The diagnosis and when to treat dyslipidemia in diabetics in Hamad General Hospital are established on the basis of WHO expert group [ 24 ] criteria; the WHO recommends screening for lipid disorders at least annually in diabetic patients and more often if needed to achieve goals. IRB ethical approval, for this study, was obtained from Medical Research Committee of Hamad Medical Corporation prior to commencement of data collection. Patients were identified as statin users rosuvastatin, atorvastatin, pravastatin during the study period September —September by using the Pharmacy Database.
Data collection sheets were designed by the researcher for each patient. Fifty patients were included in the study for each statin dose, and these had to have been on the same dose for at least 2 years between the periods indicated previously.
The prescribed doses in HMC for diabetic patients with dyslipidemia are as follows:. Patients had been checked 3 times to exclude duplications which finally resulted in a total sample of patients. The researcher developed a structured data collection sheet for this study. The designed data collection sheet was tested among 25 patients as a pilot study. Thereafter, any discrepancies found between the data collection sheet and the data available in the Medical Record were resolved.
The first part included the type of statin prescribed for the patient for at least 2 years continuously and dose of statin.
The second part included information about sociodemographic characteristics including age, sex, nationality, height, weight, and BMI. Lifestyle habits like smoking and alcohol intake were included in the second section.
The third section collected information about type of DM, its duration, and presence of hypertension. The fourth section included items about laboratory investigations such as fasting blood glucose, glycated hemoglobin HbA1C , total cholesterol, HDL and LDL cholesterol levels, triglycerides, creatine kinase level, serum creatinine, bilirubin, LFTs, GGT, and serum albumin and adverse events like microalbuminuria and macroalbuminuria.
Data were analyzed using SPSS version Student's t -test was used to ascertain the significance of differences between mean values of two continuous variables and confirmed by nonparametric Mann-Whitney test. In addition, paired t -test was used to determine the difference between baseline and 2 years after regarding biochemistry parameters, and this is confirmed by the Wilcoxon test which is a nonparametric test that compares two paired groups.
Chi-square and Fisher exact tests were performed to test for differences in proportions of categorical variables between two or more groups. Table 1 presents the sociodemographic characteristics of the study population. Finally, all of the statins appear to have reduced rather than raised HDL-C levels. Figure 3 presents the percentage of patients with the new onset of microalbuminuria after taking statins. Atorvastatin was the safest statin as it resulted in the least number of patients at the end of 2 years of treatment with the new onset of microalbuminuria Number of patients with no microalbuminuria at baseline but developed it after 2 years.
Table 3 presents an overview of the safety profile of each of the statins at their various doses among patients. A slightly adverse effect of statins on renal function was observed due to the new onset of microalbuminuria among some of the patients; nonetheless no case of microalbuminuria progressed to the more dangerous macroalbuminuria.
Safety comparison on hepatic, renal, and muscular functions: adverse events after 2 years of statin use. Indeed, it should be noted that rosuvastatin, which is the latest statin to receive approved labeling by the Food and Drug Administration, has been consistently found to be the most effective at reducing LDL-C levels in the most recent studies comparing its efficacy to other statins [ 25 ]. The lowering of triglycerides is another important goal in reducing CVD risk among diabetic patients [ 5 ].
These findings are similar to the majority of studies in the literature, which have shown a slightly higher reduction in triglycerides in patients taking rosuvastatin in comparison to atorvastatin [ 26 ]. It thus appears that, in relation to this factor triglycerides , that both rosuvastatin and atorvastatin are effective at reducing it. In the current study, all of the statins appear to have reduced rather than raised HDL-C levels.
In this instance, the findings in the current study are contrary to the studies in the literature. A number of factors could be at play which could explain the discrepancy between the current study's results and those in the international literature.
It is evident from Table 1 which has the patient characteristics that many of the patients had more than two risk factors for CVD. For instance, the patients were diabetic, and most of them were over 55 years old and had hypertension. In addition, over two-thirds of the patients were obese and Qatari. In other diabetic research studies conducted in Qatar, it was found that having Qatari ethnicity was correlated with poor lifestyle habits such as sedentary lifestyle and poor eating choices [ 2 , 3 ].
In other words, the subjects had so many other factors which caused their HDL-C levels to be so low that the statins were only able to have a minimal effect. One of the most common complaints related to statin use is related to the effect of statins on muscular function. Muscle symptoms range from myalgia, which includes muscle pain without creatine kinase CK elevations, to myositis which is muscle symptoms with CK elevations [ 18 ].
In general, elevations of CK of more than ten times the upper limit of normal are regarded as significant elevations justifying the discontinuation of statin treatment [ 28 ]. In other words, all statins, irrespective of dose, were regarded as safe in terms of myositis. Adverse effects that occurred most commonly in patients receiving rosuvastatin therapy in comparison to placebo were myalgia, constipation, asthenia, abdominal pain, and nausea.
Liver function tests should be performed with rosuvastatin at baseline, after 12 weeks of therapy, and periodically thereafter. Rosuvastatin should be discontinued if liver enzymes increase to three times the upper limit of normal ULN , which occurred in clinical trials between the range of 0 to 0. Elevated creatinine kinase CK levels, myopathy, and in rare cases, rhabdomyolysis have also been reported with rosuvastatin.
Elevated CK of greater than ten times the ULN has been found to occur with 40 mg doses of rosuvastatin in 0. Additionally, myopathy, defined as increased levels of CK in addition to muscle aches, was reported in 0.
