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Current Vascular Pharmacology

Editor-in-Chief

ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

Clinical Trial

Effects of Xuezhikang versus Pravastatin on Triglyceride Level in Patients with T2DM and Dyslipidemia: Study Protocol for a Multicenter Randomized Controlled Trial

Author(s): Jin Xu, Liyuan Zhu, Yingying Xie, Miao Zhang, Zixi Xiao, Rongkai Su, Tie Wen and Ling Liu*

Volume 21, Issue 3, 2023

Published on: 14 April, 2023

Page: [211 - 217] Pages: 7

DOI: 10.2174/1570161121666230328110215

Price: $65

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Abstract

Background: Hypertriglyceridemia, is commonly found in patients with diabetes. Xuezhikang, an extract of red yeast rice, is effective in reducing cardiovascular events in Chinese patients with diabetes and coronary heart disease (CHD). Xuezhikang has been reported to significantly decrease the level of triglycerides (TG), a potential causal risk factor for myocardial infarction. On the basis of a similar reduction in low-density lipoprotein cholesterol, this study will evaluate the effect of xuezhikang on TG levels compared with pravastatin in patients with type 2 diabetes mellitus (T2DM) and dyslipidemia.

Methods: This is an open-label, multicenter, randomized controlled study to assess the effects of xuezhikang (1.2 g/day) and pravastatin (20 mg/day) on TG and other blood lipid parameters in patients with T2DM and dyslipidemia. A total of 114 patients will be enrolled and randomly assigned 1:1 to receive xuezhikang or pravastatin treatment for 6 weeks.

Result: The primary outcome measure is the change from baseline in fasting TG levels after 6 weeks. The change from baseline in other fasting and postprandial lipid parameters, and glucose profiles at 1, 2, and 4 h after a nutritious breakfast will also be explored.

Conclusion: This study will evaluate the effect of a 6-week treatment with xuezhikang compared with pravastatin on fasting and postprandial TG levels and other blood lipid parameters in patients with T2DM and dyslipidemia without atherosclerotic cardiovascular disease (ASCVD). The results will provide more information on optimizing the lipid control of patients with diabetes in the primary prevention of ASCVD.

