阿托伐他汀在高胆固醇血症患者中引起胰岛素抵抗并增加环境血糖。
Atorvastatin causes insulin resistance and increases ambient glycemia in hypercholesterolemic patients.
机构信息
Department of Cardiology, Gachon University, Gil Medical Center, Incheon, Korea.
Diabetes Unit, National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, Maryland.
出版信息
J Am Coll Cardiol. 2010 Mar 23;55(12):1209-1216. doi: 10.1016/j.jacc.2009.10.053.
OBJECTIVES
We investigated whether atorvastatin might decrease insulin sensitivity and increase ambient glycemia in hypercholesterolemic patients.
BACKGROUND
Clinical trials suggest that some statin treatments might increase the incidence of diabetes despite reductions in low-density lipoprotein (LDL) cholesterol and improvement in endothelial dysfunction.
METHODS
A randomized, single-blind, placebo-controlled parallel study was conducted in 44 patients taking placebo and in 42, 44, 43, and 40 patients given daily atorvastatin 10, 20, 40, and 80 mg, respectively, during a 2-month treatment period.
RESULTS
Atorvastatin 10, 20, 40, and 80 mg significantly reduced LDL cholesterol (39%, 47%, 52%, and 56%, respectively) and apolipoprotein B levels (33%, 37%, 42%, and 46%, respectively) after 2 months of therapy when compared with either baseline (all p < 0.001 by paired t test) or placebo (p < 0.001 by analysis of variance [ANOVA]). Atorvastatin 10, 20, 40, and 80 mg significantly increased fasting plasma insulin (mean changes: 25%, 42%, 31%, and 45%, respectively) and glycated hemoglobin levels (2%, 5%, 5%, and 5%, respectively) when compared with either baseline (all p < 0.05 by paired t test) or placebo (p = 0.009 for insulin and p = 0.008 for glycated hemoglobin by ANOVA). Atorvastatin 10, 20, 40, and 80 mg decreased insulin sensitivity (1%, 3%, 3%, and 4%, respectively) when compared with either baseline (p = 0.312, p = 0.008, p < 0.001, and p = 0.008, respectively, by paired t test) or placebo (p = 0.033 by ANOVA).
CONCLUSIONS
Despite beneficial reductions in LDL cholesterol and apolipoprotein B, atorvastatin treatment resulted in significant increases in fasting insulin and glycated hemoglobin levels consistent with insulin resistance and increased ambient glycemia in hypercholesterolemic patients. (Effects of Atorvastatin on Adiponectin Levels and Insulin Sensitivity In Hypercholesterolemic Patients; NCT00745836).
目的
我们研究了阿托伐他汀是否会降低高胆固醇血症患者的胰岛素敏感性并增加环境血糖。
背景
临床试验表明，尽管降低了低密度脂蛋白（LDL）胆固醇并改善了内皮功能障碍，但某些他汀类药物治疗可能会增加糖尿病的发病率。
方法
在为期 2 个月的治疗期间，44 名接受安慰剂的患者和 42、44、43 和 40 名分别接受阿托伐他汀 10、20、40 和 80mg 每日治疗的患者进行了一项随机、单盲、安慰剂对照的平行研究。
结果
与基线相比（配对 t 检验，所有 p <0.001）或安慰剂相比（方差分析[ANOVA]，p <0.001），阿托伐他汀 10、20、40 和 80mg 治疗 2 个月后，LDL 胆固醇（分别降低 39%、47%、52%和 56%）和载脂蛋白 B 水平（分别降低 33%、37%、42%和 46%）显著降低。与基线相比（配对 t 检验，所有 p <0.05）或安慰剂相比（ANOVA，胰岛素 p=0.009，糖化血红蛋白 p=0.008），阿托伐他汀 10、20、40 和 80mg 也显著增加了空腹血浆胰岛素（分别增加 25%、42%、31%和 45%）和糖化血红蛋白水平（分别增加 2%、5%、5%和 5%）。与基线相比（配对 t 检验，分别为 p=0.312、p=0.008、p<0.001 和 p=0.008）或安慰剂相比（ANOVA，p=0.033），阿托伐他汀 10、20、40 和 80mg 降低了胰岛素敏感性（分别降低 1%、3%、3%和 4%）。
结论
尽管 LDL 胆固醇和载脂蛋白 B 有益降低，但阿托伐他汀治疗导致空腹胰岛素和糖化血红蛋白水平显著升高，与高胆固醇血症患者的胰岛素抵抗和环境血糖升高一致。（阿托伐他汀对高胆固醇血症患者脂联素水平和胰岛素敏感性的影响；NCT00745836）。
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