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Effect of losartan and spironolactone on triglyceride-rich lipoproteins in diabetic nephropathy
Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) can improve dyslipidemia in patients with diabetes and albuminuria. Whether combined ACEi+ARB or ACEi+mineralocorticoid receptor blockade improves dyslipidemia is not known. We hypothesized long-term administrat...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975815/ https://www.ncbi.nlm.nih.gov/pubmed/27388615 http://dx.doi.org/10.1136/jim-2016-000102 |
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author | Srivastava, Anand Adams-Huet, Beverley Vega, Gloria L Toto, Robert D |
author_facet | Srivastava, Anand Adams-Huet, Beverley Vega, Gloria L Toto, Robert D |
author_sort | Srivastava, Anand |
collection | PubMed |
description | Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) can improve dyslipidemia in patients with diabetes and albuminuria. Whether combined ACEi+ARB or ACEi+mineralocorticoid receptor blockade improves dyslipidemia is not known. We hypothesized long-term administration of either losartan 100 mg or spironolactone 25 mg once daily added onto lisinopril 80 mg once daily would improve dyslipidemia in diabetic nephropathy (DN). We measured lipid levels, very-low-density (V), intermediate-density (I), low-density (LDL), high-density (HDL) lipoprotein, LDL particle size with their respective cholesterol (C) and apolipoprotein B levels (ApoB), and urine albumin/creatinine ratio (UACR) at 12-week interval during a 48-week randomized, double-blind placebo-controlled trial in 81 patients with DN. Plasma lipids and lipoprotein C were analyzed enzymatically and Apo B was determined chemically. Data were analyzed by mixed model repeated measures. ΔUACR differed among treatment arms (placebo −24.6%, los −38.2%, spiro −51.6%, p=0.02). No correlation existed between ΔUACR and ΔTG or any of the lipid or lipoprotein measurements. Compared with placebo losartan, but not spironolactone, decreased TG (−20.9% vs +34.3%, p<0.01), V+I C(−18.8% vs +21.3%, p<0.01), and V+I-ApoB (−13.2% vs +21%, p<0.01). There were no significant changes in body weight, HbA1c or other lipoprotein variables. We conclude losartan improves dyslipidemia in patients with DN. We speculate the mechanism improved clearance of VLDL and remnant lipoproteins. TRIAL REGISTRATION NUMBER: NCT00381134; Results. |
format | Online Article Text |
id | pubmed-4975815 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-49758152016-08-18 Effect of losartan and spironolactone on triglyceride-rich lipoproteins in diabetic nephropathy Srivastava, Anand Adams-Huet, Beverley Vega, Gloria L Toto, Robert D J Investig Med Original Research Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) can improve dyslipidemia in patients with diabetes and albuminuria. Whether combined ACEi+ARB or ACEi+mineralocorticoid receptor blockade improves dyslipidemia is not known. We hypothesized long-term administration of either losartan 100 mg or spironolactone 25 mg once daily added onto lisinopril 80 mg once daily would improve dyslipidemia in diabetic nephropathy (DN). We measured lipid levels, very-low-density (V), intermediate-density (I), low-density (LDL), high-density (HDL) lipoprotein, LDL particle size with their respective cholesterol (C) and apolipoprotein B levels (ApoB), and urine albumin/creatinine ratio (UACR) at 12-week interval during a 48-week randomized, double-blind placebo-controlled trial in 81 patients with DN. Plasma lipids and lipoprotein C were analyzed enzymatically and Apo B was determined chemically. Data were analyzed by mixed model repeated measures. ΔUACR differed among treatment arms (placebo −24.6%, los −38.2%, spiro −51.6%, p=0.02). No correlation existed between ΔUACR and ΔTG or any of the lipid or lipoprotein measurements. Compared with placebo losartan, but not spironolactone, decreased TG (−20.9% vs +34.3%, p<0.01), V+I C(−18.8% vs +21.3%, p<0.01), and V+I-ApoB (−13.2% vs +21%, p<0.01). There were no significant changes in body weight, HbA1c or other lipoprotein variables. We conclude losartan improves dyslipidemia in patients with DN. We speculate the mechanism improved clearance of VLDL and remnant lipoproteins. TRIAL REGISTRATION NUMBER: NCT00381134; Results. BMJ Publishing Group 2016-08 2016-07-07 /pmc/articles/PMC4975815/ /pubmed/27388615 http://dx.doi.org/10.1136/jim-2016-000102 Text en Copyright © 2016 American Federation for Medical Research This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Original Research Srivastava, Anand Adams-Huet, Beverley Vega, Gloria L Toto, Robert D Effect of losartan and spironolactone on triglyceride-rich lipoproteins in diabetic nephropathy |
title | Effect of losartan and spironolactone on triglyceride-rich lipoproteins in diabetic nephropathy |
title_full | Effect of losartan and spironolactone on triglyceride-rich lipoproteins in diabetic nephropathy |
title_fullStr | Effect of losartan and spironolactone on triglyceride-rich lipoproteins in diabetic nephropathy |
title_full_unstemmed | Effect of losartan and spironolactone on triglyceride-rich lipoproteins in diabetic nephropathy |
title_short | Effect of losartan and spironolactone on triglyceride-rich lipoproteins in diabetic nephropathy |
title_sort | effect of losartan and spironolactone on triglyceride-rich lipoproteins in diabetic nephropathy |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975815/ https://www.ncbi.nlm.nih.gov/pubmed/27388615 http://dx.doi.org/10.1136/jim-2016-000102 |
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