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나승운,박지영,최병걸,최세연,최재웅,류성기,이세진,김승환,노영균,Raghavender Goud Akkala,Hu Li,Jabar Ali,김지박,이선기,나진오,최철웅,임홍의,김진원,김응주,박창규,서홍석,오동주 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.1
Purpose: Angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) are associated with a decreasedincidence of new-onset diabetes mellitus (NODM). The aim of this study was to compare the protective effect of ACEIversus ARBs on NODM in an Asian population. Materials and Methods: We investigated a total of 2817 patients who did not have diabetes mellitus from January 2004 to September2009. To adjust for potential confounders, a propensity score matched (PSM) analysis was performed using a logistic regressionmodel. The primary end-point was the cumulative incidence of NODM, which was defined as having a fasting bloodglucose ≥126 mg/dL or HbA1c ≥6.5%. Multivariable cox-regression analysis was performed to determine the impact of ACEI versusARB on the incidence of NODM. Results: Mean follow-up duration was 1839±1019 days in all groups before baseline adjustment and 1864±1034 days in the PSMgroup. After PSM (C-statistics=0.731), a total 1024 patients (ACEI group, n=512 and ARB group, n=512) were enrolled for analysisand baseline characteristics were well balanced. After PSM, the cumulative incidence of NODM at 3 years was lower in the ACEIgroup than the ARB group (2.1% vs. 5.0%, p=0.012). In multivariate analysis, ACEI vs. ARB was an independent predictor of thelower incidence for NODM (odd ratio 0.37, confidence interval 0.17–0.79, p=0.010). Conclusion: In the present study, compared with ARB, chronic ACEI administration appeared to be associated with a lower incidenceof NODM in a series of Asian cardiovascular patients.
Park, J.Y.,Rha, S.W.,Choi, B.,Choi, J.W.,Ryu, S.K.,Kim, S.,Noh, Y.K.,Choi, S.Y.,Akkala, R.G.,Li, H.,Ali, J.,Xu, S.,Ngow, H.A.,Lee, J.J.,Lee, G.N.,Kim, J.,Lee, S.,Na, J.O.,Choi, C.U.,Lim, H.E.,Kim, J.W Elsevier/North-Holland Biomedical Press 2015 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.184 No.-
Background: High dose atorvastatin is known to be associated with new onset diabetes mellitus (NODM) in patients with high risk for developing diabetes mellitus (DM). However, low dose atorvastatin is more commonly used as compared with high dose atorvastatin. The aim of this study is to investigate the impact of low dose atorvastatin (LDA, 10mg or 20mg) on the development of NODM up to three years in Asian patients. Methods: From January 2004 to September 2009, we investigated a total of 3566 patients who did not have DM. To adjust for potential confounders, a propensity score matching (PSM) analysis was performed using the logistic regression model. After PSM (C-statistics: 0.851), a total of 818 patients (LDA group, n=409 patients and control group, n=409 patients) were enrolled for analysis. Results: Before PSM, the cumulative incidence of NODM (5.8% vs. 2.1%, p<0.001), myocardial infarction (0.5% vs. 0.1%, p-value=0.007), and major adverse cardio-cerebral event (MACCE, 1.8% vs. 0.7%, p-value=0.012) at three-years were higher in the LAD group. However, after PSM, there was a trend toward higher incidence of NODM (5.9% vs. 3.2%, p=0.064) in the LDA group, but the incidence of MACCE (1.2% vs. 1.5%, p-value=1.000) was similar between the two groups. In multivariable analysis, the LDA administration was tended to be an independent predictor of NODM (OR: 1.99, 95% CI: 1.00-3.98, p-value 0.050). Conclusions: In this study, the use of LDA tended to be a risk factor for NODM in Asian patients and reduced clinical events similar to the control group. However, large-scale randomized controlled trials will be needed to get the final conclusion.