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Chen J, Hu L, Liu Z. Medical treatments for abdominal aortic aneurysm: an overview of clinical trials. Expert Opin Investig Drugs 2024:1-14. [PMID: 38978286 DOI: 10.1080/13543784.2024.2377747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/04/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Abdominal aortic aneurysm is a progressive, segmental, abdominal aortic dilation associated with a high mortality rate. Abdominal aortic aneurysms with diameters larger than 55 mm are associated with a high risk of rupture, and the most effective treatment options are surgical repair. Close observation and lifestyle adjustments are recommended for smaller abdominal aortic aneurysms with lower rupture risk. The development of medical therapies that limit or prevent the progression, expansion, and eventual rupture of abdominal aortic aneurysms remains an unmet clinical need. AREAS COVERED This review provides an overview of completed and ongoing clinical trials examining the efficacies of various drug classes, including antibiotics, antihypertensive drugs, hypolipidemic drugs, hypoglycemic drugs, and other potential therapies for abdominal aortic aneurysms. A search of PubMed, Web of Science, Clinical Trials, and another six clinical trial registries was conducted in January 2024. EXPERT OPINION None of the drugs have enough evidence to indicate that they can effectively inhibit the dilation of abdominal aortic aneurysm. More clinical trial data is required to support the efficacy of propranolol. Future research should also explore different drug delivery mechanisms, such as nanoparticles, to elevate drug concentration at the aneurysm wall.
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Affiliation(s)
- Jinyi Chen
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Lanting Hu
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenjie Liu
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Pramana KAAP, Pintaningrum Y, Rahmat B. The effects of statin therapy on aneurysm size, growth rate, and matrix metalloproteinases-9 levels in patients with aortic aneurysm: a systematic review and meta-analysis. Egypt Heart J 2023; 75:88. [PMID: 37831310 PMCID: PMC10575821 DOI: 10.1186/s43044-023-00407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/29/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Aortic aneurysm enlargement over time causes rupture, which frequently results in death. The family of proteases known as matrix metalloproteinases (MMP) is assumed to be proteolytic activity involved in the growth of aortic aneurysms. Statins are pleiotropic lipid-lowering medications with anti-inflammatory action. Statins can lower aneurysmal enlargement and MMP secretion, according to a number of studies, however the evidence is still up for debate. The purpose of this study is to assess how statins affect aortic aneurysm patient's aneurysm diameter size, growth rate, and MMP-9 levels. METHODS From January 2000 to December 2022, electronic journal searches in PubMed, ScienceDirect, and Cochrane were conducted to discover papers evaluating the effects of statin treatment in patients with aortic aneurysm. Aneurysm diameter size, growth rate, and MMP-9 levels were the outcomes we were looking for. Meta-analyses were run on the included studies, and mean differences (MD) and 95% CIs were calculated with Review Manager v5.4. RESULTS Our analysis includes a total of ten research. Statin medication substantially reduced aneurysm diameter size by 0.30 mm (P = 0.04; MD - 0.30; 95% CI - 0.58 to - 0.01) and growth rate by 0.34 mm/year (P < 0.00001; MD - 0.34; 95% CI - 0.40 to - 0.29) compared to placebo. There was no significant change in MMP-9 concentrations between individuals with aortic aneurysm who took a statin and those who did not. CONCLUSION Overall, this meta-analysis demonstrates that statin medication is considerably helpful in reducing aneurysm diameter size and aneurysmal growth rate in individuals with aortic aneurysm.
