Differential metabolic effects of pravastatin and simvastatin in hypercholesterolemic patients.
Differential metabolic effects of pravastatin and simvastatin in hypercholesterolemic patients.
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DOI：
10.1016/j.atherosclerosis.2008.09.021
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发表时间：
2009-06
期刊：
影响因子：
5.3
通讯作者：
Shin, Eak Kyun
中科院分区：
文献类型：
--
作者：
Koh, Kwang Kon;Quon, Michael J.;Han, Seung Hwan;Lee, Yonghee;Kim, Soo Jin;Park, Jeong Beorn;Shin, Eak Kyun
在实验研究中，亲脂性和亲水性他汀类药物对脂联素和胰岛素抵抗有不同的影响，在大规模临床研究中，对新发糖尿病的发病率有不同的影响。因此，我们假设辛伐他汀和普伐他汀可能对高胆固醇血症患者有不同的代谢作用。这是一项随机、单盲、安慰剂对照、平行研究。年龄、性别和体重指数相匹配。43例患者分别给予安慰剂、辛伐他汀20 mg或普伐他汀40 mg，每日1次，疗程2个月。辛伐他汀和普伐他汀治疗2个月后与基线（P < 0.001）或安慰剂治疗（ANOVA P < 0.001）相比，脂蛋白水平显著改变，血流介导的舒张功能改善。与基线相比，辛伐他汀治疗显著增加胰岛素水平（平均%变化; 127%，P = 0.014），降低血浆脂联素水平（10%，P = 0.012）和QUICKI评估的胰岛素敏感性（6%，P = 0.007）。相比之下，与基线相比，普伐他汀治疗没有显著改变胰岛素水平（-3%，P = 0.437），但显著增加血浆脂联素水平（9%，P = 0.011）和胰岛素敏感性（6%，P = 0.008）。此外，与普伐他汀相比，辛伐他汀的这些作用是显著的（通过秩方差分析，胰岛素水平P <0.001，脂联素P < 0.001，QUICKI方差分析P = 0.001）。与基线相比，辛伐他汀显著增加血浆瘦素水平（35%，P = 0.028），而普伐他汀没有（1%，P = 0.822）。尽管辛伐他汀和普伐他汀治疗引起脂蛋白和内皮依赖性舒张功能的变化相当，但在高胆固醇血症患者中，辛伐他汀和普伐他汀治疗具有不同的代谢效应，可能具有临床意义。
Lipophilic and hydrophilic statins have different effects on adiponectin and insulin resistance in experimental studies and different effects on the rate of onset of new diabetes in large scale clinical studies. Therefore, we hypothesized that simvastatin and pravastatin may have differential metabolic effects in hypercholesterolemic patients. This was a randomized, single-blind, placebo-controlled, parallel study. Age, gender, and body mass index were matched. Forty-three patients were given placebo, simvastatin 20 mg, or pravastatin 40 mg, respectively once daily for 2 months. Simvastatin and pravastatin therapy significantly changed lipoprotein levels and improved flow-mediated dilation after 2 months when compared with baseline (P < 0.001) or placebo treatment (P < 0.001 by ANOVA). Simvastatin therapy significantly increased insulin levels (mean % changes; 127%, P = 0.014) and decreased plasma adiponectin levels (10%, P = 0.012) and insulin sensitivity as assessed by QUICKI (6%, P = 0.007) when compared with baseline. By contrast, pravastatin therapy did not significantly change insulin levels (−3%, P = 0.437) but significantly increased plasma adiponectin levels (9%, P = 0.011) and insulin sensitivity (6%, P = 0.008) when compared with baseline. In addition, these effects of simvastatin were significant when compared with pravastatin (P < 0.001 for insulin levels by ANOVA on Ranks, P < 0.001 for adiponectin and P = 0.001 for QUICKI by ANOVA). When compared with baseline, simvastatin significantly increased plasma leptin levels (35%, P = 0.028), but pravastatin did not (1%, P = 0.822). Despite causing comparable changes in lipoprotein and endothelium-dependent dilation, simvastatin and pravastatin therapy had differential metabolic effects in hypercholesterolemic patients that may be clinically relevant.
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