Blood glucose and the metabolism of cholesterol in coronary patients with and without simvastatin treatment

Background and aim of the studyAssociation of blood glucose with cholesterol metabolism and with cholesterol lowering during simvastatin treatment has not been studied earlier in hypercholesterolemic subjects with coronary heart disease.MethodsBaseline blood glucose was compared with cholesterol synthesis (e.g. ratios of squalene and lathosterol) and absorption (e.g. sitosterol ratio) without and with simvastatin for one year in 806 non-diabetes Finnish subjects of the Scandinavian Simvastatin Survival Study.ResultsBaseline blood glucose was positively correlated with the baseline synthesis and negatively with the absorption of cholesterol, and positively with the synthesis/absorption ratio (e.g. p = 0.001 for lathosterol/sitosterol). Simvastatin decreased serum cholesterol by about 29% irrespective of glucose level, cholesterol synthesis by up to 34%, especially in the highest glucose quartile, and increased cholesterol absorption by up to 49%, especially in the lowest glucose quartile (p < 0.01 for all). The one-year synthesis/absorption ratio was decreased proportionately to the baseline glucose, e.g. for lathosterol/sitosterol by over 40% (p < 0.001) in different glucose quartiles (p < 0.001 between quartiles).ConclusionsBaseline blood glucose level is related positively to cholesterol synthesis and negatively to that of absorption. Despite a marked glucose-related decrease in cholesterol synthesis with simvastatin, serum cholesterol reduction was not dependent on the baseline glucose level.