Statins May Have Additional Lipid Profile Benefit in Pre-Diabetes

Prof. Moses Elisaf Professor of Internal Medicine University of Ioannina, Interview with:
Prof. Moses Elisaf
Professor of Internal Medicine
University of Ioannina, Greece

Medical Research: What are the main findings of the study?

Dr. Elisaf: We evaluated the effects of rosuvastatin in two groups of hyperlipidemic patients: one group had impaired fasting glucose (IFG) while the second group had normal fasting glucose. After study end, both groups had similar changes in their lipidemic profile.

However, patients with IFG had a significant greater decrease in the cholesterol concentration of the more atherogenic small dense low-density lipoprotein (sdLDL) particles (-65.7%) compared with controls (-38.5%). Moreover, a greater increase in the mean LDL particle size was observed in theĀ impaired fasting glucose group (+1.5% vs +0.4%).

In addition, redistribution from the more atherogenic sdLDL to large buoyant
LDL (lbLDL) subfractions was observed in the IFG group.

Medical Research: What was most surprising about the results?

Dr. Elisaf: As expected both groups had similar changes in their lipidemic profile with
comparable reductions of total cholesterol, triglycerides and LDL
cholesterol. However, the interesting finding in theĀ impaired fasting glucose group was the
greater decrease of sdLDL and the shift from sdLDL to lbLDL in the
subfraction profile of LDL. These changes were statistically significant
even after adjusting for baseline values between the two groups. These
results may indicate an additional beneficial effect of statin treatment in
prediabetic subjects.

Medical Research: What should clinicians and patients take away from your report?

Dr. Elisaf: Patients with prediabetes are at increased risk for both the development of
diabetes mellitus as well as cardiovascular disease. Therefore, dyslipidemic
prediabetic patients should be treated with statin in accordance with
current guidelines. Furthermore, patients should be educated regarding the
significance of compliance with statin therapy.

Based on the findings of our study, awaiting confirmation of larger studies,
the treatment of prediabetic subjects with statins may have the added
advantage of beneficially redistributing LDL profile beyond decreasing LDL
cholesterol. On the other hand, statin therapy has been associated with
detrimental effects on glucose homeostasis. However, statin-associated
cardiovascular risk reduction is comparatively high, overweighing the risk
of glucose homeostasis impairment.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Elisaf:Our study represents a pilot study on the effects of rosuvastatin on LDL
subfraction profile of prediabetic patients. Based on our results, larger
randomized control trials are required to further evaluate the effects of
statins on LDL subfraction profile in prediabetic population. In addition,
studies with hard clinical endpoints are needed in order to evaluate whether
this differential effect of statins in prediabetic patients is translated
into improved clinical outcomes. These studies will help elucidate whether a
more aggressive approach regarding statin treatment may be justified in
prediabetic subjects.


The effect of rosuvastatin on low-density lipoprotein subfractions in
patients with impaired fasting glucose
Christos V. Rizos, Michael S. Kostapanos, C. Rizos, Alexandros D. Tselepis, and Moses S. Elisaf
J CARDIOVASC PHARMACOL THER 1074248414549419, first published on September 18, 2014 doi:10.1177/1074248414549419