The beneficial therapeutic effects of statins, angiotensin-converting enzyme inhibitors and angiotensin-II receptor blockers on protein-C and protein-S activities in Egyptian patients with type-2 diabetes mellitus

Objectives Patients with type-2 diabetes mellitus (T2DM) have an increased incidence of adverse cardiovascular events secondary to endothelial dysfunction, hypercoagulability, and decreased fibrinolysis. This study aimed to evaluate protein-C and protein-S activities and carotid intima-media thickness (CIMT) in patients with T2DM who were treated with statins and/or angiotensin-converting enzyme inhibitor (ACEI)/angiotensin-II receptor blockade (ARB). Basic methods One hundred and twenty patients with T2DM participating in the study were classified into groups based on their use of statins and ACEI/ARBs. Protein-C and protein-S activity and CIMT were compared. Main results Patients treated with both statins and ACEI/ARBs showed the highest levels of protein-C and protein-S activity ( P < 0.001). This was followed by patients on statins alone and patients on ACEI/ARBs alone. Patients who were not on statin or ACEI/ARB therapy had the lowest levels of protein-C and protein-S activity. Moreover, we identified significant correlations between protein-C and protein-S activities and CIMT with hemoglobin A1c, cholesterol, and low-density lipoprotein. Conclusion ACEI/ARBs and statins have a critical impact on the hypercoagulable state characteristic of T2DM, potentially via increased levels of protein-C and protein-S activity. ACEI/ARBs also limited CIMT, an important surrogate marker for atherosclerosis.