DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20213228

Prospective, randomized, open label comparative study of efficacy of atorvastatin versus atorvastatin with vitamin D3 in patients with dyslipidemia attending tertiary care hospital

Motakatla Usha Rani, Chitra Karuppiah, Novaladi Kiruthiga, Vivek Rayavarapu

Abstract


Background: Cardiovascular diseases are one of the most important group of diseases causing premature mortality and morbidity. Dyslipidemia is an independent risk factor for cardiovascular diseases and is a disorder of lipoprotein metabolism. Various research studies support role of vitamin D against dyslipidemia. Vitamin D concentration positively correlates with HDL cholesterol and negatively with serum LDL and triglyceride levels. Vitamin D supplementation to Atorvastatin appeared to have increased cholesterol lowering activity more than either substance did alone.

Methods: The study was conducted in an outpatient department of general medicine for a duration of 12 weeks in a tertiary care hospital. Total of 100 patients with dyslipidemia were selected based on measurement of lipid profile. Out of 100 patients, 50 patients under group A were treated with atorvastatin 10mg and balance 50 patients under group B treated with atorvastatin and Vitamin D3 1000 IU/day orally. Patients were followed up monthly for 3 months and lipid profile was assessed at baseline and at the end of study. The baseline characteristics were similar in both study groups.

Results: On comparing groups at the end of 12 weeks mean LDL, triglycerides and VLDL were significantly reduced in group B than group A with p<0.001. The mean HDL level too increased in group B than group A with p<0.001.

Conclusions: Fasting plasma lipid profile improvement was higher in the atorvastatin with vitamin D3 group compared to atorvastatin group.


Keywords


Atorvastatin, Vitamin D3, Dyslipidemia, Lipid profile

Full Text:

PDF

References


Fodor G. Primary prevention of CVD: treating dyslipidemia. American Family Physician. 2011;15;83(10):1207

WHO. Cardiovascular disease. Fact sheet no. 317. 2021. Available at: www.who.int/mediacentre/factsheet/fs317/en/index.html. Accessed on 10 Feb 2021.

Jacobson TA, Ito MK, Maki KC, Orringer CE, Bays HE, Jones PH et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: part 1–executive summary. J clin lipidol. 2014;8(5):473-88.

Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am College Cardiol. 2019;74(10):e177-232.

Abhima MB, Wilson V. A comparative study of effect of Vitamin D and atorvastatin versus atorvastatin alone on serum HDL, VLDL and triglycerides in hyperlipidemic patients. MedPulse Int J Pharmacol. 2020;16(1):15-20.

Joshi SR, Anjana RM, Deepa M, Pradeepa R, Bhansali A, Dhandania VK et al. Prevalence of dyslipidemia in urban and rural India: the ICMR–INDIAB study. PloS one. 2014;9(5):e96808.

Gupta R, Rao RS, Misra A, Sharma SK. Recent trends in epidemiology of dyslipidemias in India. Indian heart j. 2017;69(3):382-92.

Salo A, Logomarsino JV. Relationship of vitamin D status and cardiometabolic risk factors in children and adolescents. Pediatric endocrinology reviews: PER. 2011;9(1):456-62.

Holick MF. The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Reviews in Endocrine and Metabolic Disorders. 2017;18(2):153-65.

Melamed ML, Michos ED, Post W, Astor B. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch internal med. 2008;168(15):1629-37.

Ahmed W, Khan N, Glueck CJ, Pandey S, Wang P, G7oldenberg N et al. Low serum 25 (OH) vitamin D levels (< 32 ng/mL) are associated with reversible myositis-myalgia in statin-treated patients. Translational Res. 2009;153(1):11-6.

Fahrleitner A, Dobnig H, Obernosterer A, Pilger E, Leb G, Weber K et al. Vitamin D deficiency and secondary hyperparathyroidism are common complications in patients with peripheral arterial disease. J general internal med. 2002;17(9):663-9.

Pérez-Castrillón JL, Vega G, Abad L, Sanz A, Chaves J, Hernandez G et al. Effects of atorvastatin on vitamin D levels in patients with acute ischemic heart disease. Am j cardiol. 2007;99(7):903-5.

Pérez-Castrillón JL, Abad Manteca L, Vega G, Del Pino Montes J, De Luis D, Dueňas Laita A. Vitamin D levels and lipid response to atorvastatin. Int j endocrinol. 2010;19;2010.

Li YC. Vitamin D regulation of the renin–angiotensin system. J cellular biochem. 2003;88(2):327-31.

Zittermann A, Gummert JF, Börgermann J. The role of vitamin D in dyslipidemia and cardiovascular disease. Curr Pharm Des. 2011;17(9):933-42.

Gupta AK, Sexton RC, Rudney H. Effect of vitamin D3 derivatives on cholesterol synthesis and HMG-CoA reductase activity in cultured cells. Journal of lipid research. 1989;30(3):379-86.

Goldstein MR. Myopathy, statins, and vitamin D deficiency. Am J Cardiol. 2007;100(8):1328.

Nimitphong H, Holick MF. Vitamin D status and sun exposure in southeast Asia. Dermatoendocrinol. 2013;5(1):34-7.

Srivastava SK. Drugs for dyslipidaemia (Hyperlipidaemia). In: A complete text book of medical pharmacology. 1st edition. New Delhi, Avichal publishers. 2012;321-40.

Schwartz JB. Effects of vitamin D supplementation in atorvastatin‐treated patients: a new drug interaction with an unexpected consequence. Clin Pharmacol Therap. 2009;85(2):198-203.

Kazlauskaite R, Powell LH, Mandapakala C, Cursio JF, Avery EF, Calvin J. Vitamin D is associated with atheroprotective high-density lipoprotein profile in postmenopausal women. J Clin Lipidol. 2010;4(2):113-9.

Maki KC, Rubin MR, Wong LG, McManus JF, Jensen CD, Marshall JW et al. Serum 25-hydroxyvitamin D is independently associated with high density lipoprotein cholesterol and the metabolic syndrome in men and women. J Clin Lipidol. 2009;3(4):289-96.

Bersot TP. Drug Therapy for Hypercholesterolemia and Dyslipidemia, in: LaurenceL. Brunton, Bruce A. Chabner, Bjorn C. Knollmann. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 13th edition. New York, Mc Graw Hill. 2011;877-904.