title: Effects of manidipine plus rosuvastatin versus olmesartan plus rosuvastatin on markers of insulin resistance in patients with impaired fasting glucose, hypertension, and mixed dyslipidemia.
abstract: OBJECTIVE
  To compare the effect of manidipine 20 mg plus rosuvastatin 10 mg versus olmesartan 20 mg plus rosuvastatin 10 mg on markers of insulin resistance in patients with mixed dyslipidemia, hypertension, and impaired fasting glucose (IFG).
  
  
  METHODS
  This study had a prospective, randomized, open-label, blinded endpoint (PROBE) design. A total of 40 patients with IFG, mixed dyslipidemia, and stage 1 hypertension were included. Following dietary intervention, patients were randomly allocated to rosuvastatin (10 mg/d) plus olmesartan (20 mg/d) or manidipine (20 mg/d). The primary end point was the between-group difference in changes in the Homeostasis Model Assessment Insulin Resistance (HOMA-IR) index following 3 months of treatment. Secondary end points included changes in fasting plasma glucose (FPG), fasting insulin levels, and glucosylated hemoglobin.
  
  
  RESULTS
  At the end of the 3-month treatment period, a significant increase in HOMA-IR index by 14% (from 2.4 [0.5-7.9] to 2.7 [0.5-5.2], P = .02 versus baseline) was seen in the olmesartan plus rosuvastatin group. On the contrary, no significant change in HOMA-IR index was observed in the manidipine plus rosuvastatin group (1.7 [0.5-5.2] to 1.7 [0.8-6.0], P = NS versus baseline, P = .04 versus olmesartan plus rosuvastatin group). An increase in fasting insulin levels was observed in the olmesartan plus rosuvastatin group (+8%, from 10.1 [2.0-29.6] to 10.9 [2.0-19.1] μU/mL, P < .05 versus baseline), while no significant change was seen in the manidipine plus rosuvastatin group (+3%, from 7.3 [2.0-17.6] to 7.5 [1.9-15.6] μU/mL, P = NS versus baseline, P = .02 versus olmesartan plus rosuvastatin group). Fasting plasma glucose and glycosylated hemoglobin did not change significantly in any group.
  
  
  CONCLUSIONS
  Manidipine seems to ameliorate the possible statin-associated increase in insulin resistance as compared with olmesartan in patients with IFG, hypertension, and mixed dyslipidemia.
authors.affiliation: Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece.
authors.forename: Evangelos N
authors.initials: EN
authors.lastname: Liberopoulos
authors.forename: Elisavet
authors.initials: E
authors.lastname: Moutzouri
authors.forename: Christos V
authors.initials: CV
authors.lastname: Rizos
authors.forename: Fotis
authors.initials: F
authors.lastname: Barkas
authors.forename: George
authors.initials: G
authors.lastname: Liamis
authors.forename: Moses S
authors.initials: MS
authors.lastname: Elisaf
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D004095:Dihydropyridines / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D023381:Endpoint Determination / Q000379:methods; D005215:Fasting / Q000097:blood; D005260:Female; D005464:Fluorobenzenes / Q000008:administration & dosage*; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D007093:Imidazoles / Q000008:administration & dosage*; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009578:Nitrobenzenes; D010879:Piperazines; D011446:Prospective Studies; D011743:Pyrimidines / Q000008:administration & dosage*; D000068718:Rosuvastatin Calcium; D016037:Single-Blind Method; D013449:Sulfonamides / Q000008:administration & dosage*; D013777:Tetrazoles / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D004095:Dihydropyridines; D005464:Fluorobenzenes; D007093:Imidazoles; D009578:Nitrobenzenes; D010879:Piperazines; D011743:Pyrimidines; D013449:Sulfonamides; D013777:Tetrazoles; C054218:manidipine; D000068718:Rosuvastatin Calcium; C437965:olmesartan