Eureka! Institutional Repository

Introduction: The high incidence of dyslipidaemia in diabetics and patients, coupled with increased cardiovascular morbidity and mortality demonstrated in these patients, necessitates hypolipidemic treatment. However, the possibility of adverse effects of statins or fixed combination with ezetimine or fibrates on glucose metabolism as well as the risk of progression or type 2 diabetes in these patients should be clarified against the potential benefit for the prevention of cardiovascular disease . Purpose: The primary purpose of this diploma thesis is to investigate a causal relationship between type 2 diabetes mellitus or pre-diabetes in patients treated with statins as monotherapy or in a fixed combination with ezetimibe, or fibrates. The secondary purpose is to measure the cost of benefit, diabetes mellitus, compared to cardiovascular protection from long-lasting statins. Material and Method: This is a prospective open-label clinical study, the sample of which comprised 100 patients with dyslipidaemia and no history of diabetes mellitus, aged 18-80 years. It will be studied prospectively, the effect of statins circulating in Greece, either as monotherapy with statins, or as a fixed combination with ezetimibe or fibrates. Patients will receive initial monotherapy with a statin for one month, and in case of failure to achieve lipid targets, or intolerance to statin appearance will receive a combined therapy with ezetimibe, or fibrates. The collection of data was carried out in Greece, at the A 'Prevention Pediatric Clinic of AHEPAS Hospital and more specifically in the external Dyslipidemia, Obesity… and Pathology Outpatient Clinic. Additionally, it will be determined fasting glucose and glycosylated hemoglobin before and 3 months after administration of the statin, and will be recorded any cardiovascular event occurred in this period, and any side effects can be associated with administration of the statin. Any other intervention or administration of drugs that may potentially increase serum glucose levels (such as cortisol, β-blocking diuretics) will be ruled out. Innovation: Examination of current literature does not give rise to unanimity regarding the effect of statins on serum glucose levels in relation to their benefit in the primary and secondary prevention of cardiovascular disease. In addition, the differentiation of the effects of the statins depending on their hydrophilicity or lipophilicity will be studied, depending on their activity (very strong, moderate power and low power). The statistical analysis for the results of the survey was made using the SPSS Statistical Program: 17. 00. Results: The overall cardiovascular benefit of hypolipidemic treatment (either statin monotherapy or combination therapy with ezetimibe or fibrates) is large (p = 0.431), against the minimal risk of developing diabetes mellitus type 2, or pre-diabetes. The type of therapeutic hypolipidemic intervention is significantly associated with the change in HbA1c value, and plays an important role in the event or absence of diabetes mellitus type 2, or prebiotic. The small relative incidence of newly emerging diabetes mellitus or pre-diabetes (16.1%), statistically significant, at a level (p = 0.023) in patients receiving statin monotherapy compared to patients treated with combination therapy with ezetimibe or fibrates (0% ), further reinforces the view that combination therapy with ezetimibe or fibrates is superior to statin monotherapy in terms of reducing the risk of developing diabetes mellitus or pre-diabetes. The significant change in fasting glucose values of -1.7 ± 1.6 for combination therapy versus -0.83 ± 2.1 for monotherapy patients and HbA1c -0.08 ± 0.11 vs -0.02 ± 0.09 respectively after the 3-month hypolipidemic therapeutic approach, further reinforces this view. The relatively low incidence of adverse events in patients treated with ezetimibe or fibrates at 18.4% compared to statin-treated patients at 6.5% further highlights the viewpoint of dose-dependent statin the difference in their pharmacokinetic activity. Conclusions: The causal relationship between the potential risk of diabetes mellitus in hypercholesterolemic patients receiving hypolipidemic therapy is very low in the case of monotherapy and minimal in the case of combined statin hypolipidemic treatment. An important role in the risk of developing diabetes is also the type of statin administered (generally the pharmacological properties of each statin), especially in the case of monotherapy. In addition, there was no statistically significant difference in the incidence of adverse events with statin administration, alone or in combination.