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Hammad MA, Abdo MS, Mashaly AM, Syed Sulaiman SA, Alghamdi S, Mangi AA, Mohamed Noor DA. The statins effects on HbA1c control among diabetic patients: An umbrella review of systematic reviews and meta-analyses of observational studies and clinical trials. Diabetes Metab Syndr 2019; 13:2557-2564. [PMID: 31405676 DOI: 10.1016/j.dsx.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
Statins have impacts on the metabolism of glucose that might influence the progress of diabetes in non-diabetics or affect glycemic control in patients with existing diabetes. Experimental proof has been contradictory about whether some statins display beneficial properties while others indicate harmful impressions. Some systematic reviews of statins had stated conflicting findings on the concern of glucose metabolism. The current study investigates the published systematic reviews and meta-analyses to combine their results and give a clear situation regarding the influence of statins therapy on glycated hemoglobin (HbA1c). This study has valuable strength points; long follow-up period and big sample size.
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Affiliation(s)
- Mohamed Anwar Hammad
- Department of Clinical Pharmacy, Pharmacy School, Universiti Sains Malaysia, Penang, Malaysia.
| | - Mahmoud Saeed Abdo
- Department of Clinical Pharmacy, Pharmacy School, Universiti Sains Malaysia, Penang, Malaysia.
| | - Abdalla Mohamed Mashaly
- Department of Clinical Pharmacy, Pharmacy School, Universiti Sains Malaysia, Penang, Malaysia.
| | | | - Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Al Baha University, Al Baha, Saudi Arabia; Faculty of Pharmacy, Gomal University, DI-Khan KPK, Pakistan.
| | - Altaf A Mangi
- Faculty of Pharmacy, Gomal University, DI-Khan KPK, Pakistan
| | - Dzul Azri Mohamed Noor
- Department of Clinical Pharmacy, Pharmacy School, Universiti Sains Malaysia, Penang, Malaysia.
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Seyam E, Hefzy E. Long-term effects of combined simvastatin and metformin treatment on the clinical abnormalities and ovulation dysfunction in single young women with polycystic ovary syndrome. Gynecol Endocrinol 2018; 34:1073-1080. [PMID: 30044162 DOI: 10.1080/09513590.2018.1490405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/14/2018] [Indexed: 01/31/2023] Open
Abstract
The aim of the current work was to investigate the value of the long term effects of combined use of simvastatin and metformin treatment for a year versus the effects of their individual treatment on the clinical, biochemical abnormalities, and ovulation dysfunction in young single women with polycystic ovary syndrome (PCOS). It was a randomized, double-blind controlled study. Where two hundreds (n = 200) single young women with PCOS were randomized into seventy (n = 70) women using simvastatin 20 mg daily combined with metformin 500 mg three times daily considered as group A (study group), and another 2 sixty five (n = 65) women groups using simvastatin and metformin individually as a single treatment use, and considered as groups (B & C), respectively. Medications period extended for twelve months treatment period. The primary outcome measures were the changes in serum androgen levels (testosterone, androstendione, and dehydro-epiandrostenion sulfate-DHEAS), LH, FSH, LH/FSH ratio, and insulin resistance (IR), in addition to menstrual regularity, hirsutism, BMI, and W/H ratio. Spontaneous ovulation, confirmed with both trans-abdominal sonography (TAS) and luteal serum progesterone as well had been also evaluated. After 12 months' treatment, in group A serum testosterone showed significant decline by 37%, with significant drop in LH serum level (51%) and a marked decline of the LH/FSH ratio (53%). IR showed a significant improvement in groups A and C but still relatively higher in group B. There was also a clear decrease of total cholesterol (36%), low-density lipoprotein (LDL; 48%), and triglycerides (26%), and increased high-density lipoprotein (HDL) by 24% in groups A and B. Improved menstrual regularity and decreased hirsutism, acne, ovarian volume, and BMI had been significantly noticed in the study groups A and C, although still relatively higher in group C. Spontaneous ovulation had been confirmed in group A: songoraphically (TAS), and biochemically (progesterone >10 ng) in 10 women after the first six months treatment, and 26 at the end of 12 months treatment, compared to 5 & 8 in group B, and 2 & 5 in group C, respectively. Combined simvastatin and metformin treatment showed significant improvement of PCOS clinical and ovarian dysfunction abnormalities much better than their individual treatment.
