Gender difference in hipolipemic and anti-inflammatory effects of statins in diabetics with coronary artery disease

Abstract

Background/Aim. Statins produce hipolipemic and pleotropic effects on markers of inflammation with stabilization of atheromatous plaque. The aim of this paper was to examine gender difference in hipolipemic and antiinflammatory effects of statins in patients with diabetes mellitus (DM) type 2 with coronary artery disease (CAD). Methods. Sixty dyslipidemic patients with DM type 2 were analyzed. Lifestyle modification and hipolipemic diet were applied in all patients divided into two groups: 30 patients with statins therapy (20 mg of simvastatin or equivalent dose of some other statins, during 3 months) and 30 patients without statins therapy. Estimation of obesity, quality of glicoregulation, and determination of inflammatory parameters: Creactive protein (CRP), fibrinogen, total and differential leukocyte count, intracellular adhesive molecules (ICAM-1), vascular adhesive molecule-(VCAM-1) and lipid profile (total cholesterol - TC, LDL-C, HDL-C, triglicerides - TG) were done. Results. Women with DM type 2 were more obese and had significant disturbances in lipid profiles, glicoregulation and inflammatory markers compared to men. Statins therapy significantly improved all lipid parameters and quality of glicoregulation in women, while there were only significant reduction of LDL-C and nonHDL-C in males. There were more significant reductions of inflammatory markers in women as compared to men with statins therapy. In the group without statins there was not such significant reduction. Concentration of ICAM-1 was the lowest in men on statins therapy, while there were no significant variability of VCAM-1 values between groups and genders. Conclusion. Women with DM type 2 and CAD have more prominent lipoprotein disorders and impaired glicoregulation with expression of enhanced proinflamatory state which could not be seen in men. Statins therapy exerts more favorable effects in women leading to stabilization of lipoprotein profiles, improvement of glicoregulation and reduction of inflammatory markers. More superior antiinflammatory effects of statins therapy in men were registered only in significant ICAM-1 reduction.Uvod/Cilj. Statini ispoljavaju hipolipemicne i dodatne nelipidne efekte kojima deluju na markere inflamacije, popravljaju endotelnu funkciju i stabilizuju ateromatozni plak. Cilj rada bio je ispitivanje polno uslovljene razlike u hipolipemicnom i antiinflamatornom delovanju statina kod bolesnika sa dijabetesom melitusom (DM) tip 2 i koronarnom bolescu (KB). Metode. Analizirano je 60 dislipidemicnih bolesnika sa DM tip 2 i KB, na hipolipemicnom rezimu sa promenom nacina zivota i ishrane. U odnosu na tip medikamentne hipolipemicne terapije bili su podeljeni u dve grupe po 30 bolesnika: na terapiji statinima (20 mg ekvivalentne doze simvastatina u trajanju od 3 meseca) i bez statinske terapije. Kod svih bolesnika vrsena je procena gojaznosti i kvaliteta glikoregulacije. Odredjivani su lipidni i pokazatelji inflamacije: C-reaktivni protein (CRP), fibrinogen, leukocitna formula, intracelularni adhezioni molekul (ICAM-1), vaskularni adhezioni molekul (VCAM-1). Rezultati. Bolesnice sa DM tip 2 imale su izrazeniju opstu i abdominalnu gojaznost, losiju glikoregulaciju, izrazenije lipoproteinske i inflamatorne poremecaje nego muskarci. Primena statina znacajno popravlja lipidne pokazatelje i kvalitet glikoregulacije kod zena, a kod muskaraca znacajno redukuje vrednosti LDL-C i nonHDL-C. Statinska terapija snaznije i znacajnije snizava markere inflamacije kod zena nego kod muskaraca. U grupi bez statinske terapije nema ovako znacajne redukcije. Koncentracije ICAM-1 su najnize kod muskaraca na terapiji statinima, dok se vrednosti VCAM-1 molekula nisu razlikovale izmedju polova i ispitivanih grupa. Zakljucak. Zene sa DM tip 2 i KB imaju teze lipoproteinske i poremecaje glikoregulacije uz izrazeniji proinflamatorni profil nego muskarci. Terapija statinima znacajnije popravlja kvalitet glikoregulacije i redukuje markere inflamacije kod zena. Superiorniji antiinflamatorni efekat statina kod muskaraca vidljiv je samo u znacajnijoj redukciji ICAM-1.