Effects of Pitavastatin on Insulin Sensitivity and Liver Fat
| Status: | Completed |
|---|---|
| Conditions: | Obesity Weight Loss, Neurology, Endocrine, Gastrointestinal |
| Therapuetic Areas: | Endocrinology, Gastroenterology, Neurology |
| Healthy: | No |
| Age Range: | 40 - 65 |
| Updated: | 8/17/2018 |
| Start Date: | March 2, 2015 |
| End Date: | April 30, 2018 |
HMG co-A reductase inhibitors, commonly called statins, are an effective treatment for
dyslipidemia and atherosclerotic heart disease with proven mortality benefit. While the
lipid-lowering effects of statins are well-known, other metabolic effects, including effects
on glucose tolerance and ectopic fat distribution, are less completely understood. Recent
studies have shown that some statins may increase the risk of diabetes. Further, research has
suggested that statins may have some benefit in nonalcoholic fatty liver disease (NAFLD), a
condition associated with obesity that includes increased fat in the liver (steatosis) and,
in some cases, inflammation and hepatocellular damage (steatohepatitis). Pitavastatin,
approved by the United States Food and Drug Administration (FDA) in 2009, is the most recent
statin to enter the market. Unlike most statins, pitavastatin is not primarily metabolized
through cytochrome P450 (CYP450), and thus has reduced potential for interactions with other
medications that are metabolized by CYP450. Previous studies have suggested that pitavastatin
may be neutral to glucose homeostasis and may improve hepatic lipid. Neither of these effects
has been proven definitively, however, and the current proposal aims to characterize in
detail the effects of pitavastatin on glucose homeostasis, hepatic steatosis, and
steatohepatitis.
dyslipidemia and atherosclerotic heart disease with proven mortality benefit. While the
lipid-lowering effects of statins are well-known, other metabolic effects, including effects
on glucose tolerance and ectopic fat distribution, are less completely understood. Recent
studies have shown that some statins may increase the risk of diabetes. Further, research has
suggested that statins may have some benefit in nonalcoholic fatty liver disease (NAFLD), a
condition associated with obesity that includes increased fat in the liver (steatosis) and,
in some cases, inflammation and hepatocellular damage (steatohepatitis). Pitavastatin,
approved by the United States Food and Drug Administration (FDA) in 2009, is the most recent
statin to enter the market. Unlike most statins, pitavastatin is not primarily metabolized
through cytochrome P450 (CYP450), and thus has reduced potential for interactions with other
medications that are metabolized by CYP450. Previous studies have suggested that pitavastatin
may be neutral to glucose homeostasis and may improve hepatic lipid. Neither of these effects
has been proven definitively, however, and the current proposal aims to characterize in
detail the effects of pitavastatin on glucose homeostasis, hepatic steatosis, and
steatohepatitis.
Inclusion Criteria:
1. Men age 40-65yo
2. BMI ≥ 27kg/m2 and waist circumference ≥102cm, high probability risk factors for NAFLD
3. At least one of the following indicating insulin resistance: Fasting glucose ≥100mg/dL
and <126mg/dL, HOMA-IR >2.0, and/or 2 hour glucose ≥140mg/dL and <200mg/dL following
standard glucose tolerance test.
4. 10-year cardiovascular disease risk ≥5% by American Heart Association(AHA)/American
College of Cardiology (ACC) Pooled Cohort Equations CV Risk Calculator or LDL ≥
100mg/dL
5. No use of any statin within 1 year of study entry and not being actively considered
for statin therapy by a treating provider.
Exclusion Criteria:
1. Diagnosis of diabetes or use of anti-diabetic medications.
2. Use of erythromycin, rifampin, cyclosporin, colchicine, or gemfibrozil.
3. Use of statin therapy within 1 year prior to study entry as above. Use of any other
lipid-modifying therapy (including fish oil, fibrates, niacin, gemfibrozil) within 6
months of study entry.
4. Contraindication to statin therapy.
5. Creatinine > upper limit of normal or known renal disease
6. AST or ALT > 3 times the upper limit of normal
7. hemoglobin < 10g/dL
8. Contraindication to undergoing a magnetic resonance scan.
9. Atherosclerotic cardiovascular disease or low-density lipoprotein cholesterol (LDL-C)
≥ 190mg/dL.
10. Triglyceride ≥500mg/dL
We found this trial at
1
site
185 Cambridge Street
Boston, Massachusetts 02114
Boston, Massachusetts 02114
617-724-5200
Principal Investigator: Steven K. Grinspoon, MD
Phone: 617-726-5312
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