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Affiliation(s)
- Emaduldin Seyam
- a Obstetrics and Gynecology Department , Minia University Faculty of Medicine , Minia , Egypt
| | - Enas Hefzy
- b Microbiology and Immunology Department , Fayoum University College of Medicine , Fayoum , Egypt
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Risk of mortality and recurrent cardiovascular events in patients with acute coronary syndromes on high intensity statin treatment. Prev Med Rep 2017; 6:203-209. [PMID: 28373930 PMCID: PMC5374870 DOI: 10.1016/j.pmedr.2017.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 02/24/2017] [Accepted: 03/13/2017] [Indexed: 12/13/2022] Open
Abstract
Several randomized controlled trials have shown a benefit of high-dose intensive statin treatment in reducing risk of death and second cardiovascular disease (CVD) events in patients previously diagnosed with an acute coronary syndrome (ACS). Non-randomized studies in clinical settings support these findings, but large, long-term, observational studies addressing CVD and non-CVD endpoints are lacking. In this retrospective longitudinal study, we followed ACS patients in Sweden during 2001–2012 using national health registry and medical record data. A total of 49,857 patients were identified, of whom 10,092 (20.2%) received high dose statins and 21,174 (42.7%) received no statins. Royston-Parmar parametric time-to-event models were implemented to model hazard for second CVD events and death, stratified by gender and diabetes diagnosis. We found that risk of a second CVD event developed similarly in both treatment groups, but was much higher in the no statin group. Risk of CVD-related death remained relatively constant for the high-statin group, while it increased over time for the no-statin group. Interestingly, males had higher mortality rates in the no-statin group, but not in the high-statin group. All-cause mortality and non-CVD-related death followed similar trends to those observed for CVD-related death. This work provides additional real-world evidence for effect of statins in CVD-related mortality. The hazard functions presented here can provide a basis for future survival modeling and health economic evaluation.
10,092 ACS patients on high dose and 21,174 on no statins were followed 2001–12. Royston-Parmar models were implemented to model hazard for new CVD events and death. Risk of a new event developed similarly, but was much higher for those not on statins. Risk of death increased over time for the no-statin, but not the high statin, group. High statin treatment reduced gender effects on risk of mortality and new events.
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Key Words
- ACS, Acute Coronary Syndrome
- Acute coronary syndromes
- CVD, Cardiovascular Disease
- Cardiovascular disease
- EMR, Electronic Medical Records
- Epidemiology
- HF, Heart Failure
- ICD, International Classification of Diseases
- IS, Ischemic Stroke
- LDL, Low Density Lipoprotein
- MI, Myocardial Infarction
- Mortality
- PCI, Percutaneous Coronary Intervention
- RCT, Randomized Controlled Trial
- STEMI, ST Elevation Myocardial Infarction
- Secondary prevention
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Alternative Interventions to Prevent Oxidative Damage following Ischemia/Reperfusion. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:7190943. [PMID: 28116037 PMCID: PMC5225393 DOI: 10.1155/2016/7190943] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/23/2016] [Accepted: 10/12/2016] [Indexed: 12/25/2022]
Abstract
Ischemia/reperfusion (I/R) lesions are a phenomenon that occurs in multiple pathological states and results in a series of events that end in irreparable damage that severely affects the recovery and health of patients. The principal therapeutic approaches include preconditioning, postconditioning, and remote ischemic preconditioning, which when used separately do not have a great impact on patient mortality or prognosis. Oxidative stress is known to contribute to the damage caused by I/R; however, there are no pharmacological approaches to limit or prevent this. Here, we explain the relationship between I/R and the oxidative stress process and describe some pharmacological options that may target oxidative stress-states.
