.)
- Correspondence: ; Tel.: +55-19-3521-7098; Fax: +55-19-3289-410
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Nazarzadeh M, Bidel Z, Canoy D, Copland E, Wamil M, Majert J, Smith Byrne K, Sundström J, Teo K, Davis BR, Chalmers J, Pepine CJ, Dehghan A, Bennett DA, Smith GD, Rahimi K. Blood pressure lowering and risk of new-onset type 2 diabetes: an individual participant data meta-analysis. Lancet 2021; 398:1803-1810. [PMID: 34774144 PMCID: PMC8585669 DOI: 10.1016/s0140-6736(21)01920-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/18/2021] [Accepted: 08/17/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Blood pressure lowering is an established strategy for preventing microvascular and macrovascular complications of diabetes, but its role in the prevention of diabetes itself is unclear. We aimed to examine this question using individual participant data from major randomised controlled trials. METHODS We performed a one-stage individual participant data meta-analysis, in which data were pooled to investigate the effect of blood pressure lowering per se on the risk of new-onset type 2 diabetes. An individual participant data network meta-analysis was used to investigate the differential effects of five major classes of antihypertensive drugs on the risk of new-onset type 2 diabetes. Overall, data from 22 studies conducted between 1973 and 2008, were obtained by the Blood Pressure Lowering Treatment Trialists' Collaboration (Oxford University, Oxford, UK). We included all primary and secondary prevention trials that used a specific class or classes of antihypertensive drugs versus placebo or other classes of blood pressure lowering medications that had at least 1000 persons-years of follow-up in each randomly allocated arm. Participants with a known diagnosis of diabetes at baseline and trials conducted in patients with prevalent diabetes were excluded. For the one-stage individual participant data meta-analysis we used stratified Cox proportional hazards model and for the individual participant data network meta-analysis we used logistic regression models to calculate the relative risk (RR) for drug class comparisons. FINDINGS 145 939 participants (88 500 [60·6%] men and 57 429 [39·4%] women) from 19 randomised controlled trials were included in the one-stage individual participant data meta-analysis. 22 trials were included in the individual participant data network meta-analysis. After a median follow-up of 4·5 years (IQR 2·0), 9883 participants were diagnosed with new-onset type 2 diabetes. Systolic blood pressure reduction by 5 mm Hg reduced the risk of type 2 diabetes across all trials by 11% (hazard ratio 0·89 [95% CI 0·84-0·95]). Investigation of the effects of five major classes of antihypertensive drugs showed that in comparison to placebo, angiotensin-converting enzyme inhibitors (RR 0·84 [95% 0·76-0·93]) and angiotensin II receptor blockers (RR 0·84 [0·76-0·92]) reduced the risk of new-onset type 2 diabetes; however, the use of β blockers (RR 1·48 [1·27-1·72]) and thiazide diuretics (RR 1·20 [1·07-1·35]) increased this risk, and no material effect was found for calcium channel blockers (RR 1·02 [0·92-1·13]). INTERPRETATION Blood pressure lowering is an effective strategy for the prevention of new-onset type 2 diabetes. Established pharmacological interventions, however, have qualitatively and quantitively different effects on diabetes, likely due to their differing off-target effects, with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers having the most favourable outcomes. This evidence supports the indication for selected classes of antihypertensive drugs for the prevention of diabetes, which could further refine the selection of drug choice according to an individual's clinical risk of diabetes. FUNDING British Heart Foundation, National Institute for Health Research, and Oxford Martin School.
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Affiliation(s)
- Milad Nazarzadeh
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK
| | - Zeinab Bidel
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK
| | - Dexter Canoy
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Emma Copland
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK
| | - Malgorzata Wamil
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | - Jeannette Majert
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK
| | - Karl Smith Byrne
- International Agency for Research on Cancer/WHO, Genomic Epidemiology Branch, Lyon, France
| | - Johan Sundström
- Clinical Epidemiology Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Koon Teo
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Barry R Davis
- The University of Texas School of Public Health, Houston, TX, USA
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Carl J Pepine
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Abbas Dehghan
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Derrick A Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Kazem Rahimi
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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15
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Ma W, Pan Q, Pan D, Xu T, Zhu H, Li D. Efficacy and Safety of Lipid-Lowering Drugs of Different Intensity on Clinical Outcomes: A Systematic Review and Network Meta-Analysis. Front Pharmacol 2021; 12:713007. [PMID: 34744709 PMCID: PMC8567017 DOI: 10.3389/fphar.2021.713007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/05/2021] [Indexed: 02/06/2023] Open
Abstract
