Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Diabetes. Dec 15, 2013; 4(6): 365-371
Published online Dec 15, 2013. doi: 10.4239/wjd.v4.i6.365
Effect of hypolipidemic treatment on glycemic profile in patients with mixed dyslipidemia
Anastazia Kei, Evangelos Liberopoulos, Moses Elisaf
Anastazia Kei, Evangelos Liberopoulos, Moses Elisaf, Department of Internal Medicine, University of Ioannina Medical School, 45110 Ioannina, Greece
Author contributions: Kei A was responsible for enrolment and assignment patients to interventions, data collection and analysis/interpretation, statistics, writing manuscript draft; Elisaf M and Liberopoulos E designed the study, edited and approved the article.
Correspondence to: Moses Elisaf, MD, FRSH, FASA, FISA, Professor of Internal Medicine, Department of Internal Medicine, University of Ioannina Medical School, Stavrou Niarchou Str., 45110 Ioannina, Greece. egepi@cc.uoi.gr
Telephone: +30-265-1007509 Fax: +30-265-1007016
Received: April 4, 2013
Revised: October 21, 2013
Accepted: November 2, 2013
Published online: December 15, 2013
Processing time: 254 Days and 15.6 Hours
Abstract

AIM: To assess the effect of different hypolipidemic treatment strategies on glycemic profile in mixed dyslipidemia patients.

METHODS: This is a prespecified analysis of a prospective, randomized, open-label, blinded end point (PROBE) study (ClinicalTrials.gov identifier: NCT01010516). Patients (n = 100) with mixed dyslipidemia on a standard statin dose who had not achieved lipid targets were randomized to switch to the highest dose of rosuvastatin (40 mg/d) or to add-on-statin extended release nicotinic acid (ER-NA)/laropiprant (LRPT) or to add-on-statin micronised fenofibrate for a total of 3 mo. Fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR) index and lipid profile were evaluated at baseline and 3 mo after treatment intervention.

RESULTS: FPG increased in add-on ER-NA/LRPT and rosuvastatin monotherapy groups by 9.7% and 4.4%, respectively (P < 0.01 between the 2 groups and compared with baseline), while it did not significantly change in the add-on fenofibrate group. Similarly, HbA1c increased by 0.3% in add-on ER-NA/LRPT group and by 0.2% in the rosuvastatin monotherapy group (P < 0.01 for all comparisons vs baseline and for the comparison between the 2 groups), while no significant change was reported in the add-on fenofibrate group. HOMA-IR increased by 65% in add-on ER-NA/LRPT and by 14% in rosuvastatin monotherapy group, while it decreased by 6% in the add-on fenofibrate group (P < 0.01 vs baseline and for all comparisons among the groups). Non-HDL-C decreased in all groups (by 23.7%, 24.7% and 7% in the rosuvastatin, ER-NA/LRPT and fenofibrate group, respectively, P < 0.01 for all vs baseline and P < 0.01 for all vs with fenofibrate group).

CONCLUSION: Both addition of ER-NA/LRPT and switch to the highest dose of rosuvastatin deteriorated glycemic profile in patients with mixed dyslipidemia, while add-on fenofibrate seems to increase insulin sensitivity.

Keywords: Diabetes mellitus; Fasting plasma glucose; Fenofibrate; Insulin; Nicotinic acid/laropiprant; Rosuvastatin

Core tip: In this study both addition of extended release nicotinic acid/laropiprant and switch to the highest dose of rosuvastatin deteriorated glycemic profile in patients with mixed dyslipidemia who were inadequately controlled with a standard statin dose. Add-on fenofibrate, on the other hand, seems to increase insulin sensitivity. Larger prospective studies should address the effect of these treatment interventions on new onset diabetes incidence and cardiovascular disease risk.