Effect of different doses of statins on the development of type 2 diabetes mellitus in patients with myocardial infarction

Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy Dovepress open access to scientific and medical research ORIGINAL RESEARCH Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy downloaded from https://www.dovepress.com/ by 213.32.59.119 on 12-Jul-2018 For personal use only. Open Access Full Text Article Effect of different doses of statins on the development of type 2 diabetes mellitus in patients with myocardial infarction This article was published in the following Dove Press journal: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy Olga Gruzdeva 1 Evgenya Uchasova 1 Yulia Dyleva 1 Olga Akbasheva 2 Victoria Karetnikova 1 Aleksandr Shilov 1 Olga Barbarash 1 1 Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia; 2State Budget Educational Institution of Higher Professional Education, Siberian State Medical University, Russian Federation Ministry of Health, Tomsk, Russia Introduction Correspondence: Evgenya Uchasova Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Disease, 6 Sosnovy Boulevard, Kemerovo 650002, Russia Tel +7 3842 64 0553 Fax +7 3842 64 3410 Email Pathological processes underlying cardiovascular diseases and type 2 diabetes mellitus (T2DM) may have common developmental mechanisms associated with lipid metabolism disorders. Dyslipidemia and progression of atherosclerosis in people with T2DM are accompanied by an increase in cardiovascular mortality.1 In acute coronary syndrome, lipid and carbohydrate metabolism changes and insulin resistance develops, which can often lead to T2DM over time.1 For primary and secondary prevention of atherosclerotic complications, the effectiveness of statins (inhibitors of a key enzyme in cholesterol synthesis of 3-hydroxy3-methylglutaryl-CoA-reductase) has been reported.2,3 A range of therapeutic benefits of statins is attributed to their hypolipidemic, anti-inflammatory, and antithrombotic properties.2 However, data from a large-scale meta-analyses suggest that statin therapy in coronary artery disease is associated with a risk for the development of T2DM.4–6 Among the most discussed mechanisms of the diabetogenic action of statins is their ability to have a negative impact on insulin sensitivity and its secretion by pancreatic 481 submit your manuscript | www.dovepress.com Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2017:10 481–489 Dovepress © 2017 Gruzdeva et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/DMSO.S149463 Powered by TCPDF (www.tcpdf.org) Background: Cardiovascular diseases and type 2 diabetes mellitus (T2DM) may have common developmental mechanisms associated with lipid metabolism disorders. Dyslipidemia and progression of atherosclerosis in people with T2DM are accompanied by an increase in cardiovascular mortality. This study examined the dose-dependent action of atorvastatin on carbohydrate metabolism and adipokine status in patients within 12 months after myocardial infarction (MI). Methods: A total of 156 male MI patients who had received atorvastatin 20 mg/day (78 patients) or 40 mg/day (78 patients) starting from day 1 of onset were enrolled. Glucose, insulin, C-peptide, resistin, adiponectin, and ghrelin levels were measured at baseline, day 12, and months 3 and 12. Patients were monitored for new incidences of T2DM for 12 months after MI. Results: For acute phase MI, patients had moderate insulin resistance, hyperglycemia, and hyperinsulinemia, high leptin and resistin levels, and low ghrelin and adiponectin levels. Atorvastatin 20 mg/day was more effective at correcting the imbalances. Patients taking atorvastatin 40 mg/ day (group 2) following MI showed increases in levels of glucose, insulin, and C-peptide and insulin resistance progression after 12 months of therapy, as evidenced by increased quantitative insulin sensitivity check index scores and detection of new T2DM cases. Conclusion: Atorvastatin improved adipokine profiles and ghrelin levels, with low doses showing more significant effects. Atorvastatin dose prescribed for MI patients should take into account the degree of insulin resistance and adipokine status. Keywords: statin, myocardial infarction, inflammation, adipokine, resistin Dovepress Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy downloaded from https://www.dovepress.com/ by 213.32.59.119 on 12-Jul-2018 For personal use only. Gruzdeva et al β cells.7 The relationship between statin therapy and the incidence of new-onset T2DM, as well as the mechanisms of this phenomenon, are poorly studied. Regulators of lipid metabolism, among which there are substances that both normalize tissue sensitivity to insulin (adiponectin, ghrelin) and promote insulin resistance occurrence (leptin, resistin), may be significant in the formation of insulin resistance and T2DM.8,9 This study examined the dose-dependent action of atorvastatin on parameters of carbohydrate metabolism and adipokine status of patients within 12 months after myocardial infarction (MI). Methods Ethical considerations The study protocol was approved by the local ethics committee of the Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases and was developed according to WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects, 2000 edition, and the “GCP Principles in the Russian Federation” approved by the Russian Ministry of Health (2003). All patients provided written informed consent. Study design Between 2009 and 2010, an open, retrospective, randomized, comparative, controlled three-stage study was conducted by the Municipal Budgetary Healthcare Institution Kemerovo Cardiology Dispensary and Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases. Inclusion criterion was the presence of acute MI with ST-segment elevation, verified according to the Society of Cardiology of Russian Federation (VNOK) criteria (2007) and with patients being hospitalized within the first 24 h after the onset of symptoms. Exclusion criteria were as follows: female gender, presence of T2DM previously diagnosed or newly diagnosed within hospitalization, statin therapy for 1 month before MI, severe diseases affecting pro (...truncated)