Statin use and risk of diabetes mellitus
STATINS IN DIABETES
Statins are used for primary and secondary prevention of cardiovascular diseases. Other benefits due to statins are not mediated by their lipid lowering properties but due to its pleiotropic effects. In conditions like heart failure, cardiac arrhythmias, vascular disease and hypertension the non-lipid lowering pleotropic benefits of statins have been observed. These pleiotropic effects mediated by statins can be due to inhibition of isoprenoid synthesis which in turn inhibits intracellular signaling molecules Rho, Rac and Cdc42. The predominant mechanism that has been postulated is inhibition of Rho and its activation to Rho kinase.
Type 2 diabetes is characterized by hyperglycemia, insulin resistance and insulin deficiency. The insulin resistance contributes to the abnormal lipid profile associated with type 2 diabetes. Dyslipidemia contributes to increased cardiovascular events in patients with type 2 diabetes. A linear relationship exists between cholesterol levels and cardiovascular diseases in diabetics even if we ignore the baseline LDL. By predominantly lowering LDL-Cholesterol and due to minor effects on other lipoproteins, statins appear to be beneficial. In Heart Protection Study which was done in diabetics, the decrease in cardiovascular events like first major coronary event, stroke were to the tune of 22% as compared to placebo. It was recommended by American Diabetes Association that statin therapy should be initiated in individuals with diabetes and other cardiovascular risk factors with target LDL chol Continue reading