Gil Medical Center, Gachon University, Incheon, Republic of Korea.
Int J Cardiol. 2013 Jun 20;166(2):509-15. doi: 10.1016/j.ijcard.2011.11.028. Epub 2011 Dec 26.
Rosuvastatin and pravastatin have differential hydrophilicity and potency to inhibit hydroxymethylglutaryl-CoA reductase that may be relevant to changes in adiponectin levels, insulin resistance, and the rate of new onset diabetes in large clinical studies. Therefore, we hypothesized that rosuvastatin and pravastatin may have differential metabolic effects in hypercholesterolemic patients.
This was a randomized, single-blind, placebo-controlled, parallel study. Age, gender, and body mass index were matched. Fifty-four patients were given placebo, rosuvastatin 10mg, or pravastatin 40mg, respectively once daily for 2 months.
When compared with pravastatin therapy, rosuvastatin therapy significantly reduced total, LDL cholesterol, and apolipoprotein B levels (P<0.05 by post-hoc comparison), but comparably improved flow-mediated dilation after 2 months. Interestingly, rosuvastatin therapy significantly increased fasting insulin (mean % changes; 28%, P=0.005). and HbA1c (1%, P=0.038) while decreasing plasma adiponectin levels (9%, P=0.010) and insulin sensitivity (assessed by QUICKI; 2%, P=0.007) when compared with baseline. By contrast, pravastatin therapy significantly decreased fasting insulin (8%, P=0.042), and HbA1c levels (1%, P=0.019) while increasing plasma adiponectin levels (36%, P=0.006) and insulin sensitivity (3%, P=0.005) when compared with baseline. Moreover, these differential effects were evident when outcomes of rosuvastatin and pravastatin therapy were directly compared (P=0.002 for insulin levels by ANOVA on Ranks, P=0.003 for adiponectin, P=0.003 for QUICKI, and P=0.010 for HbA1c by ANOVA).
While significantly reducing lipoprotein profiles, rosuvastatin therapy had unwanted metabolic effects in hypercholesterolemic patients when compared with pravastatin therapy, that may be clinically relevant in patients prone to metabolic diseases.
在大型临床研究中，瑞舒伐他汀和普伐他汀的亲水性和抑制羟甲基戊二酰辅酶 A 还原酶的效力存在差异，这可能与脂联素水平、胰岛素抵抗和新发糖尿病的发生率变化有关。因此，我们假设瑞舒伐他汀和普伐他汀在高胆固醇血症患者中可能具有不同的代谢作用。
这是一项随机、单盲、安慰剂对照、平行研究。年龄、性别和体重指数相匹配。54 名患者分别给予安慰剂、瑞舒伐他汀 10mg 或普伐他汀 40mg，每日 1 次，疗程 2 个月。
与普伐他汀治疗相比，瑞舒伐他汀治疗显著降低了总胆固醇、LDL 胆固醇和载脂蛋白 B 水平（事后比较 P<0.05），但在 2 个月后同样改善了血流介导的扩张。有趣的是，与基线相比，瑞舒伐他汀治疗显著增加了空腹胰岛素（平均%变化；28%，P=0.005）和糖化血红蛋白（1%，P=0.038），同时降低了血浆脂联素水平（9%，P=0.010）和胰岛素敏感性（用 QUICKI 评估；2%，P=0.007）。相比之下，与基线相比，普伐他汀治疗显著降低了空腹胰岛素（8%，P=0.042）和糖化血红蛋白水平（1%，P=0.019），同时增加了血浆脂联素水平（36%，P=0.006）和胰岛素敏感性（3%，P=0.005）。此外，当直接比较瑞舒伐他汀和普伐他汀治疗的结果时，这些差异效应是明显的（方差分析的秩次检验，P=0.002 用于胰岛素水平，P=0.003 用于脂联素，P=0.003 用于 QUICKI，P=0.010 用于糖化血红蛋白）。
虽然瑞舒伐他汀显著降低了脂蛋白谱，但与普伐他汀治疗相比，瑞舒伐他汀在高胆固醇血症患者中具有不良的代谢作用，这在易患代谢性疾病的患者中可能具有临床意义。
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