RESEARCH ARTICLE


Patient with Hypertriglyceridemia, Type 2 Diabetes, and Chronic Kidney Disease Treated with Atorvastatin and Omega-3 Fatty Acid Ethyl Esters



Vasilios G Athyros1, * , Dimitri P Mikhailidis2
1 Atherosclerosis Unit, Department of Internal Medicine, School of Medicine, Aristotelian University of Thessaloniki, Greece
2 Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital campus, University College London Medical School, University College London (UCL), London, UK


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© Athyros and Mikhailidis; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the 15 Marmara St., Thessaloniki, 55132, Greece; Tel: +30 2310 892606; Fax: +30 2310 454237; E-mail: athyros@med.auth.gr


Abstract

This is a case report that describes a 67-year-old woman with mixed hyperlipidemia and diabetic nephropathy. She was initially prescribed a combination of simvastatin plus gemfibrozil by her general practitioner (GP). When referred to our cardiovascular unit, we further diagnosed the patient to have mixed hyperlipidemia and rhabdomyolysis. Because of concerns with her chronic kidney disease (CKD), we temporarily stopped all her drug treatments and started insulin treatment for her type 2 diabetes (T2D). A month later when her T2D was stabilised, we prescribed atorvastatin and an omega-3 fatty acid ethyl ester supplement to treat her hypertriglyceridemia. Within two months her blood lipids were within the recommended range. In patients with stage 3–5 CKD, it is not advisable to prescribe the fibrate gemfibrozil, particularly in combination with a statin that is metabolised predominantly in the kidneys. To minimise adverse events without compromise on efficacy, we used a combination of omega-3 fatty acid ethyl esters, which are not metabolised in the kidneys, with a statin that is minimally metabolised in the kidneys for the treatment of her hyperlipidemia.

Keywords: Hypertriglyceridemia, statin, omega-3 fatty acid ethyl esters, type 2 diabetes..