Rosuvastatin in older patients with systolic heart failure

Lipid abnormalities and cardiovascular risk in the elderly

The relationship between dyslipidaemia and cardiovascular disease is well documented. However, it is relevant to consider that cholesterol levels vary with age. Moreover, there is some controversy regarding the ability of lipid levels to predict vascular risk beyond the age of 70 years. In general, raised low-density lipoprotein cholesterol (LDL-C) and triglyceride levels as well as reduced levels of high-density lipoprotein cholesterol (HDL-C) predict risk in the elderly. There is evidence supporting the use of statins in the elderly. It is also likely that these drugs are under-used in this population.

Relative safety profiles of high dose statin regimens

Recent clinical trials recommend achieving a low-density lipoprotein cholesterol level of <100 mg/dl in high-risk and <70 mg/dl in very high risk patients. To attain these goals, however, many patients will need statins at high doses. The most frequent side effects related to the use of statins, myopathy, rhabdomyolysis, and increased levels of transaminases, are unusual. Although low and moderate doses show a favourable profile, there is concern about the tolerability of higher doses. During recent years, numerous trials to analyze the efficacy and tolerability of high doses of statins have been published. This paper updates the published data on the safety of statins at high doses.

Glutamate synthase: a fascinating pathway from L-glutamine to L-glutamate

Glutamate synthase is a multicomponent iron-sulfur flavoprotein belonging to the class of N-terminal nucleophile amidotransferases. It catalyzes the conversion of L-glutamine and 2-oxoglutarate into two molecules of L-glutamate. In recent years the X-ray structures of the ferredoxin-dependent glutamate synthase and of the a subunit of the NADPH-dependent glutamate synthase have become available. Thanks to X-ray crystallography, it is now known that the ammonia reaction intermediate is transferred via an intramolecular tunnel from the amidotransferase domain to the synthase domain over a distance of about 32A. Although ammonia channeling is a recurrent theme for N-terminal nucleophile and triad-type amidotransferases, the molecular mechanisms of ammonia transfer and its control are different for each known amidotransferase. This review focuses on the intriguing mechanism of action and self-regulation of glutamate synthase with a special focus on the structural data.