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Cho Y, Choe E, Lee YH, Seo JW, Choi Y, Yun Y, Wang HJ, Ahn CW, Cha BS, Lee HC, Kang ES. Risk of diabetes in patients treated with HMG-CoA reductase inhibitors. Metabolism 2015; 64:482-8. [PMID: 25312577 DOI: 10.1016/j.metabol.2014.09.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 09/17/2014] [Accepted: 09/20/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE 3-Hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) are used to control blood cholesterol levels and reduce cardiovascular disease. It has been repeatedly reported that statins may cause new-onset diabetes mellitus (DM). However, limited evidence exists from direct head to head comparisons of statins on whether the risk of DM differs among statins. We investigated the risk of development of new-onset diabetes in subjects treated with different statins. METHODS We retrospectively enrolled consecutive 3680 patients without DM or impaired fasting glucose who started receiving statin treatment for cholesterol control. We evaluated the incidence of new-onset diabetes according to the type of statin. RESULTS The mean duration of follow-up was 62.6±15.3 months. The incidence of DM was significantly higher in the pitavastatin group (49 of 628; 7.8%) compared to that in the other statin groups [atorvastatin (68 of 1327; 5.1%), rosuvastatin (77 of 1191; 6.5%), simvastatin (11 of 326; 3.4%), and pravastatin (12 of 298; 5.8%); p=0.041]. The risk of diabetes was the highest in the pitavastatin group compared with that in the simvastatin group [hazard ratio (HR)=2.68, p=0.011]. Other statins showed no significant risk differences compared to that for simvastatin. Fasting blood glucose (FBG) level at baseline and body-mass index (BMI) were associated with the development of diabetes [FBG, HR=1.11, p<0.001; BMI, HR=1.02, p=0.005]. CONCLUSIONS Among the five statins, pitavastatin showed the strongest effect on the development of new-onset diabetes.
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Affiliation(s)
- Yongin Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - EunYeong Choe
- Endocrinology and Metabolism Clinic, International St. Mary's Hospital Internal Medicine, Incheon, South Korea
| | - Yong-Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Won Seo
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Younjeong Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yujung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Jin Wang
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Woo Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Bong Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Chul Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea.
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Sun J, Yuan Y, Cai R, Sun H, Zhou Y, Wang P, Huang R, Xia W, Wang S. An investigation into the therapeutic effects of statins with metformin on polycystic ovary syndrome: a meta-analysis of randomised controlled trials. BMJ Open 2015; 5:e007280. [PMID: 25818277 PMCID: PMC4386233 DOI: 10.1136/bmjopen-2014-007280] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To investigate the therapeutic effects of statins with metformin on polycystic ovary syndrome (PCOS). SETTINGS Endocrinology department. PARTICIPANTS MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials were searched until October 2014. Studies comparing statins and placebo, as well as the combination of statins and metformin and metformin alone, were included in the analysis. INTERVENTIONS Data were independently extracted by two researchers; any convergence was resolved by a third reviewer. PRIMARY AND SECONDARY OUTCOME MEASURES The following properties were extracted from the qualified trials to identify the effects of statins: clinical variables, metabolic characteristics, hormone outcomes, sign of inflammation, glucose parameters and insulin outcomes. RESULTS Data from four trials comparing statin and metformin with metformin alone were analysed. The combination of statins and metformin decreases the levels of C reactive protein (standardised mean difference (SMD) -0.91; 95% CI -1.81 to -0.02; p=0.046), triglyceride (SMD -1.37; 95% CI -2.46 to -0.28; p=0.014), total cholesterol (SMD -1.28; 95% CI -1.59 to -0.97; p=0.000) and low-density lipoprotein (LDL) cholesterol (SMD -0.74; 95% CI -1.03 to -0.44; p=0.000). However, the combined therapy fails to reduce fasting insulin (SMD -0.92; 95% CI -2.07 to 0.24; p=0.120), homeostasis model assessment of insulin resistance (SMD -1.15; 95% CI -3.36 to 1.06; p=0.309) and total testosterone (SMD -1.12; 95% CI -2.29 to 0.05; p=0.061). Analysis of the five trials comparing statin with placebo shows that statin monotherapy reduces LDL-cholesterol, triglyceride and total cholesterol. CONCLUSIONS Combined statin and metformin therapy can improve lipid and inflammation parameters, but cannot effectively improve insulin sensitivity and reduce hyperandrogenism in women with PCOS. A large-scale randomised controlled study must be conducted to ascertain the long-term effects of the therapy.
