瑞舒伐他汀改善1型糖尿病患者生酮饮食后LDL亚组分谱:1例报告

IF 2.1 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE
Miodrag Janić, Mojca Lunder, Andrej Janež, Mišo Šabović, Viviana Maggio, Manfredi Rizzo
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引用次数: 0

摘要

采用生酮饮食的人可能会增加低密度脂蛋白胆固醇(LDL-C),即瘦质量超反应(LMHR)表型。然而,这种增加并不一定对应于心血管(CV)风险的增加,并且该群体中高危个体的最佳治疗策略仍不确定。病例介绍:一名61岁的1型糖尿病患者在采用生酮饮食后出现了LMHR表型。在左颈总动脉球茎处发现动脉粥样硬化斑块,将其重新归类为心血管疾病二级预防类别。在每日使用瑞舒伐他汀20mg后,他的LDL-C亚谱从较易致动脉粥样硬化的B型表型转变为较易致动脉粥样硬化的a型表型,但总体LDL-C水平没有显著降低。这表明瑞舒伐他汀提供了有益的效果,补充了与生酮饮食相关的代谢改善,包括更好的血糖和胰岛素控制,潜在的小密度LDL-C和甘油三酯的预先降低,以及高密度脂蛋白胆固醇(HDL-C)的增加。在这种情况下,没有观察到糖尿病酮症酸中毒发展的低阈值趋势。结论:在开始降脂治疗之前和之后评估LDL-C亚组对出现瘦质量超反应(LMHR)表型的个体至关重要,特别是在确诊动脉粥样硬化的情况下。鉴于在这一人群中经常观察到明显升高的LDL-C水平,如果不进行亚分分析,可能很难准确评估致动脉粥样硬化胆固醇的负担及其减少的程度。在这种情况下,他汀类药物治疗似乎是一种合理且潜在有益的干预措施,即使在LMHR个体中也是如此。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rosuvastatin Improved LDL Subfractions Profile in a Patient with Type 1 Diabetes Following a Ketogenic Diet: A Case Report.

Introduction: People on a ketogenic diet may develop an increase in low-density lipoprotein cholesterol (LDL-C), known as the lean mass hyper-responder (LMHR) phenotype. However, this increase does not necessarily correspond to a heightened cardiovascular (CV) risk, and optimal treatment strategies for high-risk individuals within this group remain uncertain.

Case presentation: A 61-year-old man with type 1 diabetes developed the LMHR phenotype after adopting a ketogenic diet. An atherosclerotic plaque was discovered in the bulb of his left common carotid artery, reclassifying him into the secondary prevention category of CV disease. After the introduction of rosuvastatin 20 mg daily, his LDL-C subfraction profile changed from a more atherogenic type B phenotype to a less atherogenic type A phenotype without significantly decreasing overall LDL-C levels. This suggests that rosuvastatin provided a beneficial effect, complementing the metabolic improvements associated with the ketogenic diet, including better blood glucose and insulin control, potential prior reductions in small dense LDL-C and triglycerides, and an increase in high-density lipoprotein cholesterol (HDL-C).In this case, no trend toward a lower threshold was observed for the development of diabetic ketoacidosis.

Conclusion: Assessing LDL-C subfractions before and after the initiation of lipid-lowering therapy is essential in individuals who develop the lean mass hyper-responder (LMHR) phenotype, particularly in the presence of confirmed atherosclerosis. Given the markedly elevated LDL-C levels often observed in this population, it may be difficult to accurately evaluate the burden of atherogenic cholesterol and the extent of its reduction without subfraction analysis. In such cases, statin therapy appears to be a reasonable and potentially beneficial intervention, even among LMHR individuals.

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来源期刊
Current vascular pharmacology
Current vascular pharmacology 医学-外周血管病
CiteScore
9.20
自引率
4.40%
发文量
54
审稿时长
6-12 weeks
期刊介绍: Current Vascular Pharmacology publishes clinical and research-based reviews/mini-reviews, original research articles, letters, debates, drug clinical trial studies and guest edited issues to update all those concerned with the treatment of vascular disease, bridging the gap between clinical practice and ongoing research. Vascular disease is the commonest cause of death in Westernized countries and its incidence is on the increase in developing countries. It follows that considerable research is directed at establishing effective treatment for acute vascular events. Long-term treatment has also received considerable attention (e.g. for symptomatic relief). Furthermore, effective prevention, whether primary or secondary, is backed by the findings of several landmark trials. Vascular disease is a complex field with primary care physicians and nurse practitioners as well as several specialties involved. The latter include cardiology, vascular and cardio thoracic surgery, general medicine, radiology, clinical pharmacology and neurology (stroke units).
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