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[1]
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285(19): 2486-97.
[http://dx.doi.org/10.1001/jama.285.19.2486] [PMID: 11368702]
[2]
Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2020; 41(2): 255-323.
[http://dx.doi.org/10.1093/eurheartj/ehz486] [PMID: 31497854]
[3]
Athyros VG, Doumas M, Imprialos KP, et al. Diabetes and lipid metabolism. Hormones (Athens) 2018; 17(1): 61-7.
[http://dx.doi.org/10.1007/s42000-018-0014-8] [PMID: 29858856]
[4]
Tomlinson B, Patil NG, Fok M, Lam CWK. Managing dyslipidemia in patients with Type 2 diabetes. Expert Opin Pharmacother 2021; 22(16): 2221-34.
[http://dx.doi.org/10.1080/14656566.2021.1912734] [PMID: 33823719]
[5]
Chait A, Ginsberg HN, Vaisar T, Heinecke JW, Goldberg IJ, Bornfeldt KE. Remnants of the triglyceride-rich lipoproteins, diabetes, and cardiovascular disease. Diabetes 2020; 69(4): 508-16.
[http://dx.doi.org/10.2337/dbi19-0007] [PMID: 32198194]
[6]
Toth P. Triglyceride-rich lipoproteins as a causal factor for cardiovascular disease. Vasc Health Risk Manag 2016; 12: 171-83.
[http://dx.doi.org/10.2147/VHRM.S104369] [PMID: 27226718]
[7]
Bays HE, Jones PH, Brown WV, Jacobson TA. National Lipid Association Annual Summary of Clinical Lipidology 2015. J Clin Lipidol 2014; 8(6): S1-S36.
[http://dx.doi.org/10.1016/j.jacl.2014.10.002] [PMID: 25523435]
[8]
Verbeek R, Hovingh GK, Boekholdt SM. Non-high-density lipoprotein cholesterol. Curr Opin Lipidol 2015; 26(6): 502-10.
[http://dx.doi.org/10.1097/MOL.0000000000000237] [PMID: 26780004]
[9]
Krähenbühl S, Pavik-Mezzour I, von Eckardstein A. Unmet Needs in LDL-C Lowering: When Statins Won’t Do! Drugs 2016; 76(12): 1175-90.
[http://dx.doi.org/10.1007/s40265-016-0613-0] [PMID: 27456066]
[10]
Hunninghake DB, Stein EA, Bays HE, et al. Rosuvastatin improves the atherogenic and atheroprotective lipid profiles in patients with hypertriglyceridemia. Coron Artery Dis 2004; 15(2): 115-23.
[http://dx.doi.org/10.1097/00019501-200403000-00008] [PMID: 15024300]
[11]
Adams SP, Tsang M, Wright JM. Lipid lowering efficacy of atorvastatin. Cochrane Database Syst Rev 2012; 12: CD008226.
[PMID: 23235655]
[12]
Zhao SP, Liu L, Cheng YC, et al. Xuezhikang, an extract of cholestin, protects endothelial function through antiinflammatory and lipid-lowering mechanisms in patients with coronary heart disease. Circulation 2004; 110(8): 915-20.
[http://dx.doi.org/10.1161/01.CIR.0000139985.81163.CE] [PMID: 15313947]
[13]
Heber D, Yip I, Ashley JM, Elashoff DA, Elashoff RM, Go VLW. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr 1999; 69(2): 231-6.
[http://dx.doi.org/10.1093/ajcn/69.2.231] [PMID: 9989685]
[14]
Cicero AFG, Fogacci F, Banach M. Red Yeast Rice for Hypercholesterolemia. Methodist DeBakey Cardiovasc J 2019; 15(3): 192-9.
[http://dx.doi.org/10.14797/mdcj-15-3-192] [PMID: 31687098]
[15]
Li JJ, Lu ZL, Kou WR, et al. Beneficial impact of Xuezhikang on cardiovascular events and mortality in elderly hypertensive patients with previous myocardial infarction from the China Coronary Secondary Prevention Study (CCSPS). J Clin Pharmacol 2009; 49(8): 947-56.
[http://dx.doi.org/10.1177/0091270009337509] [PMID: 19602720]
[16]
Ye P, Lu ZL, Du B, et al. Effect of xuezhikang on cardiovascular events and mortality in elderly patients with a history of myocardial infarction: A subgroup analysis of elderly subjects from the China Coronary Secondary Prevention Study. J Am Geriatr Soc 2007; 55(7): 1015-22.
[http://dx.doi.org/10.1111/j.1532-5415.2007.01230.x] [PMID: 17608873]
[17]
Li M, He Q, Chen Y, et al. Xuezhikang capsule for type 2 diabetes with hyperlipemia: A systematic review and meta-analysis of randomized clinical trails. Evid Based Complement Alternat Med 2015; 2015: 468520.
[http://dx.doi.org/10.1155/2015/468520] [PMID: 26246836]
[18]
