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Yu JM, Chen WM, Shia BC, Wu SY. Long-term outcomes of statin dose, class, and use intensity on primary prevention of cardiovascular mortality: a national T2DM cohort study. Eur J Clin Pharmacol 2023; 79:687-700. [PMID: 37010535 DOI: 10.1007/s00228-023-03488-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To investigate how statins reduce cardiovascular mortality in patients with type 2 diabetes (T2DM) in a dose-, class-, and use intensity-dependent manner. METHODS We used an inverse probability of treatment-weighted Cox hazards model, with statin use status as a time-dependent variable, to estimate the effects of statin use on cardiovascular mortality. RESULTS Adjusted hazard ratio [aHR; 95% confidence interval (CI)] for cardiovascular mortality was 0.41 (0.39-0.42). Compared with nonusers, pitavastatin, pravastatin, simvastatin, rosuvastatin, atorvastatin, fluvastatin, and lovastatin users demonstrated significant reductions in cardiovascular mortality [aHRs (95% CIs) = 0.11 (0.06, 0.22), 0.35 (0.32, 0.39), 0.36 (0.34, 0.38), 0.39 (0.36, 0.41), 0.42 (0.40, 0.44), 0.46 (0.43, 0.49), and 0.52 (0.48, 0.56), respectively]. In Q1, Q2, Q3, and Q4 of cDDD-year, our multivariate analysis demonstrated significant reductions in cardiovascular mortality [aHRs (95% CIs) = 0.63 (0.6, 0.65), 0.44 (0.42, 0.46), 0.33 (0.31, 0.35), and 0.17 (0.16, 0.19), respectively; P for trend < 0.0001]. The optimal statin dose daily was 0.86 DDD, with the lowest aHR for cardiovascular mortality of 0.43. CONCLUSIONS Persistent statin use can reduce cardiovascular mortality in patients with T2DM; in particular, the higher is the cDDD-year of statin, the lower is the cardiovascular mortality. The optimal statin dose daily was 0.86 DDD. The priority of protective effects on mortality are pitavastatin, rosuvastatin, pravastatin, simvastatin, atorvastatin, fluvastatin, and lovastatin for the statin users compared with non-statin users.
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Affiliation(s)
- Jung-Min Yu
- Department of Cardiovascular Surgery, Taichung Tzu Chi Hospital, Taichung, Taiwan
- Department of Surgery, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan.
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan.
- , No. 83, Nanchang St., Luodong Township, Luodong, Yilan County, 265, Taiwan.
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan.
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan.
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
- Division of Radiation Oncology, Lotung Poh-Ai Hospital, Lo-Hsu Medical Foundation, Yilan, Taiwan.
- Big Data Center, Big Data & Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Management, College of Management, Fo Guang University, Yilan, Taiwan.
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Zhao W, Zhao SP. Different effects of statins on induction of diabetes mellitus: an experimental study. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:6211-23. [PMID: 26648697 PMCID: PMC4664500 DOI: 10.2147/dddt.s87979] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background To determine the effect of different statins on the induction of diabetes mellitus. Materials and methods Four statins (atorvastatin, pravastatin, rosuvastatin, and pitavastatin) were used. Cytotoxicity, insulin secretion, glucose-stimulated insulin secretion, and G0/G1 phase cell cycle arrest were investigated in human pancreas islet β cells, and glucose uptake and signaling were studied in human skeletal muscle cells (HSkMCs). Results Human pancreas islet β cells treated with 100 nM atorvastatin, pravastatin, rosuvastatin, and pitavastatin had reduced cell viability (32.12%, 41.09%, 33.96%, and 29.19%, respectively) compared to controls. Such cytotoxic effect was significantly attenuated by decreasing the dose to 10 and 1 nM, ranged from 1.46% to 17.28%. Cells treated with 100 nM atorvastatin, pravastatin, rosuvastatin, and pitavastatin had a reduction in the rate of insulin secretion rate by 34.07%, 30.06%, 26.78%, and 19.22%, respectively. The inhibitory effect was slightly attenuated by decreasing the dose to 10 and 1 nM, ranging from 10.84% to 29.60%. Insulin secretion stimulated by a high concentration of glucose (28 mmol/L) was significantly higher than a physiologic concentration of glucose (5.6 mmol/L) in all treatment groups. The glucose uptake rates at a concentration of 100 nM were as follows: atorvastatin (58.76%) < pravastatin (60.21%) < rosuvastatin (72.54%) < pitavastatin (89.96%). We also found that atorvastatin and pravastatin decreased glucose transporter (GLUT)-2 expression and induced p-p38 MAPK levels in human pancreas islet β cells. Atorvastatin, pravastatin, and rosuvastatin inhibited GLUT-4, p-AKT, p-GSK-3β, and p-p38 MAPK levels in HSkMCs. Conclusion Statins similar but different degree of effects on pancreas islet β cells damage and induce insulin resistance in HSkMC.
