Role of statins in diabetes complications

Diabetes is one of the major causes of morbidity and mortality in the Western world and it currently affects 35 million people in the US alone. Cardiovascular and renal complications of diabetes, Type I and II, account for much of this morbidity, and are now known to be the end result of a complex interplay of pathophysiological processes. These include haemodynamic and metabolic abnormalities such as endothelial dysfunction, inflammation, vasoconstriction, oxidation and fibrosis. For some time it has been difficult to elucidate whether these processes and subsequent dysfunction in organs such as the heart and kidney is due to processes that often coexist with diabetes, such as hypertension. However, it is now clear that there is a distinct pro-inflammatory and pro-fibrotic state in diabetes, which may in addition be complicated by synergistic disease processes. The use of statins in diabetes has been of interest for a while due to the known effect of statins on inflammatory and fibrotic pathways. This review covers the clinical evidence for the use of statins in diabetes, the major known pathophysiological processes that occur in diabetic organ disease and discusses the known and putative effects of statins on these pathways. It concludes with a brief discussion of some early and yet unpublished work regarding the addition of statin therapy to angiotensin inhibition therapy in diabetic disease.