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Affiliation(s)
- Jie Sun
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, People's Republic of China
| | - Yang Yuan
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, People's Republic of China
| | - Rongrong Cai
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, People's Republic of China
| | - Haixia Sun
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, People's Republic of China
| | - Yi Zhou
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, People's Republic of China
| | - Pin Wang
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, People's Republic of China
| | - Rong Huang
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, People's Republic of China
| | - Wenqing Xia
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, People's Republic of China
| | - Shaohua Wang
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, People's Republic of China
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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: 45] [Impact Index Per Article: 4.5] [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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Ijioma N, Robinson JG. Statins and Primary Prevention of Cardiovascular Disease in Women. Am J Lifestyle Med 2015. [DOI: 10.1177/1559827613504536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives. A systematic review of randomized clinical trials and meta-analyses evaluating the efficacy, tolerability, and safety of statins in preventing cardiovascular disease (CVD) in women without cardiovascular disease. Background. Several meta-analyses have been performed evaluating statins in CVD primary prevention trials involving women. This review is an update incorporating the results of recent CVD primary prevention trials in women and the recent concerns of statins and new-onset diabetes. Method. PubMed database was searched for primary prevention trials and meta-analyses. The key terms “statins, cardiovascular disease, primary prevention in women” were used. Search was limited to all English publications published up to October 2012. Results. Statin use led to a trend towards reduction in cardiovascular mortality and morbidity in women. No significant increased risk in adverse events was observed. The slight increased incidence of diabetes is outweighed by the greater cardiovascular benefit derived from statin use. Conclusions. The data support the use of statins for primary prevention of CVD in women at higher risk of CVD. The lack of statistical significance in prior randomized controlled trials and meta-analyses is attributable to the lower numbers of women enrolled in these trials and the lower CVD risk of women in the trials resulting in the inadequate powering of these studies. Higher risk women who may benefit from CVD primary prevention with statins may be identified using validated tools such as the Reynolds scoring system, the 2011 American Heart Association risk algorithm for women, and the forthcoming National Heart, Lung, and Blood Institute risk equations.
