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Treatment with exenatide once weekly or twice daily for 30 weeks is associated with changes in several cardiovascular risk markers

Authors Chiquette E, Toth PP, Ramirez G, Cobble M, Chilton R

Received 11 September 2012

Accepted for publication 10 October 2012

Published 12 November 2012 Volume 2012:8 Pages 621—629


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Elaine Chiquette,1 Peter P Toth,2 Gilbert Ramirez,3 Michael Cobble,4 Robert Chilton5

1Amylin Pharmaceuticals, San Diego, CA, 2University of Illinois, Peoria, IL, 3Florida International University, Miami, FL, 4Atherotech, Birmingham, AL, 5University of Texas, San Antonio, TX, USA

Background: Dyslipidemia and type 2 diabetes are two of the most significant risk factors for the development of cardiovascular disease. Measurement of lipoprotein subclasses provides important information about derangements in lipid metabolism and helps refine cardiovascular risk assessment. Exenatide, a glucagon-like peptide 1 receptor agonist, improved glycemic control, obesity, hypertension, and dyslipidemia in patients with type 2 diabetes in clinical trials.
Methods: In the DURATION-1 trial, patients with type 2 diabetes were treated with exenatide once weekly or twice daily for 30 weeks. This post hoc analysis evaluated the impact of exenatide on lipoprotein subclasses in 211 DURATION-1 patients using vertical auto profile methodology and the Statistical Package for the Social Sciences general linear model adjusted for glycosylated hemoglobin (HbA1c) and weight.
Results: Baseline lipids and high sensitivity C-reactive protein were normal overall based on the standard lipid panel. Once-weekly exenatide reduced apolipoprotein B and the apolipoprotein B to apolipoprotein A1 ratio (P < 0.05), independent of glycemic improvement and weight loss. A significant shift in lipoprotein pattern away from small, dense low-density lipoprotein-4 cholesterol was also observed (P < 0.05). Exenatide once weekly increased high-density lipoprotein-2 cholesterol, even after adjustment for changes in HbA1c and weight (P < 0.05). Triglycerides, very low-density lipoprotein cholesterol, and high sensitivity C-reactive protein were reduced with both the once-weekly and twice-daily exenatide regimens (P < 0.05).
Conclusion: In this post hoc analysis, exenatide significantly improved a number of cardiovascular risk markers. Continuous exenatide exposure with exenatide once weekly elicited a greater response than did immediate-release exenatide twice daily, generally independent of glycemic improvement and weight loss. Thus, in addition to improving glycemic control, exenatide induced favorable changes in lipid and lipoprotein metabolism and decreased systemic inflammation.

Keywords: glucagon-like protein-1 receptor agonist, incretin mimetic, dyslipidemia, type 2 diabetes mellitus

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