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Affiliation(s)
| | - Yusra Pintaningrum
- Interventional Cardiology Division, Cardiology and Vascular Department, Faculty of Medicine, Mataram University, Mataram, Indonesia
| | - Basuki Rahmat
- Interventional Cardiology Division, Cardiology and Vascular Department, Faculty of Medicine, Mataram University, Mataram, Indonesia
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Sugimoto M, Banno H, Sato T, Ikeda S, Tsuruoka T, Kawai Y, Niimi K, Kodama A, Komori K. Factors Associated With Spontaneous Sac Shrinkage in Patients With Persistent Type 2 Endoleaks After EVAR. J Endovasc Ther 2022:15266028221083457. [PMID: 35287500 DOI: 10.1177/15266028221083457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Despite controversy surrounding the management of type 2 endoleaks (T2ELs) after endovascular aortic aneurysm repair (EVAR), the current European guidelines recommend reintervention for T2ELs when the aneurysm expands by ≥10 mm. Meanwhile, sac shrinkage ≥10 mm can be considered low risk for failure even with T2ELs, and the guidelines suggest less frequent follow-up delayed until 5 years after EVAR. This study reviewed patients with persistent T2ELs to identify predictors of spontaneous sac shrinkage (SpS) within 5 years. METHODS A retrospective review of elective EVAR for infrarenal aortic aneurysms between June 2007 and December 2017. Patients with >1 year follow-up and persistent T2ELs, defined as T2ELs confirmed at both the 6 and 12 month follow-up with contrast-enhanced computed tomography (CT), were included. Any reintervention or type 1 or 3 endoleaks within 12 months were excluded. SpS was defined as a ≥10 mm reduction in diameter without any reintervention. Aneurysm enlargement (AnE) was defined as a ≥5 mm increase in diameter. Factors associated with SpS within 5 years were analyzed. The clinical outcomes were reviewed. RESULTS Among 726 patients, 162 patients had persistent isolated T2ELs. After excluding 21 patients, 141 patients were enrolled. During a median follow-up of 43 months (interquartile range [IQR], 26-60), 28 SpS and 39 AnE were observed, and 31 reinterventions were performed. The cumulative rates of SpS were 14.2%±2.9% and 25.6%±5.1% at 1 and 5 years. Cox regression analysis revealed that the presence of ≥6 patent lumbar arteries had a significant negative correlation with SpS (p=0.036). During further follow-up after SpS, 2 reinterventions for type 1a and 3b endoleaks were required at 49 and 45 months. CONCLUSIONS Patients with fewer patent lumbar arteries were likely to experience SpS within 5 years, even in the presence of persistent T2ELs. Follow-up imaging studies were advisable earlier than 5 years, even after SpS.
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Affiliation(s)
- Masayuki Sugimoto
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Banno
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiro Sato
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shuta Ikeda
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Tsuruoka
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yohei Kawai
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kiyoaki Niimi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akio Kodama
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Effects of Statins on Renin-Angiotensin System. J Cardiovasc Dev Dis 2021; 8:jcdd8070080. [PMID: 34357323 PMCID: PMC8305238 DOI: 10.3390/jcdd8070080] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 12/16/2022] Open
Abstract
Statins, a class of drugs for lowering serum LDL-cholesterol, have attracted attention because of their wide range of pleiotropic effects. An important but often neglected effect of statins is their role in the renin–angiotensin system (RAS) pathway. This pathway plays an integral role in the progression of several diseases including hypertension, heart failure, and renal disease. In this paper, the role of statins in the blockade of different components of this pathway and the underlying mechanisms are reviewed and new therapeutic possibilities of statins are suggested.
