Combined lipid goal attainment in patients with type 2 diabetes and dyslipidemia: A head-to-head comparative trial of statins

Abstract

Diabetic dyslipidemia is characterized by elevated levels of triglycerides (TGs) and small dense low-density lipoprotein cholesterol (LDL-C) and low levels of high-density lipoprotein cholesterol (HDL-C). 1 The atherogenic lipid profile contributes to the excess risk of cardiovascular disease (CVD) in people with type 2 diabetes mellitus (DM). 2 Current consensus for the management of diabetic dyslipidemia recommends that the primary lipid goal of treatment is LDL-C <2.6 mmol/L, and a non-HDL-C goal of <3.4 mmol/L is a secondary target for primary CVD prevention. 3,4 Extensive evidence supports these recommendations and suggests to preferably use a statin (3-hydroxy-3-methylgluatryl coenzyme A reductase inhibitor), along with lifestyle intervention, to control diabetic dyslipidemia. 4,5 For example, in the Collaborative Atorvastatin Diabetes Study (CARDS), lowering LDL-C by 40% to a mean level of 2.1 mmol/L and lowering non-HDL-C by 36% to a mean level of 2.9 mmol/L with atorvastatin monotherapy led to a 37% reduction in the relative CVD risk compared with the placebo. 6 However, statins differ in multiple characteristics, including bioavailability, potency, liver and renal metabolism, and effects on serum lipid components. 7 Head-to-head comparisons between different statins are essential for effectively managing lipid disorders, especially in specific populations with a distinct lipid profile, such as patients with DM. 7 Simvastatin, a long-established statin, is now available in generic forms. The results from the Heart Protection Study clearly demonstrated the beneficial effects of simvastatin on cardiovascular outcomes in patients with DM after 5 years of daily treatment with 40 mg simvastatin. 8 Rosuvastatin, a synthetic statin, has high potency for lowering LDL-C levels on a milligram-equivalent basis. 9 Several studies have compared the effects of rosuvastatin with those of other statins on lipid goal attainment in patients with DM. [10][11][12][13] Moreover, in a recent primary prevention study, 20 mg of rosuvastatin significantly reduced the incidence of major cardiovascular events in individuals with elevated C-reactive protein levels. 14 However, the

Association between Pre-Pregnancy Overweightness/Obesity and Pregnancy Outcomes in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

“…There are some possible causes for more miscarriages in overweight/obese women with PCOS. First, obesity is more likely to cause diabetes mellitus because of IR [ 44 , 45 , 46 , 47 , 48 ]. Glucose metabolism is important for endometrial decidualization, and IR may have alteration on endometrial receptivity [ 49 ].…”

To Do One and To Get More: Part II. Diabetes and metabolic dysfunction-associated fatty liver diseases

“…115 So far, evidence, including randomized controlled trials (RCTs), review, and meta-analyses shows at least three classes of ADA, such as insulin sensitizers (metformin and thiazolidinediones), sodium-glucose cotransporter-2 inhibitors (SGLT-2i), glucagon-like peptide-1 receptor agonist (GLP-1R agonist), and so on that may have favorable effects on the spectrum of MAFLD (Table 1). 27,28,30,63,65,67,69,71–84,87,96–98,101,102,108–110,112–114,116,117…”

“…1 However, the poorer adherence to healthy eating patterns or poorer consumption of major food groups are common in these pre-DM and DM populations, [56][57][58] contributing to the extra need of application of the other one strategy as prescription of ADA for these pre-DM and DM populations. [59][60][61][62][63] Since DM is frequently associated with major morbidities or concomitant comorbidities, extraglycemic effect of ADA is still highly expected. Liver is one of the most vital organs involving in many detoxication and metabolism functions, and also a significant target of metabolic syndrome (MeS), based on the observation that FLD occurs very commonly in DM, [64][65][66][67][68][69] contributing to an establishment of a new term to describe this metabolic dysfunction-related chronic disease as metabolic dysfunctionassociated FLDs (MAFLD, also called as metabolic associated FLDs, and previously named NAFLD), which are based on evidence of hepatic steatosis, in addition to one of the following three criteria, namely overweight/obesity, presence of T2DM, or evidence of metabolic dysregulation (lean/normal-weight subjects with the coexistence of two other risk factors that are related to metabolic dysregulation, including central obesity, hypertension, prediabetes, hypertriglyceridemia, low levels of high-density lipoprotein [HDL] cholesterol, insulin resistance (IR), and high-sensitivity-C-reactive protein [HS-CRP] levels).…”

To do one and to get more: Part I. Diabetes and bone

“…9,10,[40][41][42] Since pharmacological therapy is not avoidable, physicians should be familiar with different pharmacologic options to target DM, since as shown above and below, DM is frequently associated with major morbidities or concomitant comorbidities. 9,10,[43][44][45][46][47] Finally, routine and continuous blood sugar monitoring to make sure that DM patients state in normalized and stabilized sugar homeostasis is a confirmatory step for successful DM control.…”