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Affiliation(s)
- Nkechinyere Ijioma
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio (NL)
- Departments of Epidemiology and Medicine, University of Iowa, Iowa City, Iowa (JGR)
| | - Jennifer G. Robinson
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio (NL)
- Departments of Epidemiology and Medicine, University of Iowa, Iowa City, Iowa (JGR)
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Li L, Zhang M, Su F, Li Y, Shen Y, Shen J, Zhang D. Combination therapy analysis of ezetimibe and statins in Chinese patients with acute coronary syndrome and type 2 diabetes. Lipids Health Dis 2015; 14:10. [PMID: 25879728 PMCID: PMC4342190 DOI: 10.1186/s12944-015-0004-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/27/2015] [Indexed: 02/02/2023] Open
Abstract
Background Dyslipidemia management situation in Chinese patients with high risk and very high risk has been demonstrated very low, despite the wide use of statins. The effects and safety of the combined treatment of ezetimibe (EZ) and statins in Chinese patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM) remain unknown. Methods Chinese Patients with ACS and T2DM were divided into the statins group (n = 40) and the combination group of EZ and statins (n = 44). In order to evaluate the clinical effects on lipids-lowering, systemic inflammation response and clinical safety, the follow-up of all patients was carried out at day 7th and 30th after treatment. Results The level of low-density lipoprotein cholesterol (LDL-C) in combination group and statins group was 1.87 ± 0.42 and 2.18 ± 0.58 mmol/L at day 7th, 1.51 ± 0.29 and 1.94 ± 0.49 mmol/L at day 30th, respectively. The control rates of LDL-C level in the combination group and the statins group were 77% and 45% at day 30th, respectively. There was no significant improvement on high-density lipoprotein cholesterol (HDL-C) level during follow-up. The triglyceride (TG) levels were significantly reduced in both groups, while no obvious difference was observed between two groups. No significant difference on serum high-sensitivity C-reactive protein (hs-CRP) level between two groups was observed. Moreover, we did not observe any significant correlation between serum lipids levels and serum hs-CRP level during follow-up. The liver dysfunction and muscle related side effects (MRSE), creatine kinase (CK) and myopathy were not observed in both groups. Conclusion Our study demonstrated that it is feasible to initiate combination therapy during acute phase for Chinese patients with ACS and T2DM, which can bring more significant effect on LDL-C-lowering and improve the control rate of LDL-C level with good safety.
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Affiliation(s)
- Lulu Li
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China. .,Charite University of Berlin, Berlin, Germany.
| | - Minli Zhang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Fuxiang Su
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Yang Li
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Yali Shen
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Jie Shen
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Daqing Zhang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
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Erqou S, Lee CC, Adler AI. Statins and glycaemic control in individuals with diabetes: a systematic review and meta-analysis. Diabetologia 2014; 57:2444-52. [PMID: 25245638 DOI: 10.1007/s00125-014-3374-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/22/2014] [Indexed: 01/14/2023]
Abstract
AIMS/HYPOTHESES Current evidence indicates that statins increase the risk of incident diabetes; however, the relationship between statins and glycaemic control in people with established diabetes has not been well characterised. To address this question, we conducted a meta-analysis of randomised controlled trials (RCTs) of statins in patients with diabetes for whom there was available data on glycaemic control. METHODS We identified studies published between January 1970 and November 2013 by searching electronic databases and reference lists. We included RCTs in which the intervention group received statins and the control group received placebo or standard treatment, with >200 participants enrolled, with the intervention lasting >12 weeks and with pre- and post-intervention HbA1c reported. We combined study-specific estimates using random-effects model meta-analysis. RESULTS In a pooled analysis of nine trials involving 9,696 participants (4,980 statin, 4,716 control) and an average follow-up of 3.6 years, the mean HbA1c of participants randomised to statins was higher than those randomised to the control group: mean difference (95% CI) was 0.12% (0.04, 0.20) or 1.3 mmol/mol (0.4, 2.2); p = 0.003. There was moderate heterogeneity across the studies (I (2) = 54%, p = 0.014) not explained by available study-level characteristics. This review was limited by the small number of studies, available data on only three statins and sparse reporting on changes in use of glucose-lowering medications. CONCLUSIONS/INTERPRETATION Statin treatment is associated with a modest increase in HbA1c in patients with diabetes.
