Anastazia Kei, Evangelos Liberopoulos, Moses Elisaf, Department of Internal Medicine, University of Ioannina Medical School, 45110 Ioannina, Greece.
World J Diabetes. 2013 Dec 15;4(6):365-71. doi: 10.4239/wjd.v4.i6.365.
To assess the effect of different hypolipidemic treatment strategies on glycemic profile in mixed dyslipidemia patients.
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.
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).
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.
评估不同降脂治疗策略对混合性血脂异常患者血糖谱的影响。
这是一项前瞻性、随机、开放标签、终点设盲（PROBE）研究（ClinicalTrials.gov 标识符：NCT01010516）的预先分析。100 例接受标准他汀剂量但未达到血脂目标的混合性血脂异常患者被随机分为三组：换用最高剂量的瑞舒伐他汀（40mg/d）、加用他汀类药物烟酸缓释剂（ER-NA）/拉罗匹坦（LRPT）或加用他汀类药物微粒化非诺贝特，治疗共 3 个月。治疗干预前和 3 个月后评估空腹血糖（FPG）、糖化血红蛋白（HbA1c）、稳态模型评估的胰岛素抵抗指数（HOMA-IR）和血脂谱。
加用 ER-NA/LRPT 和瑞舒伐他汀单药治疗组的 FPG 分别增加了 9.7%和 4.4%（两组间比较差异有统计学意义，与基线相比也均有显著差异），而加用非诺贝特组的 FPG 则无显著变化。同样，加用 ER-NA/LRPT 组的 HbA1c 增加了 0.3%，瑞舒伐他汀单药治疗组增加了 0.2%（与基线相比，所有比较差异均有统计学意义，两组间比较也有显著差异），而加用非诺贝特组的 HbA1c 则无显著变化。加用 ER-NA/LRPT 组的 HOMA-IR 增加了 65%，瑞舒伐他汀单药治疗组增加了 14%，而加用非诺贝特组则降低了 6%（与基线相比，所有比较差异均有统计学意义，组间比较也有显著差异）。非高密度脂蛋白胆固醇（非 HDL-C）在所有组中均降低（瑞舒伐他汀组降低 23.7%，ER-NA/LRPT 组降低 24.7%，非诺贝特组降低 7%，与基线相比，所有比较差异均有统计学意义，与非诺贝特组相比，所有组差异均有统计学意义）。
加用 ER-NA/LRPT 和换用最高剂量的瑞舒伐他汀均使混合性血脂异常患者的血糖谱恶化，而加用非诺贝特似乎可增加胰岛素敏感性。
