Effect of Statins on Fasting Plasma Glucose in Diabetic and Nondiabetic Patients
Effect of Statins on Fasting Plasma Glucose in Diabetic and Nondiabetic Patients
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DOI：
10.2310/jim.0b013e318197ec8b
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发表时间：
2009-03-01
影响因子：
2.6
通讯作者：
Mehta, Jawahar L.
中科院分区：
文献类型：
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作者：
Sukhija, Rishi;Prayaga, Sastry;Mehta, Jawahar L.
背景：3-羟基-3-甲基戊二酰辅酶a还原酶抑制剂（他汀类药物）可降低血清胆固醇水平和心血管发病率和死亡率。然而，他汀类药物对葡萄糖代谢的影响尚不清楚。一些研究表明，他汀类药物可能通过增加胰岛细胞钙浓度导致胰岛素释放减少或降低GLUT - 4介导的外周葡萄糖摄取而引起高血糖。方法：我们分析了来自退伍军人事务部visn16数据库的345,417例患者（平均年龄61 - 15岁，94%为男性，6%为糖尿病患者，20%为他汀类药物使用者）的数据。我们研究了该人群中空腹血糖（FPG）的变化，从第一次可用测量到最近一次记录访问的最后一次测量平均时间为2年。数据仅限于两次FPG测量的患者。糖尿病的诊断必须在第一次FPG测量之前出现。结果：在非糖尿病患者中，FPG随他汀类药物的使用从98 mg/dL增加到105 mg/dL，而在非他汀类药物的使用中，FPG从97 mg/dL增加到10.1 mg/dL （FPG随他汀类药物的使用增加P < 0.0001）。在糖尿病患者中，FPG随着他汀类药物的使用从102 mg/dL增加到141 mg/dL，而在非他汀类药物使用者中，FPG从100 mg/dL增加到129 mg/dL （FPG随着他汀类药物的使用而增加；P < 0.0001）。在调整了年龄和阿司匹林、受体阻滞剂和血管紧张素转换酶抑制剂的使用后，非糖尿病他汀类药物使用者的FPG变化为7 mg/dL（非他汀类药物使用者为5 mg/dL， P < 0.0001），糖尿病他汀类药物使用者的FPG变化为39 mg/dL（非他汀类药物使用者为32 mg/dL， P < 0.0001）。结论：他汀类药物的使用与糖尿病患者和非糖尿病患者FPG的升高有关。他汀类药物使用与FPG升高之间的关系与年龄、阿司匹林、受体阻滞剂和血管紧张素转换酶抑制剂的使用无关。
Background: The 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors (statins) reduce serum cholesterol level and cardiovascular morbidity and mortality. However, the effect of statins on glucose metabolism is unclear. Some studies have suggested that statins may cause hyperglycemia by increasing calcium concentration in the islet cells leading to decrease in insulin release or by decreasing GLUT 4-mediated peripheral glucose uptake.Methods: We analyzed the data in 345,417 patients (mean age 61 15 years, 94% males, 6% diabetic, 20% statin users) from the Veterans Affairs VISN 16 database. We studied change in fasting plasma glucose (FPG) in this population over a mean time of 2 years between the first available measurement and the last measurement form the most recent recorded visit. Data were limited to patients who had 2 FPG measurements. Diagnosis of diabetes had to be present before the first FPG measurement.Results: Among patients without diabetes, FPG increased with statin use from 98 mg/dL to 105 mg/dL, and among nonstatin users, FPG increased from 97 mg/dL to 10 1 mg/dL (increase in FPG with statin use P < 0.0001). Among patients with diabetes, FPG increased with statin use from 102 mg/dL to 141 mg/dL, and among nonstatin users, FPG increased from 100 mg/dL to 129 mg/dL (increase in FPG with statin use; P < 0.0001). After adjustment for age and use of aspirin, beta-blockers, and angiotensin-converting enzyme inhibitors, the change in FPG in nondiabetic statin users was 7 mg/dL (vs 5 mg/dL in nonstatin users, P < 0.0001) and for diabetic statin users it was 39 mg/dL (vs 32 in nonstatin users, P < 0.0001).Conclusions: Statin use is associated with a rise of FPG in patients with and without diabetes. This relationship between statin use and rise in FPG is independent of age and use of aspirin, beta-blockers, and angiotensin-converting enzyme inhibitors,