Strategies to Lower Low-Density Lipoprotein Cholesterol in Metabolic Syndrome: Averting the Diabetes Risk

Sheely, Dana; Jialal, Ishwarlal

doi:10.1089/met.2013.1503

Cited by 6 publications

(7 citation statements)

References 18 publications

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“…In contrast, one meta-analysis reported the dose-dependent relationship between statin use and an increased risk of diabetes [55]. This led to the belief that statins might influence glucose homeostasis by decreasing insulin production or increasing insulin resistance, or both [56]. Consequently, the effects of statins on diabetes and DME remain controversial.…”

Section: Discussionmentioning

confidence: 99%

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The prevalence and systemic risk factors of diabetic macular edema: a cross-sectional study from Turkey

Acan

Çalan

et al. 2018

BMC Ophthalmol

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BackgroundThe aim of this study was to evaluate the prevalence of diabetic macular edema (DME) utilizing optical coherence tomography (OCT), and to clarify the effects of the systemic findings and risk factors on the development of DME.MethodsThis cross-sectional study was conducted in the departments of ophthalmology and endocrinology at the Dokuz Eylul University School of Medicine in Izmir, Turkey. The demographics, type and duration of diabetes mellitus, treatment modality, smoking and alcohol consumption habits, as well as the systemic blood pressure, renal functional tests, hemoglobulin A1c level, serum lipid profile, and 24-h urine albumin level were noted and statistically analyzed. The relationships between the systemic findings and DME were studied.ResultsFour-hundred and thirteen eyes of 413 diabetic patients who were examined between January 2011 and July 2012 were enrolled in this study. The prevalence of DME was 15.3% among the patients. The males exhibited DME significantly more frequently than the females (p = 0.031), and the duration of diabetes was significantly longer in those patients with DME (p < 0.001). Those patients without DME frequently used antihyperlipidemic drugs and had a higher level of high density lipoprotein cholesterol (p = 0.040 and p = 0.046, respectively). The patient’s alcohol consumption, nephropathy, neuropathy, previous cataract surgery, severity of diabetic retinopathy, and insulin usage were statistically significant factors with regard to the DME prevalence.ConclusionsThis study demonstrated the prevalence of DME in Turkey by utilizing OCT. The development of DME can be avoided or limited and the response to treatment may be improved by the regulation of the DME risk factors.

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Section: Discussionmentioning

confidence: 99%

“…In the USA, DR is the leading cause of blindness in individuals aged < 60 years old, and DME is the most common cause of visual loss in those with DR [56, 66]. Fortunately, permanent vision loss can be prevented by the early diagnosis and treatment of DME.…”

Section: Discussionmentioning

confidence: 99%

The prevalence and systemic risk factors of diabetic macular edema: a cross-sectional study from Turkey

Acan

Çalan

et al. 2018

BMC Ophthalmol

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“…Moreover, a meta-analysis found that there was a dose-dependent relationship of statin use with increasing risk of diabetes [ 104 ]. It was then believed that statins might have effects on glucose homeostasis, such as decreasing insulin production or increasing insulin resistance, or both [ 105 ]. Therefore, while the use of statins is first-line treatment for dyslipidemia in the prevention of cardiovascular events in patients with diabetes, the evidence for intensive control by statins for the purposes of treating DR and DME are lacking.…”

Section: Reviewmentioning

confidence: 99%

Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss

2015

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Diabetic retinopathy (DR) is a leading cause of vision-loss globally. Of an estimated 285 million people with diabetes mellitus worldwide, approximately one third have signs of DR and of these, a further one third of DR is vision-threatening DR, including diabetic macular edema (DME). The identification of established modifiable risk factors for DR such as hyperglycemia and hypertension has provided the basis for risk factor control in preventing onset and progression of DR. Additional research investigating novel risk factors has improved our understanding of multiple biological pathways involved in the pathogenesis of DR and DME, especially those involved in inflammation and oxidative stress. Variations in DR prevalence between populations have also sparked interest in genetic studies to identify loci associated with disease susceptibility. In this review, major trends in the prevalence, incidence, progression and regression of DR and DME are explored, and gaps in literature identified. Established and novel risk factors are also extensively reviewed with a focus on landmark studies and updates from the recent literature.