There have been many meta-analyses for statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) to evaluate clinical outcomes, but the efficacy and safety of different intensity of these three drugs on clinical outcomes was absent. PCSK9i, ezetimibe, and statins were divided into seven interventions as follows: including PCSK9i + high-intensity statins (P9i+HT), PCSK9i + moderate-intensity statins (P9i+MT), ezetimibe + high-intensity statins (Eze+HT), ezetimibe + moderate-intensity statins (Eze+MT), high-intensity statins (HT), moderate-intensity statins (MT), and low-intensity statins (LT). The risk ratios (RR) and 95% confidence intervals (CI) were calculated to evaluate the clinical outcomes in all randomized controlled trials included. In traditional meta-analysis, the more intensive treatment had a lower risk of all-cause mortality (RR 0.91, 95% CI 0.88-0.95), cardiovascular mortality (RR 0.89, 95% CI 0.86-0.92), myocardial infarction (RR 0.79, 95% CI 0.77-0.81), coronary revascularization (RR 0.80, 95% CI 0.76-0.84), and cerebrovascular events (RR 0.84, 95% CI 0.80-0.88) compared with the less intensive treatment. However, the more intensive treatment had a higher risk of new-onset diabetes (RR 1.08, 95% CI 1.04-1.12). The network meta-analysis demonstrated that P9i+HT, P9i+MT, HT, and MT were significantly associated with a risk reduction in coronary revascularization and cerebrovascular events compared with PLBO. LT could effectively reduce the risk of cardiovascular mortality (RR 0.71, 95% CI 0.54-0.92), MI (RR 0.67, 95% CI 0.54-0.82), and coronary revascularization (RR 0.77, 95% CI 0.65-0.91) compared with PLBO. P9i+HT was superior to HT in reducing the risk of MI (RR 0.78, 95% CI 0.68-0.90), coronary revascularization (RR 0.84, 95% CI 0.73-0.96), and cerebrovascular events (RR 0.78, 95% CI 0.64-0.95). However, compared with PLBO, P9i+HT, HT, and MT could increase the risk of new-onset diabetes (RR 1.23, 95% CI 1.11-1.37; RR 1.23, 95% CI 1.14-1.33; RR 1.09, 95% CI 1.02-1.15, respectively). In conclusion, PCSK9i added to background statins may be recommended as preferred lipid-lowering therapy, and did not increase the additional risk of new-onset diabetes. The safety and efficacy of ezetimibe was not superior to that of statins. LT can be recommended as the initial therapy.
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Affiliation(s)
- Wenrui Ma
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, China
| | - Qinyuan Pan
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, China
| | - Defeng Pan
- Xuzhou Medical University Affiliated Hospital, Xuzhou, China
| | - Tongda Xu
- Xuzhou Medical University Affiliated Hospital, Xuzhou, China
| | - Hong Zhu
- Xuzhou Medical University Affiliated Hospital, Xuzhou, China
| | - Dongye Li
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, China.,Xuzhou Medical University Affiliated Hospital, Xuzhou, China
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16
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Brinton EA. Statin-Related New-Onset Diabetes Appears Driven by Increased Insulin Resistance: Are There Clinical Implications? Arterioscler Thromb Vasc Biol 2021; 41:2798-2801. [PMID: 34705475 DOI: 10.1161/atvbaha.121.316893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) guidelines for management of dyslipidemia and cardiovascular disease risk reduction: Putting evidence in context. Prog Cardiovasc Dis 2021; 68:2-6. [PMID: 34371083 DOI: 10.1016/j.pcad.2021.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 01/21/2023]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality in the United States (U.S.) and incurs significant cost to the healthcare system. Management of cholesterol remains central for ASCVD prevention and has been the focus of multiple national guidelines. In this review, we compare the American Heart Association (AHA)/American College of Cardiology (ACC) and the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) Cholesterol guidelines. We review the evidence base that was used to generate recommendations focusing on 4 distinct themes: 1) the threshold of absolute 10-year ASCVD risk to start a clinician-patient discussion for the initiation of statin therapy in primary prevention patients; 2) the utility of coronary artery calcium score to guide clinician-patient risk discussion pertaining to the initiation of statin therapy for primary ASCVD prevention; 3) the use of moderate versus high-intensity statin therapy in patients with established ASCVD; and 4) the utility of ordering lipid panels after initiation or intensification of lipid lowering therapy to document efficacy and monitor adherence to lipid lowering therapy. We discuss why the VA/DoD and AHA/ACC may have reached different conclusions on these key issues.
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18
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O'Malley PG, Arnold MJ, Kelley C, Spacek L, Buelt A, Natarajan S, Donahue MP, Vagichev E, Ballard-Hernandez J, Logan A, Thomas L, Ritter J, Neubauer BE, Downs JR. Management of Dyslipidemia for Cardiovascular Disease Risk Reduction: Synopsis of the 2020 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med 2020; 173:822-829. [PMID: 32956597 DOI: 10.7326/m20-4648] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION In June 2020, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) released a joint update of their clinical practice guideline for managing dyslipidemia to reduce cardiovascular disease risk in adults. This synopsis describes the major recommendations. METHODS On 6 August to 9 August 2019, the VA/DoD Evidence-Based Practice Work Group (EBPWG) convened a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions, systematically searched and evaluated the literature (English-language publications from 1 December 2013 to 16 May 2019), and developed 27 recommendations and a simple 1-page algorithm. The recommendations were graded by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. RECOMMENDATIONS This synopsis summarizes key features of the guideline in 7 crucial areas: targeting of statin dose (not low-density lipoprotein cholesterol goals), additional tests for risk prediction, primary and secondary prevention, laboratory testing, physical activity, and nutrition.
