Mehmet ÖÇ, İpek DUMAN, HÜSAMETTİN VATANSEV, MURAT ŞİMŞEK, OĞUZHAN ARUN, Bahar ÖÇ, Ateş DUMAN

Karotid endarterektomi geçiren hastalarda kontrolsüz diyabetin statin kullanan ve kullanmayan hastalarda LDL seviyelerine etkisi

Amaç: Çalışmanın amacı Karotid endarterektomi geçiren hastalarda kontrolsüz diyabetes mellitusun (DM) uzun süreli statin kullanan ve kullanmayan hastalarda Düşük Yoğunluklu Lipoprotein (LDL) seviyelerine etkisini araştırmaktı.Gereç ve yöntem: Ateroskleroz nedeniyle karotid endarterektomi geçiren 40 hastanın ameliyat öncesi LDL seviyeleri retrospektif olarak analiz edildi. Tüm hastalar en az 1 yıldır statin kullanıyordu. HbA1C seviyelerinin % 6,4'den fazla olması kontrolsüz DM kriteri kabul edildi (D+). Diğer hastalar diyabet olmayan gruplara alındı (D-). Grup 1: D+ statin kullanan (n=9), grup 2: D- statin kullanan (n=10), grup 3: D+ statin kullanmayan (n=8), grup 4: D- statin kullanmayan (n=13) hastalardan oluştu. İstatistiksel değerlendirme için Kruskal-Wallis ve Mann-Whitney testleri kullanıldı. p

Introduction: This study aims to assess the effects of uncontrolled diabetes mellitus (DM) on LDL levels of atherosclerotic patients on long term statins and patients not on statins.Material and Methods: LDL levels of 40 patients undergoing carotid endarterectomy due to atherosclerosis were retrospectively analyzed. All statin users were on statins for >1yr. Patients with HbA1C levels of >6.4% were considered as uncontrolled DM (D+). All other patients were non diabetics (D-). Group1: D+, statin user (n=9), group 2: D- statin user (n=10), group 3: D+ non statin user (n=8), and group 4: D- non statin user (n=13). LDL levels are given as mg/dl, Kruskal-Wallis and Mann-Whitney tests were used for statistics. p<0.05 = significant.Results: Demographic data were similar. LDL levels for groups 1, 2, 3 and 4 were 125.0±8.7 mg/dl, 95.0±7.0 mg/dl, 133.5±10.0 mg/dl, 114.0±10.2 mg/dl respectively. LDL levels of uncontrolled diabetic patients on and off statins were significantly higher than normal patients (p<0.05). LDL levels were similar in both uncontrolled diabetic patient groups (p>0.05). LDL levels of non-diabetic patients on statins was similar to off statin non-diabetic patients (p>0.05). Conclusions: Results of this study suggest that atherosclerotic patients with uncontrolled diabetes who are either on or off statin therapy have higher LDL results compared to non-diabetic atherosclerotic patients. Further multicenter studies with higher number of patients with proven atherosclerosis are needed.

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1. IDF Diabetes Atlas Group. Update of mortality attributable to diabetes for the IDF Diabetes Atlas: Estimates for the year 2013. Diabetes Res Clin Pract 2015;109:461-5.

2. Whayne TF Jr. Atherosclerosis: current status of prevention and treatment. Int J Angiol 2011;20:213-22.

3. Aronson D, Edelman ER. Coronary artery disease and diabetes mellitus. Cardiol Clin 2014;32:439-55.

4. Carmena R. Type 2 diabetes, dyslipidemia, and vascular risk: rationale and evidence for correcting the lipid imbalance. Am Heart J 2005;150:859-70.

5. Maki KC, Dicklin MR, Baum SJ. Statins and diabetes. Cardiol Clin 2015;33:233-43.

6. Collins R, Armitage J, Parish S, Sleigh P, Peto R; Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 2003;361:2005-16.

7. Colhoun HM, Betteridge DJ, Durrington PN, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 2004;364:685-96.

8. Cholesterol Treatment Trialists' (CTT) Collaboration, Baigent C, Blackwell L, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376:1670-81.

9. Turner RC, Millns H, Neil HA, Stratton IM, Manley SE, Matthews DR, Holman RR. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23). BMJ 1998;316:823-8.

10. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002;288:2709-16.

11. Eeg-Olofsson K, Gudbjörnsdottir S, Eliasson B, Zethelius B, Cederholm J; NDR. The triglycerides-to-HDL-cholesterol ratio and cardiovascular disease risk in obese patients with type 2 diabetes: an observational study from the Swedish National Diabetes Register (NDR). Diabetes Res Clin Pract 2014;106:136- 44.

12. Kei A, Rizos EC, Elisaf M. Statin use in prediabetic patients: rationale and results to date. Ther Adv Chronic Dis 2015;6:246- 51.

13. Naples M, Fredico LM, Xu E, Nelken J, Adeli K. Effect of rosuvastatin on insülin sensivity in an animal model of insülin resistance: evidence of statin-induced hepatic insülin sensitization. Atherosclerosis 2008;198:94-103.