THE RELATIONSHIP BETWEEN INSULIN RESISTANCE, ADIPOKINES, LIPIDS AND LOW-GRADE INFLAMMATION IN PATIENTS WITH CARDIOVASCULAR DISEASE TREATED BY STATINS

Abstract

Background. Hypolipidemic and hypotensive therapy enables to improve prognosis and decrease the risk of cardiovascular pathologies, however, an intensive regimen of prescribing statins for patients with arterial hypertension (AH) combined with obesity can promote development of hyperinsulinemia and insulin resistance (IR), which are predictors of type 2 diabetes mellitus development.
 Aim: To investigate the relationship between insulin resistance, adipokines, lipids and low-grade inflammation in patients with cardiovascular disease treated by statins.
 Materials and methods: 81 patients with overweight and/or obesity and AH or combination of AH and CAD were involved. Patients’ age ranged from 35 to 79 years, among them there were 51 males and 30 females. ACE inhibitors and ARBs, diuretics were used for treatment of AH; atorvastatin was prescribed orally in the dose 20 mg or 40 mg per day permanently as hypolipidemic therapy.
 Lipid spectrum, biochemical indices and glycated hemoglobin were determined according to common techniques on an analyzer “BioSystems” (Spain) using original kits of reagents. Concentration of insulin and hsCRP were determined on immunochemoluminescent analyzer “Immulite 2000” (Siemens, Germany). Insulin resistance index was calculated by the formula:
 НОМA-IR=fasting insulin (mcIU/ml)*fasting glucose(mmol/L)/22.5
 In НОМA-IR value > 2.77, patients were considered insulin resistant. 
 Leptin was measured using an ELISA kit DRG (USA). Adiponectin was quantified using the ELISA kit Mediagnost (Germany).
 Results. It has been revealed in our investigation that body mass index, the level of systolic blood pressure, triglycerides, highly sensitive C-reactive protein and leptin were reliably higher in patients with IR, whereas adiponectin level was lower. These associations are confirmed by the results of studying correlations between IR index, adipokines, anthropometric and biochemical parameters. Thus, thorough evaluation of carbohydrate and adipokine profile in patients with cardiovascular pathology combined with obesity, who are subjected to hypolipidemic therapy, is an important factor in preventing type 2 diabetes mellitus.
 Conclusion. Assessment of the risk of statin-induced diabetes mellitus is important for determining intensity of statin therapy, namely, presence of insulin resistance, levels of hsCRP and adipokines should be considered at the beginning and during treatment.