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Affiliation(s)
- Wang Zhao
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Shui-Ping Zhao
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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Schirris TJJ, Ritschel T, Bilos A, Smeitink JAM, Russel FGM. Statin Lactonization by Uridine 5′-Diphospho-glucuronosyltransferases (UGTs). Mol Pharm 2015; 12:4048-55. [DOI: 10.1021/acs.molpharmaceut.5b00474] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tom J. J. Schirris
- Department
of Pharmacology and Toxicology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- Center for Systems Biology and Bioenergetics of the Nijmegen Center for Mitochondrial Disorders, 6500 HB Nijmegen, The Netherlands
| | - Tina Ritschel
- Computational
Discovery and Design Group, Center for Molecular and Biomolecular
Informatics (CMBI), Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Albert Bilos
- Department
of Pharmacology and Toxicology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Jan A. M. Smeitink
- Center for Systems Biology and Bioenergetics of the Nijmegen Center for Mitochondrial Disorders, 6500 HB Nijmegen, The Netherlands
- Department
of Pediatrics, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Frans G. M. Russel
- Department
of Pharmacology and Toxicology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- Center for Systems Biology and Bioenergetics of the Nijmegen Center for Mitochondrial Disorders, 6500 HB Nijmegen, The Netherlands
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Pathogenesis and management of the diabetogenic effect of statins: a role for adiponectin and coenzyme Q10? Curr Atheroscler Rep 2015; 17:472. [PMID: 25398645 DOI: 10.1007/s11883-014-0472-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
There is growing evidence to suggest that statin therapy is associated with an increased risk of incident diabetes. The risk for statin-related diabetes depends upon many factors including age, pre-existing diabetic risk, type and potency of statin. Several mechanisms have been suggested for the diabetogenic effects of statins involving processes that alter islet ß-cell function, resulting in impaired glucose metabolism. Recent evidence suggests that the association of statin therapy with the development of diabetes may be partly mediated by a statin-induced decrease in circulating adiponectin and coenzyme Q10. The available evidence suggests the benefit of statins in reducing cardiovascular events outweigh the risk of developing diabetes. Moreover, statin therapy does not impair glycemic control in diabetic patients. Expert recommendations for the use of statins in people at risk of developing diabetes have recently been published. However, further research is required to elucidate both the association between statin use and incident diabetes as well as underlying mechanisms.
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Chogtu B, Magazine R, Bairy KL. Statin use and risk of diabetes mellitus. World J Diabetes 2015; 6:352-357. [PMID: 25789118 PMCID: PMC4360430 DOI: 10.4239/wjd.v6.i2.352] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/28/2014] [Accepted: 12/19/2014] [Indexed: 02/05/2023] Open
Abstract
The 3-hydroxy-methylglutaryl coenzyme A reductase inhibitors, statins, are widely used in the primary and secondary prevention of cardiovascular diseases to lower serum cholesterol levels. As type 2 diabetes mellitus is accompanied by dyslipidemia, statins have a major role in preventing the long term complications in diabetes and are recommended for diabetics with normal low density lipoprotein levels as well. In 2012, United States Food and Drug Administration released changes to statin safety label to include that statins have been found to increase glycosylated haemoglobin and fasting serum glucose levels. Many studies done on patients with cardiovascular risk factors have shown that statins have diabetogenic potential and the effect varies as per the dosage and type used. The various mechanisms for this effect have been proposed and one of them is downregulation of glucose transporters by the statins. The recommendations by the investigators are that though statins can have diabetogenic risk, they have more long term benefits which can outweigh the risk. In elderly patients and those with metabolic syndrome, as the risk of diabetes increase, the statins should be used cautiously. Other than a subset of population with risk for diabetes; statins still have long term survival benefits in most of the patients.
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Almeida EAD, Ozaki MR. Effect of pitavastatin on vascular reactivity in hypercholesterolemic rabbits. Arq Bras Cardiol 2014; 103:4-12. [PMID: 25014056 PMCID: PMC4126755 DOI: 10.5935/abc.20140090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/19/2014] [Indexed: 11/20/2022] Open
Abstract
Background Pitavastatin is the newest statin available in Brazil and likely the one with
fewer side effects. Thus, pitavastatin was evaluated in hypercholesterolemic
rabbits in relation to its action on vascular reactivity. Objective To assess the lowest dose of pitavastatin necessary to reduce plasma lipids,
cholesterol and tissue lipid peroxidation, as well as endothelial function in
hypercholesterolemic rabbits. Methods Thirty rabbits divided into six groups (n = 5): G1 - standard chow diet; G2 -
hypercholesterolemic diet for 30 days; G3 - hypercholesterolemic diet and after
the 16th day, diet supplemented with pitavastatin (0.1 mg); G4 -
hypercholesterolemic diet supplemented with pitavastatin (0.25 mg); G5 -
hypercholesterolemic diet supplemented with pitavastatin (0.5 mg); G6 -
hypercholesterolemic diet supplemented with pitavastatin (1.0 mg). After 30 days,
total cholesterol, HDL, triglycerides, glucose, creatine kinase (CK), aspartate
aminotransferase (AST), alanine aminotransferase (ALT) were measured and LDL was
calculated. In-depth anesthesia was performed with sodium thiopental and aortic
segments were removed to study endothelial function, cholesterol and tissue lipid
peroxidation. The significance level for statistical tests was 5%. Results Total cholesterol and LDL were significantly elevated in relation to G1. HDL was
significantly reduced in G4, G5 and G6 when compared to G2. Triglycerides, CK,
AST, ALT, cholesterol and tissue lipid peroxidation showed no statistical
difference between G2 and G3-G6. Significantly endothelial dysfunction reversion
was observed in G5 and G6 when compared to G2. Conclusion Pitavastatin starting at a 0.5 mg dose was effective in reverting endothelial
dysfunction in hypercholesterolemic rabbits.
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