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Matsukawa H, Kamiyama H, Miyazaki T, Kinoshita Y, Ota N, Noda K, Shonai T, Takahashi O, Tokuda S, Tanikawa R. Comprehensive analysis of perforator territory infarction on postoperative diffusion-weighted imaging in patients with surgically treated unruptured intracranial saccular aneurysms. J Neurosurg 2020; 132:1088-1095. [PMID: 30835684 DOI: 10.3171/2018.11.jns181235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 11/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Perforator territory infarction (PTI) is still a major problem needing to be solved to achieve good outcomes in aneurysm surgery. However, details and risk factors of PTI diagnosed on postoperative MRI remain unknown. The authors aimed to investigate the details of PTI on postoperative diffusion-weighted imaging (DWI) in patients with surgically treated unruptured intracranial saccular aneurysms (UISAs). METHODS The data of 848 patients with 1047 UISAs were retrospectively evaluated. PTI was diagnosed on DWI, which was performed the day after aneurysm surgery. Clinical and radiological characteristics were compared between UISAs with and without PTI. Poor outcome was defined as an increase in 1 or more modified Rankin Scale scores at 12 months after aneurysm surgery. RESULTS Postoperative DWI was performed in all cases, and it revealed PTI in 56 UISA cases (5.3%). Forty-three PTIs occurred without direct injury and occlusion of perforators (43 of 56, 77%). Poor outcome was more frequently observed in the PTI group (17 of 56, 30%) than the non-PTI group (57 of 1047, 5.4%) (p < 0.0001). Thalamotuberal arteries (p < 0.01), lateral striate arteries (p < 0.01), Heubner's artery (p < 0.01), anterior median commissural artery (p < 0.05), terminal internal carotid artery perforators (p < 0 0.01), and basilar artery perforator (p < 0 0.01) infarctions were related to poor outcome by adjusted residual analysis. On multivariate analysis, statin use (OR 10, 95% CI, 3.3-31; p < 0.0001), specific aneurysm locations (posterior communicating artery [OR 4.1, 95% CI 2.1-8.1; p < 0.0001] and basilar artery [OR 3.1, 95% CI 1.1-8.9; p = 0.031]), larger aneurysm size (OR 1.1, 95% CI 1.1-1.2; p = 0.043), and permanent decrease of motor evoked potential (OR 38, 95% CI 3.1-468; p = 0.0045) were related to PTI. CONCLUSIONS Despite efforts to avoid PTI, it occurred even without direct injury, occlusion of perforators, or evoked potential abnormality. Therefore, surgical treatment of UISAs, especially with the aforementioned risk factors of PTI, should be more carefully considered. The evaluation of PTI in the territory of the above-mentioned perforators could be useful in helping predict the clinical course in patients after aneurysm surgery.
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Affiliation(s)
| | | | | | | | - Nakao Ota
- 1Department of Neurosurgery, Stroke Center, and
| | - Kosumo Noda
- 1Department of Neurosurgery, Stroke Center, and
| | | | - Osamu Takahashi
- 3Center for Clinical Epidemiology, Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
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Abstract
Current management of aortic aneurysms relies exclusively on prophylactic operative repair of larger aneurysms. Great potential exists for successful medical therapy that halts or reduces aneurysm progression and hence alleviates or postpones the need for surgical repair. Preclinical studies in the context of abdominal aortic aneurysm identified hundreds of candidate strategies for stabilization, and data from preoperative clinical intervention studies show that interventions in the pathways of the activated inflammatory and proteolytic cascades in enlarging abdominal aortic aneurysm are feasible. Similarly, the concept of pharmaceutical aorta stabilization in Marfan syndrome is supported by a wealth of promising studies in the murine models of Marfan syndrome-related aortapathy. Although some clinical studies report successful medical stabilization of growing aortic aneurysms and aortic root stabilization in Marfan syndrome, these claims are not consistently confirmed in larger and controlled studies. Consequently, no medical therapy can be recommended for the stabilization of aortic aneurysms. The discrepancy between preclinical successes and clinical trial failures implies shortcomings in the available models of aneurysm disease and perhaps incomplete understanding of the pathological processes involved in later stages of aortic aneurysm progression. Preclinical models more reflective of human pathophysiology, identification of biomarkers to predict severity of disease progression, and improved design of clinical trials may more rapidly advance the opportunities in this important field.