The occurrence of rhabdomyolysis was only noted with 80 mg doses not currently FDA-approved of rosuvastatin in rare cases. The recommendation for management is discontinuation of rosuvastatin with any report of myopathy or elevated CK. The FDA-approved dosage range of rosuvastatin is 5 to 40 mg daily, however the 40 mg dose should only be used in patients who do not reach their LDL-cholesterol goal with the 20 mg dosage. The recommended starting dose of rosuvastatin should be individualized to each patient, with an initial dose of 10 mg daily in most patients, administered with or without food.
A 5 mg daily dose is recommended in patients 1 requiring less aggressive cholesterol reduction, 2 with renal impairment, 3 with concurrent use of cyclosporine, or 4 with predisposing risk factors for myopathy. Category X is defined as studies in animals or human beings have demonstrated fetal abnormalities or there is evidence of fetal risk based on human experience or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit.
Therefore, rosuvastatin is contraindicated in women who are or may become pregnant, and should only be administered to women of childbearing age if their ability to conceive is highly unlikely and they have been informed of the potential hazards.
Additionally, it is unknown if rosuvastatin is excreted in human milk. Studies in lactating rats indicated that the levels of rosuvastatin in breast milk are three times higher than plasma levels, therefore, it is recommended for lactating women that either nursing or administration of rosuvastatin be discontinued.
The cost of rosuvastatin is comparable to the other agents; however, lovastatin and fluvastatin are the least expensive. However, it has not been investigated if this difference decreases CHD events and mortality.
Also, it is currently unknown if the further decrease in LDL-cholesterol of 8. Rosuvastatin has potentially desirable pharmacologic and pharmacokinetic properties, making it a beneficial selection for cholesterol treatment in terms of hepatic selectivity, hydrophilicity, half-life, and biliary excretion. These properties potentially lead to increased efficacy as well as decreased adverse effects and drug interactions with rosuvastatin. The current place in therapy for rosuvastatin remains to be decided.
Pravastatin and atorvastatin can help reduce the risk of heart attacks and strokes in people with coronary heart disease. Both medications can also help reduce the risk of death from heart disease. Risk factors for heart disease include high blood pressure, smoking, and high cholesterol levels. Both pravastatin and atorvastatin are FDA approved to reduce elevated total-cholesterol and LDL levels also known as hyperlipidemia or hypercholesterolemia.
Statin medications can also help treat elevated levels of triglycerides , which are another type of fats or lipids in the body. Someone with elevated levels of triglycerides has hypertriglyceridemia. Pravastatin and Lipitor can also increase HDL levels in the blood. Both pravastatin and atorvastatin are effective medications for treating high blood cholesterol.
The more effective drug depends on your overall condition, the severity of your condition, other drugs you might be taking, and other factors. One comparative study found that there is no significant difference between pravastatin, simvastatin, and atorvastatin for preventing cardiovascular events.
In other words, these statin drugs were similarly effective for reducing heart attacks and coronary heart disease. A systematic review that pooled over 90 clinical trials compared statin drugs such as fluvastatin, atorvastatin, pravastatin, simvastatin, and rosuvastatin. The review concluded that atorvastatin, fluvastatin, and simvastatin had the highest probability of being the best treatment for preventing cardiovascular events.
Consult a healthcare provider to determine the best statin drug for you. After conducting a blood test and evaluating your overall condition, a provider will be able to determine whether pravastatin or atorvastatin is a more effective drug for you. They might also prescribe a different statin drug such as Zocor simvastatin or Crestor rosuvastatin. Pravastatin is a generic medication that is usually covered by Medicare and insurance plans.
Lipitor is a brand-name medication that is also available in a cheaper, generic version. The generic version of Lipitor, atorvastatin, is typically covered by most Medicare and insurance plans. Brand-name Lipitor may be covered by insurance plans with a high copay. The most common side effects of pravastatin are musculoskeletal or muscle pain, nausea, vomiting, diarrhea, and headache.
The most common side effects of atorvastatin are musculoskeletal or muscle pain, diarrhea, and joint pain arthralgia. Both pravastatin and atorvastatin can also cause other side effects such as indigestion, dizziness, fatigue, rash, and urinary tract infections.
Serious side effects of statin drugs include muscle disease myopathy and the rapid breakdown of muscle tissue rhabdomyolysis. Contact a healthcare provider immediately if you experience persistent or unexplained muscle pain, weakness, or tenderness.
Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Inclusion Criteria: Patients who have been diagnosed as stable angina pectoris, and successful percutaneous coronary intervention PCI were performed with intravascular ultrasound IVUS and optical coherence tomography OCT guidance.
Patients with written consent by their own volition after being provided sufficient explanation for their participation in this clinical trial. Patients who received PCI in the past on the lesion where the evaluation of coronary plaque volume is planned. Patients who had plaques in a non-culprit site and might receive PCI during the treatment period.
Patients receiving lipid-lowering drugs fibrates, probucol, nicotinic acid, cholestyramine or cholesterol absorption inhibitors. Patients with familial hypercholesterolemia. Patients with cardiogenic shock. Patients receiving cyclosporine. Patients with any allergy to pravastatin and rosuvastatin.
Patients with hepatobiliary disorders. Pregnant women, women suspected of being pregnant, or lactating women. Patients who are ineligible in the opinion of the investigator. Contacts and Locations. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
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