Platí „LDL-hypotéza“ i pro pacienty s diabetem?


Authors: Milan Kvapil
Authors‘ workplace: Interní klinika 2. LF UK a FN Motol Praha, přednosta prof. MUDr. Milan Kvapil, CSc., MBA
Published in: Vnitř Lék 2015; 61(7-8): 711-716
Category: Vanýsek´s day 2015

Overview

The basic symptom of diabetes mellitus is hyperglycemia. However the increased cardiovascular risk in patients with both type 1 and type 2 diabetes mellitus has a multifactorial etiology. Concurrent negative effects of hyperglycemia, hypertension and hyperlipidemia on the vascular system reinforce one another. Consistent prevention of cardiovascular risk parameters in patients with type 2 diabetes mellitus (DM2T) has brought significant decline in mortality and morbidity due to cardiovascular diseases. Still there is “residual risk” remaining. The full use of the potential of statins and their combination with ezetimibe may lower the CV risk even more and extend the life of patients with DM2. The importance of an intervention by means of PCSK9 inhibitors for the cardiovascular risk reduction in patients with diabetes mellitus is the subject of study.

Key words:
diabetes mellitus – ezetimibe – PCSK9 inhibitors – cardiovascular risk – LDL-cholesterol – statins


Sources

1. Lind M, Svensson AM, Kosiborod M et al. Glycemic Control and Excess Mortality in Type 1 Diabetes. N Engl J Med 2014; 371(21): 1972–1982.

2. Guzder RN, Gatling W, Mullee MA et al. Early mortality from the time of diagnosis of Type 2 diabetes: a 5-year prospective cohort study with a local age- and sex-matched comparison cohort. Diabet Med 2007; 24(10): 1164–1167.

3. Nathan DM. DCCT/EDIC Research Group. The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabetes Care 2014; 37(1): 9–16.

4. Gerstein HC, Miller ME, Genuth S et al. ACCORD Study Group. Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med 2011; 364(9): 818–828.

5. Diabetes Control and Complications Trial Research Group. Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications Trial. Ophthalmology 1995; 102(4): 647–661.

6. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352(9131): 837–853. Erratum in Lancet 1999; 354(9178): 602.

7. Collins R, Armitage J, Parish S et al. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 2003; 361(9374): 2005–2016.

8. Haffner SM, Lehto S, Rönnemaa T et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339(4): 229–234.

9. Pyŏrälä K, Pedersen TR, Kjekshus J et al. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S). Diabetes Care 1997; 20(4): 614–620.

10. Colhoun HM, Betteridge DJ, Durrington PN et al. CARDS investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 2004; 364(9435): 685–696.

11. Kvapil M. Ezetimib – nová možnost pro kombinovanou léčbu hypercholesterolemie. Vnitř Lék 2004; 50(8): 643–644.

12. Phan BA, Dayspring TD, Toth PP. Ezetimibe therapy: mechanism of action and clinical update. Vasc Health Risk Manag 2012; 8: 415–427. Dostupné z DOI:<http://dx.doi.org/10.2147/VHRM.S33664>.

13. Jia L, Betters JL, Yu L. Niemann-pick C1-like 1 (NPC1L1) protein in intestinal and hepatic cholesterol transport. Annu Rev Physiol 2011; 73: 239–259. Dostupné z DOI: <http://dx.doi.org/10.1146/annurev-physiol-012110–142233>.

14. Informace dostupné z WWW: <http://www.sukl.cz/SPC ezetimib>.

15. Gylling H, Miettinen TA. Cholesterol absorption and lipoprotein metabolism in type II diabetes mellitus with and without coronary artery disease. Atherosclerosis 1996; 126(2): 325–332.

16. Okada K, Yagyu H, Kotani K et al. Lipid-lowering effects of ezetimibe for hypercholesterolemic patients with and without type 2 diabetes mellitus. Endocr J 2010; 57(10): 903–908.

17. IMPROVE IT. Informace dostupné z WWW: < IMPROVE IT: http://www.cardiosource.org/science-and-quality/clinical-trials/i/improve-it.aspx?w_nav=RI (22. 11. 2014)>.

