Effects of atorvastatin on the insulin resistance in women of polycystic ovary syndrome

Abstract

Background: Atorvastatin treatment has been suggested as a therapeutic method for women with polycystic ovary syndrome (PCOS) in many clinical studies. Nonetheless, the effects of atorvastatin on insulin resistance in PCOS patients still remain controversial. Objective: The aim of this report was to evaluate the effects of atorvastatin therapy on the insulin resistance in the treatment of PCOS compared to that of placebo, in order to confer a reference for clinical practice. Methods: Randomized controlled trials (RCTs) of atorvastatin for PCOS published up to August, 2020 were searched. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated, and heterogeneity was measured by the I 2 test. Sensitivity analysis was also carried out. The outcomes of interest were as follows: fasting glucose concentration, fasting insulin level, homeostasis model assessment of insulin resistance (HOMA-IR) or body mass index (BMI) value. Results: Nine RCTs with 406 participants were included. The difference of fasting glucose concentration in PCOS patients between atorvastatin group and placebo group was not statistically significant (8 trials; SMD −0.06, 95% CI −0.31 to 0.20, P = .66). PCOS patients in atorvastatin group had lower fasting insulin level than those in placebo group (7 trials; SMD −1.84, 95% CI −3.06 to −0.62, P < .003). The homeostasis model assessment of insulin resistance (HOMA-IR) value showed significant decrease in the atorvastatin therapy compared to placebo (6 trials; SMD −4.12, 95% CI −6.00 to −2.23, P < .0001). In contrast to placebo, atorvastatin therapy did not decrease the BMI value significantly in PCOS patients (7 trials; SMD 0.12, 95% CI −0.07 to 0.31, P = .22). Conclusions: Atorvastatin therapy can reduce insulin resistance in the treatment of patients with PCOS. In addition, further large-sample, multi-center RCTs are needed to identify these findings.

Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics

“…In this investigation, atorvastatin dramatically decreased acylation stimulating protein (ASP), IL-6, and monocyte chemoattractant protein-1 (MCP-1), which are markers of inflammation and adipose tissue dysfunction, followed by a significant improvement in HOMA-IR and testosterone levels [ 105 ]. In randomized placebo-controlled research, atorvastatin significantly decreased hyperandrogenism, inflammatory markers, and insulin resistance in PCOS-affected women compared to a placebo [ 106 , 107 ]. A measure of oxidative stress, serum malondialdehyde (MDA), was dramatically lowered in obese women with PCOS receiving atorvastatin treatment [ 108 ].…”

Effect of statins combined or not combined with metformin on polycystic ovary syndrome: A systematic review and meta‐analysis

“…This current meta‐analysis showed that statins treatment could lower fasting glucose and insulin sensitivity index in women with PCOS. However, Chen et al reported that atorvastatin therapy was associated with reduced fasting insulin level and HOMA‐IR, while no relationship was found between atorvastatin and fasting glucose level 25 . A meta‐analysis published by Meng et al showed no obvious impact on fasting glucose between metformin alone and combination treatment of simvastatin and metformin 26 .…”

“…However, Chen et al reported that atorvastatin therapy was associated with reduced fasting insulin level and HOMA-IR, while no relationship was found between atorvastatin and fasting glucose level. 25 A metaanalysis published by Meng et al showed no obvious impact on fasting glucose between metformin alone…”

Exenatide prevents statin-related LDL receptor increase and improves insulin secretion in pancreatic beta cells (1.1E7) in a protein kinase A-dependent manner

“…The influence on transcriptional activity was less evident and reached statistical significance in cells exposed to high atorvastatin concentration, which might reflect a potential influence on posttranslational modifications inflicted by statin exposure. Human in vivo studies give conflicting results on the subject, showing reduced insulin expression during atorvastatin therapy in patients with polycystic ovary syndrome (Chen and Zheng, 2021), or lack of negative impact on insulin concentration in hyperlipidemic subjects (Buldak et al, 2012). Whereas fluvastatin therapy was associated with increased insulin levels and increased insulin resistance in healthy volunteers (Felder et al, 2021).…”