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“…Also, in SHARP there was no significant increase in new onset diabetes. 8 A concern raised by the results in IMPROVE-IT is the high percentage of patients in either group that discontinued therapy (42%). The authors argue that this proportion is similar to other trials of this nature.…”

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confidence: 99%

Ezetimibe–Statin Combination to Reduce Cardiovascular Events: The Evidence Base

Jialal

Abate

2015

Metabolic Syndrome and Related Disorders

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W hile the evidence base supporting the role of statin therapy to reduce cardiovascular events and mortality is well established, 1 there is sparse data showing a reduction in cardiovascular events with combination therapy and reducing residual risk. Studies combining statin with niacin and fibrates have not resulted in a significant reduction in the primary end point. [2][3][4] In the Japan EPA Lipid Intervention Study the combination of fish oil, eicosapentaenoic acid and statin in hypercholesterolemia Japanese patients resulted in a reduction in cardiovascular events. 5 However, in patients without hypercholesterolemia who received hypolipidemic agents in addition to statins there is no evidence for a benefit in either in primary or secondary prevention settings.Recently, the results of the Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMROVE-IT) were reported. This trial investigated cardiovascular benefit for the combination of the cholesterol absorption inhibitor ezetimibe (EZE) and a moderate-dose statin, simvastatin 40 mg/day 6 The study design was a randomized, placebo-controlled design including 18,144 patients who were at least 50 years of age, diagnosed with acute coronary syndromes and with low density lipoprotein (LDL) cholesterol levels of 50-100 mg/dL if on lipid lowering therapy, or 50-125 mg/dL if not on lipid lowering therapy. They received simvastatin 40 mg/day and placebo or simvastatin 40 mg/day plus EZE 10 mg/day. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularizations ( ‡30 days post randomization), or nonfatal stroke. The investigators also defined three secondary efficacy end points. The median follow-up was 6 years. If LDL-cholesterol was >79 mg/dL, the dose of simvastatin was increased to 80 mg/day. At baseline, both groups were well matched; the average age of the patients was 64 years, 24% were women, and 27% were diabetic. At 1 year, there was a significant 24% greater reduction in LDL cholesterol in the simvastatin-EZE group versus the simvastatin group. Also, at 1 year there were significantly greater reductions in nonhigh density lipoprotein (HDL) cholesterol, triglycerides, apolipoprotein-B, and high-sensitivity C-reactive protein (hsCRP) in the simvastatin-EZE group. Over the course of the entire trial, the median time-weighted average cholesterol was 69.5 mg/dL in the simvastatin group and 53.7 mg/dL in the simvastatin-EZE groups, a very significant difference.Kaplan-Meier event rates for the primary end point at 7 years was 32.7% in the simvastatin-EZE group and 34.7% in the simvastatin group, an absolute risk reduction of 2% with a hazard ratio of 0.936 (95% confidence intervals of 0.89-0.99; P = 0.016). Also, the three secondary end points were significantly lower in the simvastatin-EZE group. The risk of nonfatal myocardial infarction, ischemic stroke, and urgent coronary revascularizations were significantly lower in the simvastatin-EZE g...

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Strategies to Lower Low-Density Lipoprotein Cholesterol in Metabolic Syndrome: Averting the Diabetes Risk

Cited by 6 publications

References 18 publications

The prevalence and systemic risk factors of diabetic macular edema: a cross-sectional study from Turkey

The prevalence and systemic risk factors of diabetic macular edema: a cross-sectional study from Turkey

Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss

Ezetimibe–Statin Combination to Reduce Cardiovascular Events: The Evidence Base

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