18. Blazing MA, Giugliano RP, Cannon CP et al. Evaluating cardiovascular event reduction with ezetimibe as an adjunct to simvastatin in 18,144 patients after acute coronary syndromes: final baseline characteristics of the IMPROVE-IT study population. Am Heart J 2014; 168(2): 205–212.

19. Výsledky studie IMPROVE IT. Dostupné z WWW: <https://clinicaltrials.gov/ct2/show/NCT00202878>.

20. Stitziel NO, Won HH, Morrison AC et al. Inactivating mutations in NPC1L1 and protection from coronary heart disease. N Engl J Med 2014; 371(22): 2072–2082.

21. Kvapil M, Pavlík T, Klika P et al. Základní analýza údajů o pacientech s diabetes mellitus. DMEV 2015; 18: (Supl 1): 21.

22. Kvapil M, Dušek P, Pavlík T et al. Pilotní analýza dat VZP 2010–2013 zaměřená na hypolipidemickou terapii u pacientů s diabetem. In: Kvapil M (ed). Diabetologie 2015. Triton: Praha 2015: 227–230. ISBN 978–80–7387–887–0.

23. Stitziel NO, Won HH, Morrison AC et al. Inactivating mutations in NPC1L1 and protection from coronary heart disease. N Engl J Med 2014; 371(22): 2072–2082.

24. Shimada YJ, Cannon CP. PCSK9 (Proprotein convertase subtilisin/kexin type 9) inhibitors: past, present, and the future. Eur Heart J 2015; pii: ehv174. [Epub ahead of print].

25. Sabatine MS, Giugliano RP, Wiviott SD et al. Efficacy and safety of evolocumab in reducing lipids and cardiovascular events. N Engl J Med 2015; 372(16): 1500–1509.

26. Robinson JG, Farnier M, Krempf M et al. Efficacy and safety of alirocumab in reducing lipids and cardiovascular events. N Engl J Med 2015; 372(16): 1489–1499.

27. Raal FJ, Giugliano RP, Sabatine MS et al. Reduction in lipoprotein(a) with PCSK9 monoclonal antibody evolocumab (AMG 145): a pooled analysis of more than 1,300 patients in 4 phase II trials. J Am Coll Cardiol 2014; 63(13): 1278–1288.

28. Norata GD, Ballantyne CM, Catapano AL. New therapeutic principles in dyslipidaemia: focus on LDL and Lp(a) lowering drugs. Eur Heart J 2013; 34(24): 1783–1789.

29. Roth EM, Taskinen MR, Ginsberg HN et al. Monotherapy with the PCSK9 inhibitor alirocumab versus ezetimibe in patients with hypercholesterolemia: Results of a 24 week, double-blind, randomized Phase 3 trial. Int J Cardiol 2014; 176(1): 55–61.

30. Miyoshi T, Nakamura K, Doi M et al. Impact of Ezetimibe Alone or in Addition to a Statin on Plasma PCSK9 Concentrations in Patients with Type 2 Diabetes and Hypercholesterolemia: A Pilot Study. Am J Cardiovasc Drugs 2015; 15(3): 213–219. Dostupné z DOI: <http://dx.doi.org/10.1007/s40256–015–0119–2>.

31. Cariou B, Le Bras M, Langhi C et al. Association between plasma PCSK9 and gamma-glutamyl transferase levels in diabetic patients. Atherosclerosis 2010; 211(2): 700–702.

32. Vergès B, Duvillard L, Brindisi MC et al. Lack of association between plasma PCSK9 and LDL-apoB100 catabolism in patients with uncontrolled type 2 diabetes. Atherosclerosis 2011; 219(1): 342–348.

33. Kearney PM, Blackwell L, Collins R et al. Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008; 371(9607): 117–125.

34. Brugts JJ, Yetgin T, Hoeks SE et al. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 2009; 338: b2376. DOI: <http://dx.doi.org/10.1136/bmj.b2376>.

Labels
Diabetology Endocrinology Internal medicine

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