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Affiliation(s)
- Patrick G O'Malley
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (P.G.O., M.J.A., B.E.N.)
| | - Michael J Arnold
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (P.G.O., M.J.A., B.E.N.)
| | - Cathy Kelley
- U.S. Department of Veterans Affairs Pharmacy Benefits Management Services, Scottsdale, Arizona (C.K.)
| | - Lance Spacek
- South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas (L.S., J.R.D.)
| | - Andrew Buelt
- Bay Pines VA Healthcare System, Bay Pines, Florida (A.B.)
| | - Sundar Natarajan
- New York University School of Medicine and VA New York Harbor Healthcare System, New York, New York (S.N.)
| | - Mark P Donahue
- Duke University Medical Center and Durham VA Medical Center, Durham, North Carolina (M.P.D.)
| | - Elena Vagichev
- Walter Reed National Military Medical Center, Bethesda, Maryland (E.V., L.T.)
| | | | - Amanda Logan
- Cincinnati VA Medical Center, Cincinnati, Ohio (A.L.)
| | - Lauren Thomas
- Walter Reed National Military Medical Center, Bethesda, Maryland (E.V., L.T.)
| | - Joan Ritter
- Walter Reed Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, Maryland (J.R.)
| | - Brian E Neubauer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (P.G.O., M.J.A., B.E.N.)
| | - John R Downs
- South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas (L.S., J.R.D.)
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19
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Patoulias D, Stavropoulos K, Imprialos K, Athyros V, Doumas M, Karagiannis A. Pharmacological Management of Cardiac Disease in Patients with Type 2 Diabetes: Insights into Clinical Practice. Curr Vasc Pharmacol 2020; 18:125-138. [PMID: 32013815 DOI: 10.2174/1570161117666190426162746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/18/2018] [Accepted: 10/26/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Type 2 Diabetes Mellitus (T2DM) has emerged as a growing pandemic. Cardiovascular disease (CVD) constitutes another major health problem, with coronary heart disease being the leading cause of cardiovascular death. Patients with T2DM require a multilevel therapeutic approach, both for primary and secondary prevention of CVD. OBJECTIVE To present and summarize the most recent, highest level evidence retrieved from literature, relevant to the pharmaceutical management of CVD in T2DM. METHODS We conducted a comprehensive search of the literature on MEDLINE from its inception till today, primarily for relevant systematic reviews, meta-analyses and randomized controlled trials. RESULTS There is a trend towards more intensified therapeutic interventions in T2DM, concerning glycemic, lipid and blood pressure control. New drugs, such as sodium-glucose co-transporter 2 (SGLT-2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs) and proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitors might evolve as key players in the management of diabetes and its complications within the next years. Classic drugs, such as those targeting the renin-angiotensinaldosterone system, statins and aspirin remain first-line treatment options, both for primary and secondary prevention of CVD. Lifestyle interventions should always be integrated into a complete therapeutic strategy in diabetic patients. Novel drugs, such as finerenone and LCZ696 have provided significant results in cardiovascular outcome studies; however, their role in T2DM has to be further elucidated. CONCLUSION Pharmaceutical approach of CVD in T2DM is multilevel and complex. Drug classes featuring pleiotropic effects may boost our armamentarium in the fight against CVD.
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Affiliation(s)
- Dimitrios Patoulias
- Second Propedeutic Department of Internal Medicine, General Hospital "Hippokration", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, General Hospital "Hippokration", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Imprialos
- Second Propedeutic Department of Internal Medicine, General Hospital "Hippokration", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Athyros
- Second Propedeutic Department of Internal Medicine, General Hospital "Hippokration", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, General Hospital "Hippokration", Aristotle University of Thessaloniki, Thessaloniki, Greece.,VA Medical Center, and George Washington University, Washington, DC, United States
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, General Hospital "Hippokration", Aristotle University of Thessaloniki, Thessaloniki, Greece
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20
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Abstract
3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors are ubiquitously prescribed for cardiovascular disease (CVD) prevention and treatment. However, the use of statins has been linked to the development of new-onset diabetes mellitus (NODM), which could possibly increase future CVD risk. This phenomenon necessitates a clear discussion of the possible etiologies of this relationship and its broader clinical consequences. We discuss the reported incidence of NODM in statin users through a rigorous review of data from metaanalyses of randomized control trials examining this association. We also highlight the various possible mechanisms responsible for the development of statin-induced diabetes mellitus. Finally, we examine the clinical implications of this effect on future CVD risk and identify specific patient factors that can be used for risk-stratification strategies. Data from 14 randomized control trials metaanalyses suggest a 9-33% higher risk of NODM with statin use. Several cellular, molecular, and genetic mechanisms, as well as lifestyle habits, have been identified as potential underlying factors responsible for this elevated risk. The principle mode of the diabetogenic action of statins is still unclear, though it is likely the result of a complex interplay of pancreatic and extrapancreatic effects. It is understood that patient populations with a greater predisposition to diabetes mellitus, and those with thicker epicardial adiposity are more at risk for the development of statin-induced NODM. Despite these observations, robust data from a variety of investigations suggest that the CVD preventative benefits of statin treatment significantly outweigh the risks associated with the development of NODM. Nevertheless, further study must better identify the causative mechanisms involved in this process, its natural history, and the unique factors that will help clinicians risk stratify and appropriately monitor patients on statin therapy.