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Affiliation(s)
- Sebhat Erqou
- Department of Medicine, Weill Cornell Medical College, 565 E 68th St, Box 130, New York, NY, 10065, USA,
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The use of statins in people at risk of developing diabetes mellitus: Evidence and guidance for clinical practice. ATHEROSCLEROSIS SUPP 2014; 15:1-15. [DOI: 10.1016/j.atherosclerosissup.2014.04.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Development of reusable logic for determination of statin exposure-time from electronic health records. J Biomed Inform 2014; 49:206-12. [PMID: 24637142 DOI: 10.1016/j.jbi.2014.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/28/2014] [Accepted: 02/28/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVE We aim to quantify HMG-CoA reductase inhibitor (statin) prescriber-intended exposure-time using a generalizable algorithm that interrogates data stored in the electronic health record (EHR). MATERIALS AND METHODS This study was conducted using the Marshfield Clinic (MC) Personalized Medicine Research Project (PMRP) a central Wisconsin-based population and biobank with, on average, 30 years of electronic health data available in the independently-developed MC Cattails MD EHR. Individuals with evidence of statin exposure were identified from the electronic records, and manual chart abstraction of all mentions of prescribed statins was completed. We then performed electronic chart abstraction of prescriber-intended exposure time for statins, using previously identified logic to capture pill-splitting events, normalizing dosages to atorvastatin-equivalent dose. Four models using iterative training sets were tested to capture statin end-dates. Calculated cumulative provider-intended exposures were compared to manually abstracted gold-standard measures of ordered statin prescriptions, and aggregate model results (totals) for training and validation populations were compared. The most successful model was the one with the smallest discordance between modeled and manually abstracted Atorvastatin 10mg/year Equivalents (AEs). RESULTS Of the approximately 20,000 patients enrolled in the PMRP, 6243 were identified with statin exposure during the study period (1997-2011), 59.8% of whom had been prescribed multiple statins over an average of approximately 11 years. When the best-fit algorithm was implemented and validated by manual chart review for the statin-ordered population, it was found to capture 95.9% of the correlation between calculated and expected statin provider-intended exposure time for a random validation set, and the best-fit model was able to predict intended statin exposure to within a standard deviation of 2.6 AEs, with a standard error of +0.23 AEs. CONCLUSION We demonstrate that normalized provider-intended statin exposure time can be estimated using a combination of structured clinical data sources, including a medications ordering system and a clinical appointment coordination system, supplemented with text data from clinical notes.
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Strandberg TE, Kurimo P, Kolehmainen L, Strandberg AY, Pitkälä KH, Tilvis RS. Midlife characteristics of older men using statins. J Am Geriatr Soc 2013; 61:831-2. [PMID: 23672552 DOI: 10.1111/jgs.12229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Despite issues about the value of statins, benefit for high cardiovascular (CV) risk outweighs problems. However, the practitioner must be aware of concerns, be prepared to respond, and justify statin usage. Symptoms of statin-related myopathy are of more concern than stated by pharmaceutical companies. Occurrence of myopathy symptoms, estimated to be up to 10.4%, can decrease statin adherence of high CV risk patients. Dosage modification, or use of pitavastatin, may help the problematic patient. There are concerns that there may be little benefit of statins for primary prevention in women. However, evidence appears to support statin use in women at high CV risk, both in primary and secondary prevention. Abandoning low-density lipoprotein cholesterol (LDL-C) as a valid target is unwarranted; there is much evidence to support "lower is better." The practitioner must be aware of the complicated processes causing atherosclerosis and when to incorporate new approaches to disease management. Tailoring therapy for CV risk, when indicated, may contribute further to LDL-C reduction. Liver inflammation can occur with statins but is of minimal concern; frequently, statins alleviate the problem. Unless liver transaminases are over three times normal, a statin should be prescribed, if indicated. The net effect of statins on cognition appears to be zero-no harm, no benefit. Despite reports of improved cognition, statins should not be prescribed for this. With diabetes mellitus (DM), statins can increase incidence, but the CV benefit far outweighs any risk. Therefore, statins should be prescribed in DM to reduce CV risk. Statins are a major medical contribution when used appropriately.
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Affiliation(s)
- Thomas F. Whayne
- Division of Cardiovascular Medicine, Department of Medicine (Cardiology), Gill Heart Institute, University of Kentucky, Lexington, Kentucky
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