Zhao SP, Liu L, Cheng YC, Li YL. Effect of xuezhikang, a cholestin extract, on reflecting postprandial triglyceridemia after a high-fat meal in patients with coronary heart disease. Atherosclerosis 2003; 168(2): 375-80.
[http://dx.doi.org/10.1016/S0021-9150(03)00142-4] [PMID: 12801622]
[19]
Jørgensen AB, Frikke-Schmidt R, West AS, Grande P, Nordestgaard BG, Tybjærg-Hansen A. Genetically elevated non-fasting triglycerides and calculated remnant cholesterol as causal risk factors for myocardial infarction. Eur Heart J 2013; 34(24): 1826-33.
[http://dx.doi.org/10.1093/eurheartj/ehs431] [PMID: 23248205]
[20]
Jones PH, Davidson MH, Stein EA, et al. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR* Trial). Am J Cardiol 2003; 92(2): 152-60.
[http://dx.doi.org/10.1016/S0002-9149(03)00530-7] [PMID: 12860216]
[21]
Feillet C, Farnier M, Monnier LH, et al. Comparative effects of simvastatin and pravastatin on cholesterol synthesis in patients with primary hypercholesterolemia. Atherosclerosis 1995; 118(2): 251-8.
[http://dx.doi.org/10.1016/0021-9150(95)05611-4] [PMID: 8770319]
[22]
Moriarty PM, Roth EM, Karns A, et al. Effects of Xuezhikang in patients with dyslipidemia: A multicenter, randomized, placebo-controlled study. J Clin Lipidol 2014; 8(6): 568-75.
[http://dx.doi.org/10.1016/j.jacl.2014.09.002] [PMID: 25499939]
[23]
Cheng YC. Clinical observation on effect of combination ezetimibe with Xuezhikang on cholestin extract. J Qiqihar Uni Med 2014; 35: 2397-9.
[24]
American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2020. Diabetes Care 2020; 43 (Suppl. 1): S14-31.
[http://dx.doi.org/10.2337/dc20-S002] [PMID: 31862745]
[25]
Lu Z, Kou W, Du B, et al. Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction. Am J Cardiol 2008; 101(12): 1689-93.
[http://dx.doi.org/10.1016/j.amjcard.2008.02.056] [PMID: 18549841]
[26]
Zhao S, Lu Z, Du B, et al. Xuezhikang, an extract of cholestin, reduces cardiovascular events in type 2 diabetes patients with coronary heart disease: Subgroup analysis of patients with type 2 diabetes from China coronary secondary prevention study (CCSPS). J Cardiovasc Pharmacol 2007; 49(2): 81-4.
[http://dx.doi.org/10.1097/FJC.0b013e31802d3a58] [PMID: 17312447]
[27]
Stahel P, Xiao C, Davis X, Tso P, Lewis GF. Glucose and GLP-2 (Glucagon-Like Peptide-2) mobilize intestinal triglyceride by distinct mechanisms. Arterioscler Thromb Vasc Biol 2019; 39(8): 1565-73.
[http://dx.doi.org/10.1161/ATVBAHA.119.313011] [PMID: 31294621]
[28]
Cohen JC, Berger GM. Effects of glucose ingestion on postprandial lipemia and triglyceride clearance in humans. J Lipid Res 1990; 31(4): 597-602.
[http://dx.doi.org/10.1016/S0022-2275(20)42827-5] [PMID: 2351868]
[29]
2016 Chinese guideline for the management of dyslipidemia in adults. Zhonghua Xin Xue Guan Bing Za Zhi 2016; 44: 833-53.
[PMID: 27903370]
[30]
Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Atherosclerosis 2019; 290: 140-205.
[http://dx.doi.org/10.1016/j.atherosclerosis.2019.08.014] [PMID: 31591002]
[31]
Handelsman Y, Jellinger PS, Guerin CK, et al. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Management of Dyslipidemia and Prevention of Cardiovascular Disease Algorithm – 2020 Executive Summary. Endocr Pract 2020; 26(10): 1196-224.
[http://dx.doi.org/10.4158/CS-2020-0490] [PMID: 33471721]
[32]
Chinese expert consensus on lipid management of very high-risk atherosclerotic cardiovascular disease patients. Zhonghua Xin Xue Guan Bing Za Zhi 2020; 48: 280-6.
[33]
Rawla P, Sunkara T, Thandra KC, Gaduputi V. Hypertriglyceridemia-induced pancreatitis: Updated review of current treatment and preventive strategies. Clin J Gastroenterol 2018; 11(6): 441-8.
[http://dx.doi.org/10.1007/s12328-018-0881-1] [PMID: 29923163]
[34]
Tsuang W, Navaneethan U, Ruiz L, Palascak JB, Gelrud A. Hypertriglyceridemic pancreatitis: Presentation and management. Am J Gastroenterol 2009; 104(4): 984-91.