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21
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Martins ÂM, Silva Sarto DAQ, Caproni KDP, Silva J, Silva J, Souza PS, dos Santos L, Ureña MJE, de Souza Carvalho MDG, Vilas Boas BM, Miranda LPA, Garcia JAD. Grape juice attenuates left ventricular hypertrophy in dyslipidemic mice. PLoS One 2020; 15:e0238163. [PMID: 32881885 PMCID: PMC7470265 DOI: 10.1371/journal.pone.0238163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/11/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE We evaluated the effects of grape juice (Vitis labrusca L.) on dyslipidemia, resistance to insulin, and left ventricular hypertrophy (LVH) in mice homozygous for the absence of the LDL receptor gene (LDLr -/-) under a hyperlipidemic diet. METHODOLOGY We divided 30 male mice (3 months old) into three groups (n = 10); the HL group was fed a high-fat diet, the HLU group received a high-fat diet and 2 g/kg/day of grape juice, and the HLS group was fed a high-fat diet and simvastatin (20 mg/kg/day). We assessed the blood pressure profile of the mice. We also determined the levels of C-reactive protein (CRP) and lipid profile, glycemic and insulinemic profiles, and calculated the HOMA-IR. Cardiomyocyte hypertrophy, interstitial collagen deposit, and the expression of CD40 ligand (CD40L) and metalloproteinases 2 and 9 were assessed immunohistologically. RESULTS After 60 days, the mice treated with grape juice showed similar results as those of the group treated with simvastatin. The use of grape fruit attenuated dyslipidemia and insulin resistance and significantly increased the levels of high cholesterol density lipoproteins (HDLc). The antioxidant potential of phenolic compounds associated with the increase in HDLc levels in the mice of the HLU group prevented the development of LVH and arterial hypertension since it inhibited the inflammatory response induced by the CD40 pathway and its ligand CD40L. Consequently, there was a lower expression of MMP-2 and MMP-9 and lower serum levels of CRP. CONCLUSION Grape juice has a hypolipidemic and cardiac protective potential, presenting a similar effect as that of simvastatin through a direct antioxidant action of phenolic compounds, or indirectly, via antioxidant action and anti-inflammatory activity of the HDLc. These results suggest that grape juice is a functional food possessing a high potential to prevent cardiovascular diseases.
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Affiliation(s)
- Ângela Maria Martins
- Federal Institute of Education, Science and Technology of the South of Minas Gerais, Machado, Minas Gerais, Brazil
| | | | - Karine de Paula Caproni
- Federal Institute of Education, Science and Technology of the South of Minas Gerais, Machado, Minas Gerais, Brazil
| | - Janaína Silva
- Federal Institute of Education, Science and Technology of the South of Minas Gerais, Muzambinho, Minas Gerais, Brazil
| | - Jaqueline Silva
- Federal Institute of Education, Science and Technology of the South of Minas Gerais, Muzambinho, Minas Gerais, Brazil
| | - Paulo Sérgio Souza
- Federal Institute of Education, Science and Technology of the South of Minas Gerais, Muzambinho, Minas Gerais, Brazil
| | - Leandro dos Santos
- Academic Unity of Serra Talhada, Rural Federal University of Pernambuco, Serra Talhada, Pernambuco, Brazil
| | - Marcos Javier Espino Ureña
- Autonomous University of Santo Domingo and Dominican Institute of Agricultural and Forestry Research, Santo Domingo, Dominican Republic
| | | | - Brígida Monteiro Vilas Boas
- Federal Institute of Education, Science and Technology of the South of Minas Gerais, Machado, Minas Gerais, Brazil
| | | | - José Antonio Dias Garcia
- Federal Institute of Education, Science and Technology of the South of Minas Gerais, Machado, Minas Gerais, Brazil
- José do Rosário Vellano University, Alfenas, Minas Gerais, Brazil
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Statin Treatment-Induced Development of Type 2 Diabetes: From Clinical Evidence to Mechanistic Insights. Int J Mol Sci 2020; 21:ijms21134725. [PMID: 32630698 PMCID: PMC7369709 DOI: 10.3390/ijms21134725] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022] Open
Abstract
Statins are the gold-standard treatment for the prevention of primary and secondary cardiovascular disease, which is the leading cause of mortality worldwide. Despite the safety and relative tolerability of statins, observational studies, clinical trials and meta-analyses indicate an increased risk of developing new-onset type 2 diabetes mellitus (T2DM) after long-term statin treatment. It has been shown that statins can impair insulin sensitivity and secretion by pancreatic β-cells and increase insulin resistance in peripheral tissues. The mechanisms involved in these processes include, among others, impaired Ca2+ signaling in pancreatic β-cells, down-regulation of GLUT-4 in adipocytes and compromised insulin signaling. In addition, it has also been described that statins’ impact on epigenetics may also contribute to statin-induced T2DM via differential expression of microRNAs. This review focuses on the evidence and mechanisms by which statin therapy is associated with the development of T2DM. This review describes the multifactorial combination of effects that most likely contributes to the diabetogenic effects of statins. Clinically, these findings should encourage clinicians to consider diabetes monitoring in patients receiving statin therapy in order to ensure early diagnosis and appropriate management.
