engleski

Potential benefit of statins and folic acid in the prevention of nephropathy

Aims: Elevated homocysteine (HCY) level might increase the risk of diabetic nephropathy, particularly in hypertensive patients with albuminuria. The aim of the study was to investigate the association between homocysteine level, hypertension and albuminuria, as well as therapeutic possibilities associated with the above parameters in the prevention of nephropathy. Methods: A total of 266 type 2 diabetic patients (54.4 &plusmn ; 10.8 years old ; diabetes duration 12.1 &plusmn ; 7.4 years) were studied during a one-year follow-up. Patients were randomized to receive either atorvastatin (n = 59), pravastatin (n = 41), simvastatin (n = 48), folic acid (n = 44) or lisinopril (n = 35). The control group included 39 patients. HCY, atherogenic index of plasma (AIP), pulse pressure (PP) and albumin excretion rate (AER) were determined. The patients were assigned to groups based on AER (<30 mg/24 h, 30&#8211; 300 mg/24 h, >300 mg/24 h) and PP (< 45, 45&#8211; 50, 50&#8211; 65, > 65). Among-group differences were tested by one-way ANOVA and differences between the beginning and the end of the study using Wilcoxon signed ranks test. Results: ANOVA revealed significant differences in initial HCY and AIP (P = 0.001 and P = 0.041, respectively) according to AER, and in HCY and AIP (both P < 0.001) according to PP. PP and AER were significantly reduced in the lisinopril-treated group (P < 0.001) (Wilcoxon test). Both AIP and PP were significantly reduced in simvastatin- (P < 0.001 and P = 0.002, respectively) and atorvastatin&#8211; (P < 0.001 and P = 0.009, respectively) treated groups. HCY was significantly reduced in simvastatin&#8211; , pravastatin&#8211; and folic acid-treated groups (P = 0.012, P = 0.005 and P = 0.001, respectively), primarily in the group of patients with normoalbuminuria (P < 0.05). The reduction in HCY was most pronounced in the folic acid-treated group (P < 0.01). Conclusion: In addition to an effect of lisinopril on AER and PP, folic acid, reducing HCY, and statins, reducing HCY, AIP and PP, might be a support in the prevention of diabetic nephropathy.

Folic Acid; Diabetic Nephropathy; Statins

nije evidentirano