Shahid Abbas, Shazia Abbas.
Lipid-lowering effect of Atorvastatin in patients with type-2 Diabetes Mellitus.
Pak Armed Forces Med J Jan ;54(2):170-5.
Dyslipidemia is an important factor in the causation of macrovascular disease in type 2 diabetics. The role of atorvastatin in the management of dyslipidemia in patients with type 2 diabetes mellitus is not very well elucidated. The American College of Cardiology and American Diabetes Association suggest the aggressive therapy of diabetic dyslipidemia will reduce the risk of coronary heart disease in diabetics and that optmal levels are serum low-density lipoprotein cholesterol <2.60 mmol/L(<100mg/dl), high density lipoprotein cholesterol >1.15 mmol/L (>45 mg/dl) and triglycerdes <2.30 mmol/L (<200mg/dl). This study was planned to compare the effect of atorvastatin together with behavioral modification and behavioral modification alone, In age, sex and body mass index matched patients with type 2 diabetes mellitus with dyslipidemia, In reaching the target levels of various lipids as suggested by the American Diabetes Association criteria 2001. An open label, prospective study was conducted on 80 patients with type 2 diabetes mellitus, who had fair to moderate glycemic control with a total glycated hemoglobin <10%. The patients in the control group (n=40) were treated with only behavioral modifications like calorie control and daily walking for 30-45 minutes, and no lipid lowering agent was given. The lipid profile was re-evaluated after 6 and 12 weeks. The patients in the test group (n=40) were advised behavioral. modification and given atorvastatin. The starting dose was 10 mg at bed time. After 6 weeks of atorvastatin therapy, a lipid profile was done. If the goal of low-density lipoprotein cholesterol <100 mg/dl and /or triglycerides <200mg/dl and /or high-density lipoprotein cholesterol>45 mg/dl was not achieved, the dose of atorvastatin was increased to 20mg at bedtime for another 6 weeks. It was observed that low-density lipoprotein dyslipidemia was most prevalent. In the control group, a favourable alteration in lipid levels was brought about but none was statistically significant and the American Diabetes Association goals were not lipid moieties, and the target levels were achieved in 80% of patients after 12 weeks. There was no significant alteration in glycemic control and liver functions. Myopathy was not seen in any patient. In our study, behavioral modification alone did not achieve the larget levels of various lipids in diabetic dyslipidemia as per the American Diabetes Association guidelines. Hence, pharmacological therapy with statins should be resorted to in patients with type 2 diabetes mellitus who carry a high risk of coronary hearts disease. Atorvastatin is a safe and effective lipid-lowering drug.
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