Xavier Pintó Sala

Consensus on the Statin of Choice in Patients with Impaired Glucose Metabolism: Results of the DIANA Study

Introduction and ObjectivesDespite the recognized clinical benefit of statins on cardiovascular prevention, providing correct management of hypercholesterolaemia, possible adverse effects of their use cannot be disregarded. Previously published data shows that there is a risk of developing diabetes mellitus or experiencing changes in glucose metabolism in statin-treated patients. The possible determining factors are the drug characteristics (potency, dose), patient characteristics (kidney function, age, cardiovascular risk and polypharmacy because of multiple disorders) and the pre-diabetic state.MethodsIn order to ascertain the opinion of the experts (primary care physicians and other specialists with experience in the management of this type of patient) we conducted a Delphi study to evaluate the consensus rate on diverse aspects related to the diabetogenicity of different statins, and the factors that influence their choice.ResultsConsensus was highly significant concerning aspects such as the varying diabetogenicity profiles of different statins, as some of them do not significantly worsen glucose metabolism. There was an almost unanimous consensus that pitavastatin is the safest statin in this regard.ConclusionsFactors to consider in the choice of a statin regarding its diabetogenicity are the dose and patient-related factors: age, cardiovascular risk, diabetes risk and baseline metabolic parameters (which must be monitored during the treatment), as well as kidney function.

La diabetogenicidad de las estatinas: ¿son todas iguales? Estado de la cuestión

Statins are the cornerstone of cardiovascular prevention for general population, and in patients with type 2 diabetes mellitus (T2DM). However, statin therapy predisposes to type 2 diabetes, particularly in patients with predisposition to this condition. Some statins have been associated with increases in blood glucose in patients with or without DM2, and others have shown to have neutral effects, varying from one another their glucose or diabetogenic capacity. In many statin trials the incidence of DM2 has not been systematically evaluated and others the power to detect differences between statins is lacking. Evidence highest quality available comes from the meta-analysis of controlled clinical trials. The only controlled clinical trial to evaluate the incidence of new-onset T2DM is the J-PREDICT conducted with pitavastatin in patients with abnormal glucose tolerance. Preliminary results of this study show that pitavastatin is associated with a significant decrease in the incidence of de novo T2DM compared to only modification lifestyle. Therefore, pitavastatin may be an appropriate therapeutic alternative of choice to reduce vascular risk in patients with T2DM or at risk of presenting it.

Control de la dislipidemia aterogénica en paciente diabético tipo 2: Procedimientos en la práctica clínica – Estudio LIPEDIA

INTRODUCTION Treatment of atherogenic dyslipidemia (AD) in type 2 diabetes (DM2) should focus on the global control of dyslipidemia. The aim of this study was to determine how hospital (MSs) and primary care specialist (GPs) from Spain manage AD in DM2 during their daily practice. METHODS An observational, cross-sectional, multicentric study was conducted. Information about daily practice was obtained from 497 MSs and 872 GPs across Spain. RESULTS 66% of MSs and 30.5% of GPs considered DM2 patients to be high-risk. Most consider the c-LDL targets based on European guidelines. The statins most widely used are atorvastatin and simvastatin. However both MSs and GPs considered rosuvastatin to be the most appropriate statin for these patients. 82% of MSs and 68% of GPs considered that >50% of their patients achieved the c-LDL target. The main reasons of not achieving this target were lack of treatment adherence and pressure from the administration. Seventy four percent of MSs reported that there are no common clinical protocols with GPs. CONCLUSIONS The differences in the perception of the real cardiovascular risk of the patient, low use of more appropriate statins, lack of adherence and poor perception of real c-LDL control may contribute to the failure in achieving lipid targets in DM2.

Relación entre la enfermedad cardiovascular y la afección dental. Revisión sistemática

BACKGROUND AND OBJECTIVE The relationship between atherothrombotic cardiovascular disease (ATCD) and localised infections in teeth, including caries and chronic apical periodontitis (CAP) has not been studied much and is not well defined. METHOD A systematic search was performed using the scientific databases PubMed and Medline from 1989 to 2016. RESULTS A significant relationship was observed with ATCD in 10 out of 10 studies addressing the degree of oral hygiene, in 14 of 17 that included loss of teeth, in 6 of 12 that analysed caries and in 11 of 15 that included CAP. However, there was a huge methodological heterogeneity. CONCLUSIONS It can be concluded that there is an association between CAP and ATCD. Patients with ATCD present a worse oral hygiene status and fewer teeth.

REVISIÓNLa diabetogenicidad de las estatinas: ¿son todas iguales? Estado de la cuestiónStatins diabetogenicity: are all the same? state of art

Statins are the cornerstone of cardiovascular prevention for general population, and in patients with type 2 diabetes mellitus (T2DM). However, statin therapy predisposes to type 2 diabetes, particularly in patients with predisposition to this condition. Some statins have been associated with increases in blood glucose in patients with or without DM2, and others have shown to have neutral effects, varying from one another their glucose or diabetogenic capacity. In many statin trials the incidence of DM2 has not been systematically evaluated and others the power to detect differences between statins is lacking. Evidence highest quality available comes from the meta-analysis of controlled clinical trials. The only controlled clinical trial to evaluate the incidence of new-onset T2DM is the J-PREDICT conducted with pitavastatin in patients with abnormal glucose tolerance. Preliminary results of this study show that pitavastatin is associated with a significant decrease in the incidence of de novo T2DM compared to only modification lifestyle. Therefore, pitavastatin may be an appropriate therapeutic alternative of choice to reduce vascular risk in patients with T2DM or at risk of presenting it.

La diabetogenicidad de las estatinas

Statins are the cornerstone of cardiovascular prevention for general population, and in patients with type 2 diabetes mellitus (T2DM). However, statin therapy predisposes to type 2 diabetes, particularly in patients with predisposition to this condition. Some statins have been associated with increases in blood glucose in patients with or without DM2, and others have shown to have neutral effects, varying from one another their glucose or diabetogenic capacity. In many statin trials the incidence of DM2 has not been systematically evaluated and others the power to detect differences between statins is lacking. Evidence highest quality available comes from the meta-analysis of controlled clinical trials. The only controlled clinical trial to evaluate the incidence of new-onset T2DM is the J-PREDICT conducted with pitavastatin in patients with abnormal glucose tolerance. Preliminary results of this study show that pitavastatin is associated with a significant decrease in the incidence of de novo T2DM compared to only modification lifestyle. Therefore, pitavastatin may be an appropriate therapeutic alternative of choice to reduce vascular risk in patients with T2DM or at risk of presenting it.