Treatment of dyslipidemia among patients with diabetes or vascular disease improves patients’ outcome. Statins are the most popular drugs used, but there is controversy on the optimum dose. In this study we aim to compare atorvastatin 20 mg versus atorvastatin 40 mg on lipid profile. Fifty five newly diagnosed patients suffering from dyslipidemia associated with diabetes or coronary artery disease aged(20–75) years with fasting total cholesterol concentrations (200 mg/L) or more and Triglyceride level 250 mg/L were randomly assigned to atorvastatin 20 mg or atorvastatin 40 mg. The lipid profile was taken at the start of study (baseline data) and after 6 months (final data). We planned follow-up for an average of 6 months. Data were analyzed using SPSS version 20. For statistical analysis the paired sample t test and the independent sample t test were used.Treatment was completed for 6 months. There were improvement in the lipid profile in both doses (p=0.05). No significant differences were found in lipid profile between the two groups except in cholesterol level (P-value 0,01) while regarding the remaining variables(TG, HDL, LDL, F.B.S,SGOT,SGPT) P-values were not statistical significantly different(0.776, 0.201, 0.383, 0.256, 0.832, 0.449 respectively). Atorvastatin lowered LDL by 23% as well as improved HDL by 6,3%. The reductions of lipid profile with atorvastatin were large with both doses (20 and 40 mg). Furthermore there is no difference between the two doses. Therefore it is recommended to start with the lower dose
___
1. Laurence L. Brunton, PhD, John S Lazo, PhD, Keith L. Parker, MD, PhD Goodman & Gilman's The Pharmacological Basis of Therapeutics - 12th edition. 2011.
2. Richard Finkel Pharm. D. Michelle A. Clark Ph.D. Lippincott's Illustrated Reviews: Pharmacology, 4th edition. Copyright Lippincott Williams & Wilkins. 2009.
3. Moray longmore, Ian Wilkinson, Tomturmezei, Cheek Ay Cheung oxford hand book of clinical medicine 7th edition 2014.
4. Dobler CC, Wong KK, Marks GB. Associations between statins and COPD: a systematic review. BMC Pulm Med. 2009;12(9):32.
5. Janda S, Park K, FitzGerald JM, Etminan M, Swiston J. Statins in COPD: a systematic review. Chest. 2009;136(3):734-43.
6. Hurst JR., Hagan G, MD; Wedzicha JA. Mechanism of StatinAssociated Mortality Reduction in COPD. Chest. 2007;132(4):1409- 10.
7. Young RP, Hopkins RJ. Possible role of statins in COPD-related pulmonary hypertension. Chest. 2010;137(5):1250-1. 8. Josan K1
, McAlister FA. Cholesterol lowering for secondary prevention: what statin dose should we use? Vasc Health Risk Manag. 2007;3(5):615–27.
9. Kosmas I. Paraskevas, Dimitri P, Mikhailidis, MD,b Frank JV, FACSc , Athens, Greece; London, United Kingdom; and New York, NY Optimal statin type and dosage for vascular patients. 2011;53(3):837-44.
10. Friend AS, Kamalesh M, Schellhase E, Eckert GJ, Evans TS. Effect of time to titration to maximum dose of statins on cardiovascular outcomes: a retrospective analysis in high-risk patients. Am J Cardiovasc Drugs. 2009;9(2):103-7.
11. Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ. 2003;326(7404):1423.
12. Navi BB, Segal AZ. The role of cholesterol and statins in stroke. Curr Cardiol Rep. 2009;11(1):4-11.
13. Turner AM, Jowett NI. The role of statin therapy in preventing recurrent stroke. Nurs Times. 2006;102(38):25-6.
14. Martin JH, Mangiafico S, Kelly DJ. Role of statins in diabetes complications. Curr Diabetes Rev. 2009;5(3):165-170.
15. Preiss D1, Seshasai SR, Welsh P, Murphy SA, Ho JE, Waters DD, DeMicco DA, Barter P, Cannon CP, Sabatine MS, Braunwald E, Kastelein JJ, de Lemos JA, Blazing MA, Pedersen TR, Tikkanen MJ, Sattar N, Ray KK. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta analysis. JAMA. 2011;305(24):2556-64.
16. Culver AL, Ockene IS, Balasubramanian R, Olendzki BC, Sepavich DM, Wactawski-Wende J, Manson JE, Qiao Y, Liu S, Merriam PA, Rahilly-Tierny C, Thomas F, Berger JS, Ockene JK, Curb JD, Ma Y. Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative. Arch Intern Med. 2012;172(2)144-52.
17. Delahoy PJ, Magliano DJ, Webb K, Grobler M, Liew D. The relationship between reduction in low-density lipoprotein cholesterol by statins and reduction in risk of cardiovascular outcomes: an updated meta-analysis. Clin Ther. 2009;31(2):236–44.
18. Mills EJ, Rachlis B, Wu P, Devereaux PJ, Arora P, Perri D. Primary prevention of cardiovascular mortality and events with statin treatments: a network meta-analysis involving more than 65,000 patients. J Am Coll Cardiol. 2008;52(22):1769-81.
19. Toth PP. The role of statins in managing diabetic dyslipidemia J Fam Pract. 2010;59(5 Suppl)S33-9.
20. Buemi M, Nostro L, Crascì E, Barillà A, Cosentini V, Aloisi C, Sofi T, Campo S, Frisina N. Statins in nephrotic syndrome: a new weapon against tissue injury. Med Res Rev. 2005;25(6):587-609.
21. Resh M, Mahmoodi BK, Navis GJ, Veeger NJ, Lijfering WM. Statin use in patients with nephrotic syndrome is associated with a lower risk of venous thromboembolism. Thromb Res. 2011;127(5):395-9.