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Maini J, Rehan HS, Yadav M, Gupta LK. Exploring the role of adipsin in statin-induced glucose intolerance: a prospective open label study. Drug Metab Pers Ther 2020; 35:/j/dmdi.ahead-of-print/dmpt-2020-0101/dmpt-2020-0101.xml. [PMID: 32229661 DOI: 10.1515/dmpt-2020-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/17/2020] [Indexed: 06/10/2023]
Abstract
Background Evidence from the literature, highlights the increased risk of developing glucose intolerance and type 2 diabetes mellitus (T2DM) with statin therapy. In addition, few animal studies demonstrate that adipsin secreted from adipocytes plays a crucial role in insulin secretion and the development of T2DM. Methods To further explore the role of serum adipsin, in this prospective open label study, 55 newly diagnosed dyslipidemic patients were enrolled. Before starting statin therapy, liver function test (LFT), kidney function test (KFT), lipid profile, glycemic parameters [glycated hemoglobin A (HbA1c), fasting blood sugar (FBS), and postprandial blood sugar (PPBS)], serum insulin, and serum adipsin were estimated. Then these patients were prescribed statin (i.e. atorvastatin, rosuvastatin, or pitavastatin) and after 12 weeks of therapy, all the above investigations were repeated. Results After 12 weeks of statin therapy, the LFT and KFT values remained unchanged and lipid parameters showed significant improvement. But the glycemic parameters deranged significantly (p < 0.001), i.e. FBS, PPBS, and HbA1c increased by 12.49% (102.99 ± 20.76 mg/dL), 24.72% (147.71 ± 47.29 mg/dL), and 21.43% (6.38 ± 1.34%), respectively. On the other hand, the baseline adipsin (2.73 ± 1.99 ng/mL) and insulin (16.13 ± 12.50 mIU/L) levels reduced significantly (p < 0.0001) to 1.43 ±1.13 ng/mL and 6.91 ± 5.93 mIU/L, respectively. The reduction in serum adipsin also showed a positive correlation with reduction in serum insulin (r = 0.85; p < 0.0001). None of the patients experienced any significant adverse effect or reaction leading to discontinuation of therapy. Conclusions There might be an association between reduction in adipsin and development of glucose intolerance by statin therapy.
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Affiliation(s)
- Jahnavi Maini
- Department of Pharmacology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Harmeet Singh Rehan
- Department of Pharmacology, Lady Hardinge Medical College and Associated Hospitals, New Delhi-110001,India, Phone: +91 9811694040
| | - Madhur Yadav
- Deaprtment of Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Lalit Kumar Gupta
- Department of Pharmacology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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24
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Barmak A, Niknam K, Mohebbi G. Synthesis, Structural Studies, and α-Glucosidase Inhibitory, Antidiabetic, and Antioxidant Activities of 2,3-Dihydroquinazolin-4(1 H)-ones Derived from Pyrazol-4-carbaldehyde and Anilines. ACS OMEGA 2019; 4:18087-18099. [PMID: 31720511 PMCID: PMC6843711 DOI: 10.1021/acsomega.9b01906] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/10/2019] [Indexed: 06/10/2023]
Abstract
A series of new quinazoline derivatives were designed and synthesized via a one-pot condensation reaction between isatoic anhydride and aromatic aldehydes with anilines using aluminum sulfate as a catalyst in refluxing ethanol. Their structures were confirmed by their physical, IR, 1H NMR, 13C NMR, and mass spectroscopy data and evaluated for some biological effects, including the antioxidant and α-glucosidase inhibitory activities as well as some in vivo hematological parameters. The ability of synthesized compounds in the inhibition of α-glucosidase was also investigated through the in silico study. The significant and important changes in some hematological tests were perceived. Notably, compound 4h showed more reducing effects on cholesterol and triglyceride levels. This molecule certainly has the potential to be developed as the antihyperlipemic compound. The tested compounds, in particular, compounds 4j and 4l, were found to be uniquely reducing blood sugar levels. The entire synthesized compounds showed the potent α-glucosidase inhibitory activity compared with acarbose as a standard material. Amongst, the compounds 4h and 4i showed the strongest enzyme inhibitory potentials than the standard drug acarbose. There was a good correlation between in vitro and in silico studies for ligands 4i and 4l. The majority of compounds presented a good radical scavenging activity, though the compound 4j exhibited the strongest activity, even to the standard of ascorbic acid. Further studies are required to determine whether these main compounds could be a potential treatment for diabetes and hyperlipidemia diseases.
