Effect of Atorvastatin in Patients with Type 2 Diabetes Mellitus

摘要

Background: Dyslipidemia is an important factor in causation of cardiovascular disease in type 2 diabetics. Type 2 diabetes is associated with a substantially increased risk of cardiovascular disease, but the role of lipid-lowering therapy with statins for the primary prevention of cardiovascular disease in diabetes is inadequately defined.Aim of the Study: The study was planned to compare the effect of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, in reaching target levels of various lipids as suggested by ADA (2001).Material and methods: 100 patients with type 2 diabetes mellitus were carried out in this study. The criteria for diagnosis of diabetes mellitus and dyslipidemia were based on those laid down by ADA (2001), Patients with type 2 diabetes mellitus with a serum level of LDL-c >100 mg/dl and/or HDL-c <45 mg/dl and/or TG >200 mg/dl were recruited for this study. Patients (n=100) were given atorvastatin in an initial dose of 10 mg per day. After 6 and 12 weeks of atorvastatin therapy, the lipid profile levels were tested. Total cholesterol, TG and HDL-c levels were measured enzymatically. Low-density lipoprotein cholesterol values were calculated using the Friedewald equation. Results: After 12 weeks of atorvastatin therapy, Glycosylated Hb decreased from a mean of 9.1 % to 8.7% Similarly, fasting plasma glucose decreased from 155.6 to 148 mg/dl and significantly reduced the levels of total cholesterol (31%), LDL-c (40.7%) and TG (27.3%), and increased the levels of HDL-c (-23.1%).Conclusion: In our study, Type 2 Diabetes Mellitus did not achieve the target levels of various lipids in diabetic dyslipidemia as per the American Diabetes Association guidelines. Thus, atorvastatin is an effective lipid-lowering drug in achieving the goal for lipids, especially LDL-c. Introduction Patients with type 2 diabetes mellitus have a twofold to fourfold excess risk of coronary artery disease (CAD) compared with nondiabetic patients. (1) Indeed, 70% to 85% of adult diabetic patients die of CAD, cerebrovascular disease, peripheral vascular disease, or a combination of these conditions. (2) In type 2 diabetes mellitus, dyslipidemia is usually present in the form of increased serum triglyceride (TG) levels, decreased high-density lipoprotein cholesterol (HDL-c) levels, normal or slightly higher low-density lipoprotein cholesterol (LDL-c) levels as compared to nondiabetics. (3) However, the qualitative abnormalities of LDL-c (denser, smaller, glycosylated and oxidised particles) increase their affinity towards the endothelium, making them more atherogenic. Thus, an elevated level of LDL-c is the primary risk and prognostic factor for coronary heart disease (CHD) in patients with type 2 diabetes mellitus. (4) The various statins (lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin) not only lower the lipid levels but also stabilize vulnerable plaque, restore endothelial function, and have an antiplatelet, anti-inflammatory, and antioxidant action. (5) As per recent American Diabetes Association (ADA) criteria 2001(6) the role of atorvastatin in the management of dyslipidemia in patients with type 2 diabetes mellitus is not very well elucidated.This study was planned to compare the effect of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, in reaching target levels of various lipids as suggested by ADA (2001). Material and Methods Study Design and PatientsThe study was carried out on 100 patients with type 2 diabetes mellitus. The criteria for diagnosis of diabetes mellitus and dyslipidemia were based on those lay down by ADA (2001). (6), Patients with type 2 diabetes mellitus with a serum level of LDL-c >100 mg/dl and/or HDL-c <45 mg/dl and/or TG >200 mg/dl were recruited for this study. All patients with type 2 diabetes mellitus had been under a fair or moderate glycemic control with a total glycated hemoglobin (GHb) 10 mg per day. After 6and 12 weeks of atorvastatin therapy