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Liu J, Wu YP, Qi JJ, Yue ZP, Hu CD. Effect of Statin Therapy on Diabetes Retinopathy in People With Type 2 Diabetes Mellitus: A Meta-Analysis. Clin Appl Thromb Hemost 2021; 27:10760296211040109. [PMID: 34617462 PMCID: PMC8642113 DOI: 10.1177/10760296211040109] [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] [Indexed: 12/15/2022] Open
Abstract
Objective: We tried to find the relationship between statin and
diabetes retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).
Methods: We searched the databases of PubMed, EMBASE, and
the Cochrane Library for eligible studies reporting on the relationships between
statin use and DR, from inception to September 25, 2020. The terms searched
including Diabetes Mellitus, Type 2, Hydroxymethylglutaryl-CoA Reductase
Inhibitors, and Diabetic Retinopathy. We expressed the results as the odds
ratios (ORs) with 95% confidence intervals (CIs) which were calculated using a
random-effects model. Results: A total of 6 eligible studies,
including 43 826 patients, were included in the meta-analysis. The meta-analysis
showed that statin was not associated with elevated risk of DR [OR = 0.96 (95%
CI: 0.80-1.16), P = .68]. Similarly, no differences were found
between statin and placebo in participants ≥500 [OR = 0.98 (95% CI: 0.80-1.21)]
or participants <500 [OR = 0.90 (95% CI: 0.49-1.66)]. Further, we conducted a
meta-analysis to study the effect of statin therapy on DR in people with type 2
diabetes according to age and found that statin use was associated with a
decreased risk of DR in patients with type 2 diabetes 40 years of age or older
[OR = 0.87 (95% CI: 0.82-0.92)]. Conclusion: Our meta-analysis revealed
that statin was not associated with elevated risk of DR in patients with
T2DM. Moreover, statin use was associated with a lower incidence of DR in
patients with type 2 diabetes 40 years of age or older.
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Affiliation(s)
- Jun Liu
- Handan Central Hospital, Handan, Hebei Province, China
| | - Yi-Ping Wu
- Handan Central Hospital, Handan, Hebei Province, China
| | - Jun-Juan Qi
- Handan Central Hospital, Handan, Hebei Province, China
| | - Zeng-Ping Yue
- Handan Central Hospital, Handan, Hebei Province, China
| | - Cheng-Dong Hu
- Handan Central Hospital, Handan, Hebei Province, China
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Corrao G, Monzio Compagnoni M, Rea F, Merlino L, Catapano AL, Mancia G. Clinical significance of diabetes likely induced by statins: Evidence from a large population-based cohort. Diabetes Res Clin Pract 2017; 133:60-68. [PMID: 28892732 DOI: 10.1016/j.diabres.2017.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/13/2017] [Accepted: 08/14/2017] [Indexed: 01/05/2023]
Abstract
AIM To provide information on the extent to which type 2 diabetes more likely induced by statins affects the risk of macrovascular complications compared to diabetes unlikely induced by statins. METHODS The 84,828 residents in the Italian Lombardy Region who were newly treated with statins between 2003 and 2005 were followed from the index statin prescription until 2009 (step-1 follow-up) to identify those starting antidiabetic therapy. The proportion of days of follow-up covered by statins measured adherence with statins. Cohort members who experienced diabetes were 1:3 matched with those who did not developed diabetes for gender, age and previous adherence with statin treatment. The 3321 diabetic - non-diabetic sets, were followed from the initial antidiabetic therapy until 2012 (step-2 follow-up) to estimate the hazard ratio (HR), and 95% Confidence Interval (CI), for macrovascular complications (proportional hazard models) associated with diabetes separately in each category of adherence with statins. RESULTS During the step-1 follow-up, the risk of new-onset diabetes increased progressively with increasing adherence with statins. During the step-2 follow-up, the risk of macrovascular complications associated with diabetes decreased progressively from 1.70 (1.18-2.44), 1.41 (1.17-1.70), 1.30 (1.07-1.57) until 1.10 (0.40-2.80) as adherence with statins during the step-1 follow-up increased. CONCLUSIONS Type 2 diabetes lost its association with increasing macrovascular risk when previous adherence with statins was very high, and thus the chance of its induction by the drug greater. Statin-dependent type 2 diabetes might be prognostically less adverse than diabetes unlikely induced by statins.
