Effect of Atorvastatin on Glycemic Control in Prediabetic Patients
Condition: Prediabetic State
MeSH terms: Prediabetic State
Study type: Observational

Summary: 
      The study was conducted to find out any possible effect of Atorvastatin on glycemic
      parameters in prediabetic patients.
    

Detailed description: 
      Diabetes is a growing public health problem throughout the world, threatening global health
      and economic prosperity. Currently, approximately 171 to 194 million people in the world have
      diabetes, the majority of the cases being Type II. This number is expected to increase to
      more than 330 million by the year 2025-a record doubling within a single generation. India
      with 62.2 million diabetic patients is fast becoming the diabetes capital of the world with
      possibility of the number of diabetic patients reaching the 80 million mark by 2030. Every
      sixth diabetic in the world is an Indian. China with 43.2 million patients comes second,
      followed by the US where 26.8 million people suffer from the disease.

      This spectacular increase in the frequency of Type II diabetes is being paralleled by a
      similarly alarming increase in obesity, which is one of the major risk factors for Type II
      diabetes. Because of the close linkage of these two conditions, Ziv and Shafrir have
      suggested the term "diabesity" to describe this association. This dual epidemic which was
      largely ignored by the public health community until recently has come as a great surprise
      involving enormous economic burden as well as in terms of health. Disorders of glucose
      metabolism are associated with increased risk for cardiovascular disease (CVD) complications,
      including coronary, peripheral and cerebral arterial disease, that account for the majority
      of morbidity and mortality among patients with diabetes mellitus (DM).

      Type II diabetes is commonly associated with dyslipidaemia, which represents a synergistic
      risk factor for cardiovascular disease. The National Cholesterol Education Program Adult
      Treatment Panel III (ATP III) listed diabetes as a coronary heart disease (CHD) risk
      equivalent for setting therapeutic goals for LDL cholesterol. A goal for LDL cholesterol of
      <100 mg/dl was recommended for patients with CHD and CHD risk equivalents. For the majority
      of patients with diabetes, this LDL cholesterol goal would evoke the use of
      cholesterol-lowering drugs, particularly statins. Some Interventional studies emphasized that
      statin treatment leads to a reduction in cardiovascular events independent of lipid reduction
      with possible benefits for patients with Type II diabetes. Statins could also contribute to
      diabetes prevention owing to lipid-lowering and so-called pleiotropic action. Statins improve
      endothelial function, inhibit smooth muscle cell proliferation, and reduce oxidative stress
      and inflammation. Thus, with recent FDA approved indications for statins being widened,
      statins are currently amongst the most widely used drugs in patients with or without
      diabetes.

      Although statin therapy reduces cardiovascular risk, its relationship with the development of
      diabetes is controversial. Retrospective analysis of the West of Scotland Coronary Prevention
      Study (WOSCOPS) revealed that 5 years of treatment with pravastatin reduced diabetes
      incidence by 30%. The authors suggested that although lowering of triglyceride levels could
      influence diabetes incidence, other mechanisms such as anti-inflammatory action may be
      involved. On the contrary, pravastatin did not decrease diabetes incidence in another trial
      including glucose-intolerant humans, suggesting that early inception of statin therapy may be
      required for effective diabetes prevention. Likewise, simvastatin did not affect diabetes
      incidence in patients with atherosclerosis in the Heart Protection Study. In contrast,
      atorvastatin marginally increased diabetes incidence in the Anglo-Scandinavian Cardiac
      Outcomes Trial (ASCOT-LLA), which could be explained by statistical variation.

      A recent review of 13 studies by Naveed Sattar, et al. published in The Lancet in 2010, on
      statins and their side-effects including a total of more than 91,140 participants suggested
      that use of statins is associated with increased risk of Type II diabetes by 9%.

      However researchers of this meta-analysis have stressed that this study does not prove that
      statins directly raise the risk of Type II diabetes, but it raises the possibility of either
      a direct or indirect link between statins and diabetes that merits further investigation.
      Thus, exploring the role of statins in the initiation or progression of diabetes mellitus is
      an exciting area for investigation.
    

Intervention name(s): Atorvastatin
Intervention type(s): Drug
Intervention description(s): Some patients were receiving 20 mg of Atorvastatin wheras others were on a higher dose of 40-80mg daily. Patients were taking statins for either dyslipidemia, or primary or secondary prevention of cardiovascular disease.
Intervention MeSH terms: Atorvastatin
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The study population was selected from patients attending Cardiology and Medicine
        Outpatient Department of S.C.B. Medical College, Cuttack, following inclusion and exclusion
        criteria.
      
Keywords: Atorvastatin; Prediabetics; HbA1c