Diabetes Metab J > Volume 41(2); 2017 > Article
Kong, Koo, and Moon: Response: Efficacy of Moderate Intensity Statins in the Treatment of Dyslipidemia in Korean Patients with Type 2 Diabetes Mellitus (Diabetes Metab J 2017;41:23-30)
We appreciate Dr. Jeon's interest and comments on our article entitled “Efficacy of moderate intensity statins in the treatment of dyslipidemia in Korean patients with type 2 diabetes mellitus” which was published in Diabetes and Metabolism Journal [1].
Cardiovascular disease (CVD) is a leading cause of all deaths worldwide, accounting for 31% of deaths (17.5 million deaths) per year in 2012 [2]. In Korea, CVD is also one of the leading causes of death, accounting for 19% of deaths per year in 2015 [3]. CVD can be prevented by comprehensive management of risk factors including diabetes mellitus, hypertension, dyslipidemia, and smoking [4]. Notably, statin treatment to reduce the level of low density lipoprotein cholesterol (LDL-C) has reduced the rate of morbidity and mortality associated with CVD. Therefore, statin therapy was the mainstay of treatment for both primary and secondary CVD prevention. Since the 2013 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines were published, there have been many debates and discussions on the issue of whether to set a therapeutic target level of LDL-C concentration or to recommend a specific intensity statin regardless of LDL-C levels. In addition, in the case of the Korean population, it is necessary to confirm whether the CVD risk prediction model, i.e., the pooled cohort equation used in the ACC/AHA guidelines, would also be suitable for the Korean population and whether the effect of statin treatment would be similar to Caucasians.
As several previous studies have reported [5,6,7], we also observed that moderate-intensity statins were more effective in Korean patients with type 2 diabetes mellitus (T2DM) than in Caucasians. We agree with Dr. Jeon's opinion that we may have to reclassify statin intensities according to LDL-C lowering efficacy in the Korean population. In particular, rosuvastatin had a considerably greater LDL-C lowering effect in our study (51.6% reduction of LDL-C with 5 mg of rosuvastatin and 56% reduction with 10 mg of rosuvastatin) than in Caucasian populations. This finding was consistent with those of other previous studies [7]. Such a high efficacy could be associated with high plasma levels of rosuvastatin and its metabolites such as N-desmethyl rosuvastatin and rosuvastatin-lactone in Asians, which are partly due to genetic polymorphisms influencing hepatic clearance of the enzyme CYP2C9 [6,8]. Therefore, low dose rosuvastatin could be cost-effective in Asian populations including Korea; however, adverse effects would be similar among Koreans and Caucasians depending on plasma levels (and efficacies) despite the lower dose.
Depending on whether we recommend reducing LDL-C levels by 30% to 50% from baseline or reducing LDL-C concentrations below 100 mg/dL, moderate-intensity statins could be a mainstay of treatment for managing dyslipidemia in Korean patients with T2DM. If the percent reduction is a priority, we can recommend low-intensity statins to 40- to 75-year-old Korean patients with T2DM for primary prevention. However, before we recommend low-intensity statins, we have to consider whether it will be enough to reduce the incidence of CVD events in a high-risk population. Hence, more concrete evidence is required to develop Korean guidelines for the management of dyslipidemia; therefore, further research is warranted to elucidate the adequate intensity and type of statins that could reduce actual CVD events instead of LDL-C lowering efficacy in the Korean population.

NOTES

CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.

REFERENCES

1. Kong SH, Koo BK, Moon MK. Efficacy of moderate intensity statins in the treatment of dyslipidemia in Korean patients with type 2 diabetes mellitus. Diabetes Metab J 2017;41:23-30.
crossref pmid
2. World Health Organization. World Health Statistics 2016: monitoring health for the SDGs. Geneva: World Health Organization; 2016.
3. Statistics Korea. The cause of death statistics in the Republic of Korea, 2015. Daejeon: Statistics Korea; 2016.
4. Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O'Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr, Sorlie P, Stone NJ, Wilson PW, Jordan HS, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, Tomaselli GF. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;129(25):Suppl 2. S49-S73.
crossref pmid
5. Liao JK. Safety and efficacy of statins in Asians. Am J Cardiol 2007;99:410-414.
crossref pmid
6. Lee E, Ryan S, Birmingham B, Zalikowski J, March R, Ambrose H, Moore R, Lee C, Chen Y, Schneck D. Rosuvastatin pharmacokinetics and pharmacogenetics in white and Asian subjects residing in the same environment. Clin Pharmacol Ther 2005;78:330-341.
crossref pmid
7. Kwon JE, Kim Y, Hyun S, Won H, Shin SY, Lee KJ, Kim SW, Kim TH, Kim CJ. Cholesterol lowering effects of low-dose statins in Korean Patients. J Lipid Atheroscler 2014;3:21-28.
crossref
8. Birmingham BK, Bujac SR, Elsby R, Azumaya CT, Zalikowski J, Chen Y, Kim K, Ambrose HJ. Rosuvastatin pharmacokinetics and pharmacogenetics in Caucasian and Asian subjects residing in the United States. Eur J Clin Pharmacol 2015;71:329-340.
crossref pmid


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