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Affiliation(s)
- Giovanni Corrao
- Interuniversity Centre of Healthcare Research & Pharmacoepidemiology, Laboratory of Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
| | - Matteo Monzio Compagnoni
- Interuniversity Centre of Healthcare Research & Pharmacoepidemiology, Laboratory of Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Federico Rea
- Interuniversity Centre of Healthcare Research & Pharmacoepidemiology, Laboratory of Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Luca Merlino
- Operative Unit of Territorial Health Services, Lombardy Region, Milan, Italy
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, Centre of Epidemiology and Preventive Pharmacology (SEFAP), University of Milano, Milan, Italy; IRCSS Multimedica, Sesto San Giovanni, Milan, Italy
| | - Giuseppe Mancia
- Faculty of Medicine, University of Milano-Bicocca, Milan, Italy
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Al-Bayyari N, Saadeh N, Hailat R, Al-Zeidaneen S. Assessment of Atorvastatin Effect on Body Weight and Blood Glucose Levels Among Diabetic and Non-Diabetic Patients. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2017. [DOI: 10.1515/rjdnmd-2017-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background and aims: Atorvastatin is a member of the drug class known as statins, which used as a lipid-lowering agent. The study aim was to assess the effect of atorvastatin on body weight and blood glucose levels among diabetic and non-diabetic patients.
Material and Methods: A 359 hyperlipidemic Jordanian patients using atorvastatin at least for 1 year were divided into two groups: diabetic (DM) and non-diabetic (NDM). The changes in lipid profile, thyroid function test, blood glucose indices as well as body weight were assessed and compared between both groups.
Results: There was no statistical significant (p > 0.05) difference between means of body weight after treatment among DM (85.74 ± 3.56) and NDM (81.75 ± 1.25) groups. Descriptive statistics and mean comparisons before and after atorvastatin treatment, showed statistical significant (p ≤ 0.05) differences in body weight and total cholesterol among NDM group and in total cholesterol and LDL-Ch among DM group. There was an increase in fasting blood glucose (FBG) and glycated hemoglobin A1c (HbA1c) and a decrease in triglycerides among both groups but the difference was not statistically (p > 0.05) significant.
Conclusions: Atorvastatin may increase body weight, fasting blood glucose and HbA1c for diabetic and non-diabetic patients.
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Affiliation(s)
- Nahla Al-Bayyari
- Department of Nutrition and Food Technology, Faculty of Al-Huson University College , Al-Balqa Applied University , Al-Salt , Jordan
| | - Nesreen Saadeh
- Department of Internal Medicine, Faculty of Medicine , Jordan University of Science and Technology , Irbid , Jordan
| | - Raed Hailat
- Department of Medicine , King Abdullah University Hospital , Irbid , Jordan
| | - Safaa Al-Zeidaneen
- Department of Allied Medical Sciences, Al-Zarqa University College , Al-Balqa Applied University , Al-Salt , Jordan
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Pareek A, Chandurkar N, Thulaseedharan NK, Legha R, Agarwal M, Mathur SL, Salkar HR, Pednekar S, Pai V, Sriram U, Khyalappa R, Parmar M, Agrawal N, Dhruv U, Saxena S. Efficacy and safety of fixed dose combination of atorvastatin and hydroxychloroquine: a randomized, double-blind comparison with atorvastatin alone among Indian patients with dyslipidemia. Curr Med Res Opin 2015; 31:2105-17. [PMID: 26371518 DOI: 10.1185/03007995.2015.1087989] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of atorvastatin + hydroxychloroquine fixed-dose combination tablets in comparison with atorvastatin alone in treatment of dyslipidemia. METHODS This double-blind, randomized, out-patient study was conducted in 328 patients with primary dyslipidemia having low-density lipoprotein cholesterol (LDL-C) ≥ 130 mg/dL (3.37 mmol/L) to ≤ 250 mg/dL (6.48 mmol/L) and triglycerides ≤ 400 mg/dL (4.52 mmol/L). Eligible patients were randomized to receive either atorvastatin 10 mg (n = 167) or atorvastatin 10 mg + hydroxychloroquine 200 mg (n = 161) for 24 weeks. CLINICAL TRIAL REGISTRATION CTRI/2010/091/006138. MAIN OUTCOME MEASURES To compare percentage change in LDL-C, total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) from baseline to Week 12 and Week 24 between groups. To compare mean change in glycated hemoglobin (HbA1c), fasting blood glucose (FBG), high-sensitivity C-reactive protein (Hs-CRP), and percentage of patients achieving lipid goals at Week 12 and Week 24. RESULTS At Week 24, percentage reduction in LDL-C (-32.52 [-36.13 to -28.91] vs -39.54 [-43.25 to -35.83]; p = 0.008), TC (-24.41 [-27.10 to -21.72] vs -29.30 [-32.07 to -26.54]; p = 0.013), and non-HDL-C (-30.37 [-33.71 to -27.04] vs -36.76 [-40.18 to -33.33]; p = 0.009) was significantly greater in combination treated patients. Both the treatments showed a significant reduction in triglycerides at Week 24 from baseline, however, this reduction was not statistically significantly different between treatment groups. No significant change in HDL-C was observed in patients from both the treatment groups. At Week 24, change in HbA1c (0.22 [0.07 to 0.37] vs -0.13 [-0.28 to 0.03]; p = 0.002) and FBG was also statistically significant in favor of combination therapy (0.37 [0.07 to 0.67] vs -0.29 [-0.59 to 0.03]; p = 0.003), whereas no statistically significant difference was observed in change in Hs-CRP (p = 0.310). Significantly more patients from the combination group achieved LDL-C and TC goals. Exploratory analysis in patients with pre-diabetes showed development of diabetes in 8 patients (15.09%) from the monotherapy group and 1 patient (1.96%) from the combination group (p = 0.034). Study medications were generally safe and well tolerated. CONCLUSION Based on study results and widely reported pleiotropic benefits, hydroxychloroquine could emerge as a potential drug for combination with statins for treatment of dyslipidemia. Long duration studies with larger sample sizes are required to further explore the role of hydroxychloroquine as adjunct to statins in reducing risk of cardiovascular events and prevention of statin-induced diabetes.
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Affiliation(s)
- Anil Pareek
- a a Medical Affairs and Clinical Research Department , Ipca Laboratories Limited , Mumbai , India
| | - Nitin Chandurkar
- b b Clinical Research and Development , Ipca Laboratories Limited , Mumbai , India
| | - N K Thulaseedharan
- c c Department of Medicine , Calicut Medical College and Hospital , Calicut , India
| | - R Legha
- d d Department of Medicine , Government TD Medical College and Hospital , Alappuzha , India
| | - Manish Agarwal
- e e Medilink Hospital and Research Centre , Ahmedabad , India
| | - S L Mathur
- f f Department of Medicine , SN Medical College and Hospital , Jodhpur , India
| | - H R Salkar
- g g Department of Medicine , NKP Salve Institute of Medical Sciences and Lata Mangeshkar Medical College and Hospital , Nagpur , India
| | - Sangeeta Pednekar
- h h Department of Medicine , LTMMC and LTMG Hospital , Mumbai , India
| | - Vikas Pai
- i i Dr. Vikas Govind Pai Clinical Research Foundation , Pune , India
| | - Usha Sriram
- j j Associates in Clinical Endocrinology Education and Research , Chennai , India
| | - Rajesh Khyalappa
- k k Department of Medicine , Dr. DY Patil Medical College and Hospital , Kolhapur , India
| | - Mahendra Parmar
- l l Department of Medicine , Government Medical College and SSG Hospital , Vadodara , India
| | | | - Urman Dhruv
- n n HCG Medi Surge Hospital , Ahmedabad , India
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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: 42] [Impact Index Per Article: 4.7] [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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Nielsen SF, Nordestgaard BG. Statin use before diabetes diagnosis and risk of microvascular disease: a nationwide nested matched study. Lancet Diabetes Endocrinol 2014; 2:894-900. [PMID: 25217178 DOI: 10.1016/s2213-8587(14)70173-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The role of statins in the development of microvascular disease in patients with diabetes is unknown. We tested the hypothesis that statin use increases the risk of diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, and gangrene of the foot in individuals with diabetes. METHODS We identified all patients living in Denmark who were aged 40 years or older and were diagnosed with incident diabetes between Jan 1, 1996, and Dec 31, 2009. We obtained patients' data from the Danish Patient Registry and information on drug use from the Danish Registry of Medicinal Product Statistics. We randomly selected 15,679 individuals from the database who had used statins regularly until their diagnosis of diabetes (statin users) and matched them in a 1:3 ratio with 47,037 individuals who had never used statins before diagnosis (non-statin users). Our primary outcome was to compare the cumulative incidence of diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, or gangrene of the foot in statin users versus non-statin users. We analysed data with Cox regression models, adjusted for covariates including sex, age at diabetes diagnosis, and method of diabetes diagnosis. To address potential biases between statin users and non-statin users, we made adjustments to our analysis with a propensity score and with other factors. Median follow-up was 2·7 years (range 0-13). FINDINGS During 215,725 person-years of follow-up, 2866 patients developed diabetic retinopathy, 1406 developed diabetic neuropathy, 1248 developed diabetic nephropathy, and 2392 developed gangrene of the foot. Compared with non-statin users, statin users had a lower cumulative incidence of diabetic retinopathy (hazard ratio 0·60, 95% CI 0·54-0·66; p<0·0001), diabetic neuropathy (0·66, 0·57-0·75; p<0·0001), and gangrene of the foot (0·88, 0·80-0·97; p=0·010), but not diabetic nephropathy (0·97, 0·85-1·10; p=0·62). These results were similar after adjusting for the competing risk of death, after matching for a propensity score, after adjusting for visits to a family doctor, and by stratification on covariates. The corresponding multivariable adjusted hazard ratio for risk of diabetes in the total population was 1·17 (95% CI 1·14-1·21; p<0·0001). INTERPRETATION Use of statins before diagnosis of incident diabetes was not associated with an increased risk of microvascular disease. Whether statins are protective against some forms of microvascular disease-a possibility raised by these data-will need to be addressed in other studies similar to ours, in mendelian randomisation studies, and preferably in randomised controlled trials. FUNDING Herlev Hospital, Copenhagen University Hospital.