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Affiliation(s)
- Alireza Barmak
- Department
of Chemistry, Faculty of Sciences, Persian
Gulf University, Bushehr 7516913817, Iran
| | - Khodabakhsh Niknam
- Department
of Chemistry, Faculty of Sciences, Persian
Gulf University, Bushehr 7516913817, Iran
| | - Gholamhossein Mohebbi
- The
Persian Gulf Marine Biotechnology Research Center, the Persian Gulf
Biomedical Research institute, Bushehr University
of Medical Sciences, Bushehr 7514763448, Iran
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25
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26
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Perego C, Da Dalt L, Pirillo A, Galli A, Catapano AL, Norata GD. Cholesterol metabolism, pancreatic β-cell function and diabetes. Biochim Biophys Acta Mol Basis Dis 2019; 1865:2149-2156. [DOI: 10.1016/j.bbadis.2019.04.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 12/20/2018] [Accepted: 01/06/2019] [Indexed: 12/11/2022]
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27
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Esper RJ, Nordaby RA. Cardiovascular events, diabetes and guidelines: the virtue of simplicity. Cardiovasc Diabetol 2019; 18:42. [PMID: 30922303 PMCID: PMC6437845 DOI: 10.1186/s12933-019-0844-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/09/2019] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular (CV) events or their minor syndromes, as various forms of ischemia, are medical emergencies that do not allow enough time for a guiding anamnesis or proper clinical examination, and lead to relying on Treatment Guidelines, but in many situations it is appropriate to deviate from them. Pathological studies have associated 75% of coronary artery events with atherosclerotic plaque rupture; it is now known that rupture alone is not enough for obstruction or occlusion of the vessel lumen. Concomitant conditions are required for the clinical manifestation of cardiovascular disease, including prothrombogenic and dysfunctional endothelium, less fibrinolytic capacity to protect it, increased platelet activation, increased adrenergic tone, microcirculation vasoconstriction, and other countless factors that contribute to thrombus formation, causing ischemia or infarction. But in most cases, repair of plaque rupture and re endothelization of the lesion are asymptomatic and silent. Atherosclerotic process is a chronic and progressive immune inflammation. Most of the therapeutic indications include statins, which cause side effects in 10% of patients, with a range varying between 7 and 21%, according to different authors. Many investigators have proved that statin use contribute to the genesis of diabetes, reports vary between 1 and 46%, where marked elevation of blood glucose fasting levels and glycosylated hemoglobin have been observed, be it by increased tissue resistance to insulin or by reduced β-cell insulin secretion. Physicians should base their indications on the recommendations provided by Guidelines, but they should not forget that every patient is different, and they should not get confused due to lack of time in an emergency nor be influenced by the latest publications or techniques until they have been properly tested.
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Affiliation(s)
- Ricardo J Esper
- Buenos Aires University, Buenos Aires, Argentina. .,University del Salvador, Virrey Loreto 2111, C1426DXM, Buenos Aires, Argentina. .,ACC & AHA, Houston, USA.
| | - Roberto A Nordaby
- University del Salvador, Virrey Loreto 2111, C1426DXM, Buenos Aires, Argentina
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28
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Ahmadizar F, Ochoa-Rosales C, Glisic M, Franco OH, Muka T, Stricker BH. Associations of statin use with glycaemic traits and incident type 2 diabetes. Br J Clin Pharmacol 2019; 85:993-1002. [PMID: 30838685 DOI: 10.1111/bcp.13898] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/25/2019] [Accepted: 02/01/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS There are several epidemiological studies on the association between statins and incident diabetes, but most of them lack details. In this study, we aimed to investigate the association of statin use with glycaemic traits and incident type 2 diabetes. METHODS Using the prospective population-based Rotterdam Study, we included 9535 individuals free from diabetes at baseline (>45 years) during the study period between 1997 and 2012. Linear regression analysis was applied to examine the cross-sectional associations between statin use and glycaemic traits including fasting blood serum of glucose and insulin concentrations, and insulin resistance. In a longitudinal follow-up study, we applied a Cox regression analysis to determine adjusted hazard ratios (HR) for incident type 2 diabetes in new users of statins. RESULTS The mean age at baseline was 64.3 ± 10.1 years and 41.7% were men. In the fully adjusted model, compared to never users of statins, baseline use of statins was associated with higher concentrations of serum fasting insulin (β = 0.07; 95% CI: 0.02-0.13) and insulin resistance (β = 0.09; 95% CI: 0.03-0.14). Ever use of statins was associated with a 38% higher risk of incident type 2 diabetes (HR = 1.38; 95% CI: 1.09-1.74). This risk was more prominent in subjects with impaired glucose homeostasis and in overweight/obese individuals. CONCLUSIONS Individuals using statins may be at higher risk for hyperglycaemia, insulin resistance and eventually type 2 diabetes. Rigorous preventive strategies such as glucose control and weight reduction in patients when initiating statin therapy might help minimize the risk of diabetes.
