The Effect of Statin and Folic Acid on High Density Lipoprotein, C-reactive Protein and Homocysteine Levels: a Role in the Prevention of Microangiopathy

Introduction: We studied potential benefits of statins and folic acid on lipids and markers of inflammation to investigate their role in the development of microangiopathy. Methods: A total of 259 type 2 diabetics were studied during a 1.5-yr. follow-up. Patients were randomised to receive either atorvastatin, pravastatin, simvastatin or folic acid. Homocysteine (HCY), C-reactive protein (CRP), lipid values, pulse pressure (PP), postprandial hyperglycaemia (PPG), aterogenic index of plasma (AIP) and albumin excretion rate (AER) were determined. The patients were assigned to groups based on AER /mg/24h/ ( 300), and PP ( 70). Results: ANOVA revealed significant differences in initial HCY, high density lipoprotein (HDL) and AIP (p<0.001 all) according to PP, and in initial CRP (p=0.041) according to AER. HDL was significantly increased in the simvastatin- and pravastatin-treated group (p=0.032 vs. p= 0.011). HCY was significantly reduced in simvastatin-, pravastatin- and folic acid-treated groups (p=0.012 vs. p=0.005 vs. p=0.001), primarily in patients with AER of 15-30 mg/24h (p=0.002). The reduction in HCY was most pronounced (Wilcoxon signed ranks test) in the folic acid-treated group (p<0.01). CRP was significantly reduced in the groups treated with atorvastatin (p<0.001) and simvastatin (p=0.008). AIP and PP were significantly reduced in simvastatin- and atorvastatin-treated groups (p<0.001 vs. p=0.002, and p<0.001 vs. p=0.009, respectively). Conclusion: Statin-induced increase in HDL and decrease in HCY, CRP, AIP and PP, as well as the folic acid-induced reduction in HCY could prevent or delay the onset of microangiopathy in diabetes.