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Affiliation(s)
- Sune F Nielsen
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Herlev, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Herlev, Denmark.
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Rojas E, Velasco M, Bermúdez V, Israili Z, Bolli P. Targeting hypertension in patients with cardiorenal metabolic syndrome. Curr Hypertens Rep 2012; 14:397-402. [PMID: 22846983 DOI: 10.1007/s11906-012-0292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Diabetes mellitus coexisting with hypertension is greater than chance alone would predict. Hypertensive patients have been shown to have altered composition of skeletal muscle tissue, decreased blood flow to skeletal muscle and post-receptor signaling alterations in the IRS insulin pathway, all inducing insulin resistance states, which partially explains why blood pressure goals in DM patients are lower than in normoglycemic patients. Although optimal first-step antihypertensive drug therapy in type 2 DM or impaired fasting glucose levels (IFG) should be individualized for each patient, converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) have been demonstrated in some but not all studies to decrease the rate of development of proteinuria and diabetic renal disease. According to the ACCF/AHA 2011 Expert Consensus, elderly persons with diabetes, hypertension, and nephropathy should be initially treated with ACEIs or ARBs, although the choice of a specific antihypertensive may also depend on other associated comorbidities.
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Affiliation(s)
- Edward Rojas
- Endocrine and Metabolic Diseases Research Centre "Dr. Felix Gomez", University of Zulia, Maracaibo, Venezuela.
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Abbas A, Milles J, Ramachandran S. Rosuvastatin and atorvastatin: comparative effects on glucose metabolism in non-diabetic patients with dyslipidaemia. Clin Med Insights Endocrinol Diabetes 2012; 5:13-30. [PMID: 22879796 PMCID: PMC3411536 DOI: 10.4137/cmed.s7591] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The ever increasing interventional CVD outcome studies have resulted in statins being an essential factor of cardiovascular prevention strategies. The JUPITER study in 2008, despite reducing CVD and overall mortality, highlighted an increase in new onset diabetes in the rosuvastatin treated arm. Since then there have been many meta-analyses of the RCTs and the largest carried out by Sattar et al showed a significant increase in the incidence of diabetes during the trials. The findings from the individual studies when comparing the different statins were less clear. A higher statin dosage and risk factors associated with diabetes appeared to predict this phenomenon. There have been many studies investigating the effects of statins on glycaemic control, but again no clear conclusion is apparent. Despite the increase in new onset diabetes observed, the risk is clearly out-weighed by the CVD benefits observed in nearly all the statin trials. Thus, no change is required to any of the prevention guidelines regarding statins. However, it may be prudent to monitor glycaemic control after commencing statin therapy. This review will focus on atorvastatin which is the most widely used statin worldwide and rosuvastatin which is the most efficacious. This will be against a background of the effects of other statins on glucose metabolism in non-diabetic patients.
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Affiliation(s)
- Ahmed Abbas
- Core Medical Trainee, Southmead Hospital, North Bristol NHS Trust
| | - John Milles
- Consultant Physician/Diabetologist, Good Hope Hospital, Heart of England NHS Foundation Trust
| | - Sudarshan Ramachandran
- Consultant Chemical Pathologist, Good Hope Hospital, Heart of England NHS Foundation Trust
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