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Influence of HMG−CoA reductase inhibitor on glucose metabolism in patients with type 2 diabetes and impaired glucose tolerance−Key trial to observe glucose metabolism of atorvastatin or pravastatin in clinical use for high-LDL-cholesterol patients, KOMACHI−
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JPY
Abstract
Background:Several large−scale clinical trials have reported that the statins reduce the incidence of coronary heart disease in Western patients with type 2 diabetes(T2DM). Given the differences between Japanese and Western patients, whether these results can be extrapolated to Japanese populations remains unclear. Although differential effects on glucose metabolism among statins are presumed, few reports revealed such differences. This study examined whether pravastatin or atorvastatin use influences glucose metabolismin Japanese patients. Methods:Subjects comprised 117 dyslipidemia patients ≧20 years old. Levels of fasting blood sugar(FBS), hemoglobin(Hb)A1c, and low−density lipoprotein cholesterol (LDL−C), high−density lipoprotein cholesterol(HDL−C)and triglyceride(TG)were determined before and after allocated treatment with atorvastatin(n=66)or pravastatin(n=51). Results:Mean age, proportion of women, and proportion of impaired glucose tolerance(IGT)tended to be slightly higher in the pravastatin group than in the atorvastatin group. Baseline lipid profiles were almost the same and mean levels after treatment were similar in both groups. FBS and HbA1c were significantly increased after atorvastatin treatment compared to pravastatin treatment(FBS:111 mg/dL to 130 mg/dL, p<0.0001;HbA1c:5.9% to 6.8%, p<0.0001). Frequency of exacerbated diabetes defined by FBS>126 mg/dL among patients with a baseline FBS <110 mg/dL tended to be higher in the atorvastatin group than in the pravastatin group(p=0.09). Conclusion:Pravastatin prevents new development of diabetes, while atorvastatin does not. Attention is necessary when using atorvastatin for patients with T2DM or IGT. To confirm the superiority of pravastatin, a large−scale, prospective, randomized comparative trial is necessary.
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