S19W apolipoprotein A5 gene polymorphism and efficiency of atorvastatin and fenofibrate in type 2 diabetes mellitus
Objective. To compare the efficiency of atorvastatin monotherapy and combined therapy (atorvastatin and fenofibrate) in type 2 diabetes mellitus (T2DM) depending on the genotype of S19W apolipoprotein A5 gene polymorphism ( APOA5 ). Design and methods. Altogether 135 patients with T2DM were enrolled, 114 women and 21 men (mean age 59,3 ± 0,3 years) taking biguanides, with HbA1c < 8,0 %. None of them received lipid-lowering therapy. Clinical data, serum lipids and genetic variants of АPOА5 were assessed. Atorvastatin monotherapy (20 mg/day/3 months) was initially prescribed with subsequent change to the combination therapy by atorvastatin and fenofibrate (20 mg + 145 mg/day/3 months). Results. Three-month monotherapy led to a significant reduction in triglycerides (TG) and very low density lipoproteins cholesterol (VLDL-cholesterol) levels in patients with SS genotype compared to carriers of SW genotype (p = 0,015 and p = 0,025, respectively). At the same time, after 3-month combination therapy no differences were found between АPOА5 variants. There was a trend towards greater reduction in total cholesterol, TG, and VLDL-cholesterol in SW-carriers compared to SS-carriers. There was a paradoxical decrease in high density lipoproteins cholesterol (HDL-cholesterol) in patients with SW genotype, while it remained unchanged in patients with SS genotype. Conclusions. Our results suggest that polymorphic variants in АPOА5 may affect pharmacogenetics of lipid-lowering therapy in T2DM.