Abstract
Inflammation may contribute to the high cardiovascular risk in diabetes mellitus (DM) and chronic kidney disease (CKD). Monocyte chemoattractant protein-1 (MCP-1) facilitates the recruitment of monocytes into atherosclerotic lesions and is involved in diabetic nephropathy. Interferon gamma (IFNγ) is important in atherosclerosis and increases the synthesis of chemokines including MCP-1. Lipid-lowering treatment (LLT) with statins may have anti-inflammatory effects, and ezetimibe cotreatment provides additional cholesterol lowering. After a placebo run-in period, the effects of simvastatin alone (S) or simvastatin + ezetimibe (S+E) were compared in a randomized, double-blind, cross-over study on inflammatory parameters. Eighteen DM patients with estimated glomerular filtration rate (eGFR) 15-59mL/min×1·73m(2) (CKD stages 3-4) (DM-CKD) and 21 DM patients with eGFR >75mL/min (DM only) were included. At baseline, monocyte chemoattractant protein 1 (MCP-1) (P=0·03), IFNγ (P=0·02), tumour necrosis factor-α (TNFα) (P<0·01) and soluble vascular adhesion molecule (sVCAM) (P=0·001) levels were elevated in DM-CKD compared with DM-only patients. LLT with S and S+E reduced MCP-1 levels (P<0·01 by anova) and IFNγ levels (P<0·01) in DM-CKD patients but not in DM-only patients. Reductions were most pronounced with the combination treatment. DM patients with CKD stages 3-4 had increased inflammatory activity compared with DM patients with normal GFR. Lipid-lowering treatment decreased the levels of MCP-1 and IFNγ in DM patients with concomitant CKD, which may be beneficial with regard to the progression of both atherosclerosis and diabetic nephropathy.
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