[http://dx.doi.org/10.1038/ajg.2009.27] [PMID: 19293788]
[35]
Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41(1): 111-88.
[http://dx.doi.org/10.1093/eurheartj/ehz455] [PMID: 31504418]
[36]
Elam MB, Ginsberg HN, Lovato LC, et al. Association of fenofibrate therapy with long-term cardiovascular risk in statin-treated patients with type 2 diabetes. JAMA Cardiol 2017; 2(4): 370-80.
[http://dx.doi.org/10.1001/jamacardio.2016.4828] [PMID: 28030716]
[37]
Bhatt DL, Steg PG, Miller M, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med 2019; 380(1): 11-22.
[http://dx.doi.org/10.1056/NEJMoa1812792] [PMID: 30415628]
[38]
Kolovou GD, Watts GF, Mikhailidis DP, et al. Postprandial hypertriglyceridaemia revisited in the era of non-fasting lipid profile testing: A 2019 expert panel statement, main text. Curr Vasc Pharmacol 2019; 17(5): 498-514.
[http://dx.doi.org/10.2174/1570161117666190507110519] [PMID: 31060488]
[39]
Nordestgaard BG, Langsted A, Mora S, et al. Fasting is not routinely required for determination of a lipid profile: Clinical and laboratory implications including flagging at desirable concentration cut-points—a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. Eur Heart J 2016; 37(25): 1944-58.
[http://dx.doi.org/10.1093/eurheartj/ehw152] [PMID: 27122601]
[40]
Ginsberg HN, Illingworth DR. Postprandial dyslipidemia: An atherogenic disorder common in patients with diabetes mellitus. Am J Cardiol 2001; 88(6): 9-15.
[http://dx.doi.org/10.1016/S0002-9149(01)01831-8] [PMID: 11576520]
[41]
Bansal S, Buring JE, Rifai N, Mora S, Sacks FM, Ridker PM. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA 2007; 298(3): 309-16.
[http://dx.doi.org/10.1001/jama.298.3.309] [PMID: 17635891]
[42]
Tada H, Takamura M, Kawashiri M. Lipoprotein(a) as an old and new causal risk factor of atherosclerotic cardiovascular disease. J Atheroscler Thromb 2019; 26(7): 583-91.
[http://dx.doi.org/10.5551/jat.RV17034] [PMID: 31061262]
[43]
Wu MF, Xu KZ, Guo YG, Yu J, Wu Y, Lin LM. Lipoprotein(a) and atherosclerotic cardiovascular disease: Current understanding and future perspectives. Cardiovasc Drugs Ther 2019; 33(6): 739-48.
[http://dx.doi.org/10.1007/s10557-019-06906-9] [PMID: 31655942]
[44]
O’Donoghue ML, Fazio S, Giugliano RP, et al. Lipoprotein(a), PCSK9 inhibition, and cardiovascular risk. Circulation 2019; 139(12): 1483-92.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.118.037184] [PMID: 30586750]
[45]
Romagnuolo R, Scipione CA, Marcovina SM, et al. Roles of the low density lipoprotein receptor and related receptors in inhibition of lipoprotein(a) internalization by proprotein convertase subtilisin/kexin type 9. PLoS One 2017; 12(7): e0180869.
[http://dx.doi.org/10.1371/journal.pone.0180869] [PMID: 28750079]
[46]
Villard EF, Thedrez A, Blankenstein J, et al. PCSK9 modulates the secretion but not the cellular uptake of Lipoprotein(a) ex vivo. JACC Basic Transl Sci 2016; 1(6): 419-27.
[http://dx.doi.org/10.1016/j.jacbts.2016.06.006] [PMID: 29308438]
[47]
Zhang Y, Liu J, Li S, Xu RX, Sun J, Li JJ. Impact of currently prescribed lipid-lowering drugs on plasma PCSK9 concentration: Single or in combination study in rats. Lipids Health Dis 2014; 13(1): 35.
[http://dx.doi.org/10.1186/1476-511X-13-35] [PMID: 24533584]
[48]
Yandrapalli S, Malik A, Guber K, et al. Statins and the potential for higher diabetes mellitus risk. Expert Rev Clin Pharmacol 2019; 12(9): 825-30.
[http://dx.doi.org/10.1080/17512433.2019.1659133] [PMID: 31474169]
[49]
Chen TL, Lin CS, Lin JA, et al. Evaluating risk of incident diabetes between patients who used lovastatin and red yeast rice prescriptions (LipoCol Forte): A retrospective cohort study based on a real-world database. Diabetes Metab Syndr Obes 2020; 13: 89-98.
[http://dx.doi.org/10.2147/DMSO.S223833] [PMID: 32021355]

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