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Affiliation(s)
- Fariba Ahmadizar
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Carolina Ochoa-Rosales
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Centro de Vida Saludable de la Universidad de Concepción, Concepción, Chile
| | - Marija Glisic
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Oscar H Franco
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Taulant Muka
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
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29
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Statin treatment and increased diabetes risk. Possible mechanisms. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2019; 31:228-232. [PMID: 30737072 DOI: 10.1016/j.arteri.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/26/2018] [Accepted: 12/16/2018] [Indexed: 01/30/2023]
Abstract
Statins have been associated with an increased risk of new-onset diabetes mellitus (NODM), as confirmed in previous observational studies and meta-analyses. Controversy exists as to whether this risk varies depending on statin type or dose. However, there appears to be unanimity regarding the different associated factors that raise this risk. Furthermore, diverse pathophysiologic mechanisms have been described that could explain the increased risk of diabetes in patients with statin treatment. These fundamentally cause a rise in insulin resistance together with a decrease in insulin secretion. The present review aimed to describe the relationship between statin treatment and the presence of diabetes and provide an update of previous published evidence and the possible mechanisms involved.
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30
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Abstract
PURPOSE OF REVIEW Statins are the most evidence-based therapy to target LDL-C to reduce atherosclerotic events. Yet, many people are unable to achieve adequate reduction in this key atherogenic factor. Moreover, residual risk of cardiovascular events may persist even after "optimal" LDL-C due to elevations in triglyceride-rich lipoproteins. Therefore, additional therapies beyond statins are needed, particularly in patients with diabetes. RECENT FINDINGS Clinical trials with ezetimibe and PCSK9 inhibitors have reported further reductions in cardiovascular events, beyond statins. The latter are particularly effective in lowering LDL-cholesterol and in reducing event rates. However, they are not effective in lowering triglycerides. Currently available fibrates and niacin have not proven effective in combination with statins in clinical trials, while the top line results of the REDUCE-IT trial with EPA, a pure omega-3 fatty acid, reporting 25% relative risk reduction in primary endpoints are of great interest. Recently approved agents have the promise to improve cardiovascular outcomes beyond statins. Many novel drugs in development have the potential to further improve prognosis.
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Affiliation(s)
- Om Ganda
- Adult Diabetes and Clinical Research, Joslin Diabetes Center, Harvard Medical School, 1 Joslin Place, Boston, MA, 02215, USA.
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31
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van Stee MF, de Graaf AA, Groen AK. Actions of metformin and statins on lipid and glucose metabolism and possible benefit of combination therapy. Cardiovasc Diabetol 2018; 17:94. [PMID: 29960584 PMCID: PMC6026339 DOI: 10.1186/s12933-018-0738-4] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/20/2018] [Indexed: 12/13/2022] Open
Abstract
Patients with diabetes type 2 have an increased risk for cardiovascular disease and commonly use combination therapy consisting of the anti-diabetic drug metformin and a cholesterol-lowering statin. However, both drugs act on glucose and lipid metabolism which could lead to adverse effects when used in combination as compared to monotherapy. In this review, the proposed molecular mechanisms of action of statin and metformin therapy in patients with diabetes and dyslipidemia are critically assessed, and a hypothesis for mechanisms underlying interactions between these drugs in combination therapy is developed.
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Affiliation(s)
- Mariël F. van Stee
- Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albert A. de Graaf
- Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - Albert K. Groen
- Amsterdam Diabetes Center and Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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32
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Egan BM, Li J, Davis RA, Fiscella KA, Tobin JN, Jones DW, Sinopoli A. Differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States. J Clin Hypertens (Greenwich) 2018; 20:991-1000. [PMID: 29774988 DOI: 10.1111/jch.13314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/04/2018] [Accepted: 04/20/2018] [Indexed: 01/08/2023]
Abstract
The US Preventive Services Task Force cholesterol guideline recommended statins for fewer adults than the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline by setting a higher 10-year atherosclerotic cardiovascular disease threshold (≥10.0% vs ≥7.5%) and requiring concomitant diabetes mellitus, hypertension, dyslipidemia, or cigarette smoking. The 2017 ACC/AHA hypertension guideline lowered the hypertension threshold, increasing 2016 guideline statin-eligible adults. Cross-sectional data on US adults aged 40 to 75 years enabled estimated numbers for the 2013 guideline and 2016 guideline with hypertension thresholds of ≥140/≥90 mm Hg and ≥130/80 mm Hg, respectively, on: (1) untreated, statin-eligible adults for primary atherosclerotic cardiovascular disease prevention (25.40, 14.72, 15.35 million); (2) atherosclerotic cardiovascular disease events prevented annually (124 000, 70 852, 73 199); (3) number needed to treat (21, 21, 21); and (4) number needed to harm (38, 143, 143) per 1000 patient-years for incident diabetes mellitus (42 800, 6700, 7100 cases per year). Despite the lower hypertension threshold, the 2013 cholesterol guideline qualifies approximately 10 million more adults for statins and prevents approximately 50 600 more primary atherosclerotic cardiovascular disease events but induces approximately 35 700 more diabetes mellitus cases annually than the 2016 guideline.
