DIFFERENTIAL ATORVASTATIN APPLICATION IN THE TREATMENT OF PATIENTS WITH CHRONIC OBSTRUCTIVE LUNG DISEASE WITH ASSOCIATED TYPE 2 DIABETES

Abstract

Objective. The aim of the research was to study the effectiveness of the differentiated useof atorvastatin in the treatment of patients with chronic obstructive pulmonary disease(COPD) with concomitant type 2 diabetes mellitus (DM).Material and methods. We examined 49 patients with COPD and concomitant type 2diabetes, who were divided into 2 groups. The first group (26 patients) received 40 mgof atorvastatin against a background of basic treatment, the second group (23 patients)received 20 mg of atorvastatin for 6 months. Evaluation of the effectiveness of thetherapy was carried out according to the CAT test, the test with 6-minute walking, theintegral BODE index, according to the results of spirometry and bioimpedansometry. Atthe beginning and at the end of treatment, the parameters of the blood lipid spectrum,carbohydrate metabolism, the functional state of the endothelium, as well as the levelof C-reactive protein (CRP) in the blood serum were determined. Genotyping of thepolymorphic variant C3435T of the MDR1 gene was carried out followed by assessmentof the distribution of genotypes and alleles between groups using the two-sided Pearsonchi-square test (χ2).Results. It was found that when using 40 mg of atorvastatin for six months of treatment inpatients with COPD with concomitant type 2 diabetes, there was an improvement in thelife quality according to the CAT test for the CC and CT genotypes, increased exercisetolerance for the CT genotype and a decrease in the integral BODE index regardless ofgenotype. A decrease in BMI and% fat mass was observed with the TT genotype. However,this therapy led to deterioration in carbohydrate metabolism (a significant increasein fasting glucose and after 2 hours). The level of total cholesterol (cholesterol) andcholesterol low density lipoproteins (LDL) significantly decreased with the TT genotype.With this genotype, the level of nitrates / nitrites increased significantly compared withthe SS and ST genotype. CRP decreased regardless of genotype.The use of atorvastatin at a dose of 20 mg in the treatment of patients with COPD withconcomitant type 2 diabetes mellitus leads to an improvement in the course of COPDwith concomitant type 2 diabetes, especially in the presence of the T allele (decrease inthe number of scores on the CAT test, increased exercise tolerance, decreased integralBODE index), improving the lipid spectrum of the blood and the functional state of theendothelium in the absence of an effect on carbohydrate metabolism (indicators did notsignificantly change at the end of treatment).Conclusion. It has been found that in patients with COPD with concomitant type 2 diabetes, an association of the response to treatment with atorvastatin with the C3435Tpolymorphism of the MDR1 gene was established. The use of atorvastatin at a dose of20 mg improved the course of COPD in the absence of an effect on type 2 diabetes,especially with the TT genotype.