Alternate Day Statin and Fibrate Given Alone or in Combination for Postprandial Dyslipidemia in Patients with Type 2 Diabetes Mellitus: A Preliminary Report

Sheila Farisha K. Mangelen, Erick S. Mendoza, Leilani B. Mercado-Asis

Apr 2018 DOI 10.35460/2546-1621.2017-0032     Access   

Abstract

Introduction: Postprandial lipemia represent an important risk factor for lifetime development of cardiovascular disease in patients with type 2 diabetes mellitus. Daily administration alone or combined statin and fibrate therapy has been shown to be an effective therapeutic approach but brings about serious logistics problem in our local setting. To address this concern, we report this observation where alternate day statin and fibrate treatment given alone or in combination in type 2 diabetes mellitus and similar effectiveness in lowering postprandial dyslipidemia has been obtained.

Methodology: This is a retrospective case study in an endocrine clinic involving 53 patients seen from April 2014 to October 2015. The patients were on statin and fibrate combination (atorvastatin 20-40mg and gemfibrozil 300-600 mg or fenofibrate 145-160mg), statin alone (atorvastatin 20-40mg) and fibrate alone (gemfibrozil 300-600mg/fenofibrate 145-160mg) given on alternate days. Percent reductions of cholesterol, triglycerides, LDL for combined statin and fibrate; cholesterol and LDL  for atorvastatin alone; and triglyceride for fibrate alone were determined.

Results: In this preliminary report, 26 patients have available data. Follow-up period range was 4 to 48 weeks (mean 22.76+ 11.8 weeks).  Alternate statin and fibrate (gemfibrozil) treatment yielded percent reductions from baseline as follows: cholesterol 7%, triglycerides 15%,  and LDL 37% (P values= 0.02, 0.10 and 0.019, respectively). On the other hand, alternate statin and fibrate (fenofibrate) yielded percent reduction from baseline as follows:  cholesterol 41% and LDL 20.4% (P=0.15 and 0.13, respectively). The population is small, the decrease did not yield significant difference from baseline, however there is a tendency for triglyceride to decrease (P=0.09) with the combined statin and fenofibrate. With statin alone the percent reduction from baselinewere as follows: cholesterol 39% and LDL 62% (P= 0.29 and 0.11, respectively). No percent reduction of triglyceride is seen with fibrate given on alternate day with P= 0.19 The monthly cost reduction with combined alternate statin and fibrate treatment is at 34-48% while alternate day administration of the statin reduced cost by 60%.

Conclusion: This study showed lowering of postprandial total cholesterol, triglyceride and LDL with alternate statin and fibrate treatment, and total cholesterol and LDL with alternate day statin. The cost of treatment was also significantly lowered with the alternate regimen. However, a follow through study with adequate sample size is recommended to support these observations.

Keywords: statin, fibrate and postprandial dyslipidemia

  1. Nasser Hissa MR, Cavalcante LL, Guimarães SB, Nasser Hissa M. A 16-week study to compare the effect of vildagliptin versus gliclazide on postprandial lipoprotein concentrations and oxidative stress in patients with type 2 diabetes inadequately controlled with metformin monotherapy. Diabetol Metab Syndr. 2015 Jul 11;7:62.
  2. So T, Mercado-Asis LB, Zacarias M. A Comparison of Dose Response Postprandial Lipid Profile of Health Filipino Subjects After an Oral Fat Challenge Test of Varying Fat Contents. PJIM.Jan-Feb 2004. 42:1-7.
  3. Matikainen N, Manttari S, Westerbacka J, Vehkavaara S, Lundbom N,Yki-Jarvinen H, Taskinen MR. Postprandial Lipemia Associates with Liver Fat Content. J Clin Endocrinol Metab. 2007 Aug;92(8):3052-9.
  4. Castro-Caringal JA, Mendoza ES, Mercado-Asis LB. Postprandial Lipemia is significantly Correlated with Postprandial Hyperglycemia and Poor Glycemic Control among Patients with Type 2 Diabetes Mellitus.PJIM. October-December 2015.  Vol 53 (4). pp1-3
  5. Guo J, Meng F, Ma N, Li C, Ding Z,Wang H, Hou R, Qin Y. Meta-Analysis of Safety of the Coadministration of Statin With Fenofibrate in Patients With Combined Hyperlipidemia. Am J Cardiol. 2012 Nov 1;110(9):1296-301
  6. Samson CE, Galia A, Llave KI, Zacarias MB, Mercado-Asis LB. Postprandial Peaking and Plateauing of Triglycerides and VLDL in Patients with Underlying Cardiovascular Diseases despite Treatment. Int J Endocrinol Metab. 2012; 10(4):587-593 
  7. Harivenkatesh N, David DC, Haribalaji N, Sudhakar MK.Efficacy and safety of alternate day therapy with atorvastatin and fenofibrate combination in mixed dyslipidemia: a randomized controlled trial. J Cardiovasc Pharmacol Ther. 2014 May;19(3):296-303.
  8. Istvan ES, Deisenhofer J. Structural mechanism for statin inhibition of HMG-CoA reductase. Structural mechanism for statin inhibition of HMG-CoA reductase. Science. 2001;292(5519):1160
  9. Staels B, Dallongeville J, Auwerx J, Schoonjans K, Leitersdorf E, Fruchart JC. Mechanism of action of fibrates on lipid and lipoprotein metabolism.Circulation. 1998;98(19):2088
  10. Melmed S, Polonsky K, Larsen P, Kronenberg H,Williams Textbook of Endocrinology. 12th Edition. 2011. p1664
  11. Stone NJ et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Riskin Adults. 2013.p45
  12. Wägner AW, Jorba O, Bonet R, Ordóñez-Llanos J, and  Pérez A. Efficacy of Atorvastatin and Gemfibrozil, Alone and in Low Dose Combination, in the Treatment of Diabetic Dyslipidemia. J Clin Endocrinol Metab. 2003 Jul;88(7):3212-7
  13. Ping NH, Lim C. Dela Pena LA, Tamolang SE. MIMS. 143rd Edition. 2015. p122,130

Articles related to the one you are viewing

There are currently no results to show, please try again later

CC BY: Open Access Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/