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Affiliation(s)
- Brent M Egan
- Care Coordination Institute, Greenville, SC, USA.,Department of Medicine, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Jiexiang Li
- Care Coordination Institute, Greenville, SC, USA.,Department of Mathematics, College of Charleston, Charleston, SC, USA
| | - Robert A Davis
- Care Coordination Institute, Greenville, SC, USA.,Department of Medicine, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Kevin A Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Jonathan N Tobin
- Clinical Directors Network (CDN), New York, NY, USA.,Center for Clinical and Translational Science, The Rockefeller University, New York, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Daniel W Jones
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.,Department of Physiology & Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Angelo Sinopoli
- Care Coordination Institute, Greenville, SC, USA.,Department of Medicine, University of South Carolina School of Medicine, Greenville, SC, USA
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34
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Rochlani Y, Kattoor AJ, Pothineni NV, Palagiri RDR, Romeo F, Mehta JL. Balancing Primary Prevention and Statin-Induced Diabetes Mellitus Prevention. Am J Cardiol 2017; 120:1122-1128. [PMID: 28797470 DOI: 10.1016/j.amjcard.2017.06.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/11/2017] [Accepted: 06/29/2017] [Indexed: 11/19/2022]
Abstract
Diabetes mellitus (DM), a modern-day epidemic, is a significant risk factor for cardiovascular disease. It is believed that statins elevate the risk of incident DM. Multiple trials were suggestive of the hyperglycemic effect of long-term statin use. This has prompted the Food and Drug Administration to include the risk of DM in the product label of statins. New-onset DM with statin use is biologically plausible and can be explained based on the multiple pathways in glucose metabolism affected by statins. Most pivotal clinical trials on statins were not powered to adequately assess the risk of incident DM with statin use, and the results from multiple meta-analyses are mixed. Currently, the US Preventive Services Task Force recommend the use of statins for primary prevention in patients with at least 1 cardiovascular risk factor and a 10-year risk of >7.5%. With the new American College of Cardiology/American Heart Association guidelines, the number of patients eligible for statin therapy has increased exponentially, which also calls for caution and increased vigilance in prescribing physicians regarding the controversies surrounding statin use. This article aims to highlight the existing data on statin use for primary prevention in diabetics and nondiabetics and the association of statins use with new-onset DM and its postulated mechanisms.
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Affiliation(s)
- Yogita Rochlani
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ajoe John Kattoor
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Naga Venkata Pothineni
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Francesco Romeo
- Division of Cardiology, University of Rome Tor Vergata, Rome, Italy
| | - Jawahar L Mehta
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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35
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Katsiki N, Purrello F, Tsioufis C, Mikhailidis DP. Cardiovascular disease prevention strategies for type 2 diabetes mellitus. Expert Opin Pharmacother 2017; 18:1243-1260. [DOI: 10.1080/14656566.2017.1351946] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Niki Katsiki
- Second Department of Propaedeutic Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Costas Tsioufis
- First Cardiology Clinic, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
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36
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Kazi DS, Penko JM, Bibbins-Domingo K. Statins for Primary Prevention of Cardiovascular Disease: Review of Evidence and Recommendations for Clinical Practice. Med Clin North Am 2017; 101:689-699. [PMID: 28577620 DOI: 10.1016/j.mcna.2017.03.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Numerous large randomized clinical trials have shown that statin therapy is effective and safe for primary prevention of atherosclerotic cardiovascular disease (CVD) for adults aged 40 to 75 years and support the use of 10-year CVD risk as a means to identify individuals for treatment. Uncertainty exists in those older than 75 years who may be more likely to benefit because of their underlying CVD risk, but also face uncertain harms. Several high-quality mathematical simulation models have shown that statin therapy is cost-effective for primary prevention of atherosclerotic CVD. Despite effectiveness and safety, statins are underutilized for primary prevention.
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Affiliation(s)
- Dhruv S Kazi
- Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94122, USA; Department of Epidemiology, University of California San Francisco, 550 16th Street, San Francisco, CA 94158, USA; UCSF Center for Vulnerable Populations, 2789 25th Street, Suite 350, San Francisco, CA 94110, USA; UCSF Center for Healthcare Value, 3333 California Street, Suite 265, San Francisco, CA 94118, USA; Division of Cardiology, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Joanne M Penko
- UCSF Center for Vulnerable Populations, 2789 25th Street, Suite 350, San Francisco, CA 94110, USA; Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, UCSF Box 1364, San Francisco, CA 94143-1364, USA
| | - Kirsten Bibbins-Domingo
- Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94122, USA; Department of Epidemiology, University of California San Francisco, 550 16th Street, San Francisco, CA 94158, USA; UCSF Center for Vulnerable Populations, 2789 25th Street, Suite 350, San Francisco, CA 94110, USA; Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, UCSF Box 1364, San Francisco, CA 94143-1364, USA.
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