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Affiliation(s)
- Jan H. Lindeman
- Dept. Vascular Surgery, Leiden University Medical Center, The Netherlands
| | - Jon S. Matsumura
- Division of Vascular Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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Kim W, Gandhi RT, Peña CS, Herrera RE, Schernthaner MB, Acuña JM, Becerra VN, Katzen BT. Influence of Statin Therapy on Aneurysm Sac Regression after Endovascular Aortic Repair. J Vasc Interv Radiol 2017; 28:35-43. [DOI: 10.1016/j.jvir.2016.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/05/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022] Open
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Tissier F, Mallem Y, Goanvec C, Didier R, Aubry T, Bourgeois N, Desfontis JC, Dubreuil M, Le Grand Y, Mansourati J, Pichavant-Rafini K, Plee-Gautier E, Roquefort P, Theron M, Gilard M. A non-hypocholesterolemic atorvastatin treatment improves vessel elasticity by acting on elastin composition in WHHL rabbits. Atherosclerosis 2016; 251:70-77. [PMID: 27266824 DOI: 10.1016/j.atherosclerosis.2016.05.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/13/2016] [Accepted: 05/25/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Statins are prescribed for their preventative effects within atherosclerosis development. To our knowledge, no study focusing on very low-dose (non-hypolipidemic effect) and long-term atorvastatin treatment in vivo was available. Our aim was to assess the effect of such atorvastatin treatment on the mechanical and functional characteristics of arteries in the context of primary prevention. METHODS An atorvastatin treatment (2.5 mg/kg/day) was tested against controls on 34 male 3 to 12 month-old WHHL rabbits. No effect on total cholesterol, triglycerides, HDL or LDL was observed. The arterial stiffness was evaluated on vigil animals by pulse wave velocity (PWV) measurement. Then, in vitro measurements were made to evaluate (1) the endothelial and vascular smooth muscle function, (2) the elasticity of the arterial wall and (3) the composition in collagen and elastin in the aorta. RESULTS The PWV increasing observed with age in control group was canceled by treatment, creating a significance difference between groups at 12 months (5.17 ± 0.50 vs 2.14 ± 0.34 m s(-1) in control and treated groups respectively). Vasoreactivity modifications can't explain this result but maintain of elasticity with treatment in large arteries was confirm by a static tensile test. A first possible explanation is the change of wall composition with treatment, validated by the percentage of elastin at 12 months, 4.4% lower in the control group compared to the treated group (p < 0.05). CONCLUSIONS This study shows that a non-hypocholesterolemic statin treatment could improve vessel elasticity in the atherosclerotic WHHL model. The great novelty of this work is the vessel wall composition changing associated. This first approach in animal opens the reflection on the use of these low doses in humans. This could be interesting in the context of arterial stiffening with aging, non-hyperlipidemic atherosclerosis or with cholesterol reduce by another therapy or lifestyle modification.
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Affiliation(s)
- Florine Tissier
- EA 4324 ORPHY, UBO, UFR Sciences et Techniques, 6 Avenue Victor Le Gorgeu CS 93837, 29238 Brest Cedex 3, France.
| | - Yassine Mallem
- Université LUNAM, Oniris, UPSP 5304 de Pathophysiologie animale et de Pharmacologie fonctionnelle, Nantes, France
| | - Christelle Goanvec
- EA 4324 ORPHY, UBO, UFR Sciences et Techniques, 6 Avenue Victor Le Gorgeu CS 93837, 29238 Brest Cedex 3, France
| | - Romain Didier
- EA 4324 ORPHY, UBO, UFR Sciences et Techniques, 6 Avenue Victor Le Gorgeu CS 93837, 29238 Brest Cedex 3, France; Département de Cardiologie, CHRU Brest, Brest, France
| | - Thierry Aubry
- LIMATB, Equipe Rhéologie, EA4250 UFR Sciences et Techniques, 6 Avenue Victor Le Gorgeu CS 93837, 29238 Brest Cedex 3, France
| | - Nathalie Bourgeois
- Université LUNAM, Oniris, UPSP 5304 de Pathophysiologie animale et de Pharmacologie fonctionnelle, Nantes, France
| | - Jean-Claude Desfontis
- Université LUNAM, Oniris, UPSP 5304 de Pathophysiologie animale et de Pharmacologie fonctionnelle, Nantes, France
| | - Matthieu Dubreuil
- EA 938 LSOL, UBO, UFR Sciences et Techniques, 6 Avenue Victor Le Gorgeu CS 93837, 29238 Brest Cedex 3, France
| | - Yann Le Grand
- EA 938 LSOL, UBO, UFR Sciences et Techniques, 6 Avenue Victor Le Gorgeu CS 93837, 29238 Brest Cedex 3, France
| | - Jacques Mansourati
- EA 4324 ORPHY, UBO, UFR Sciences et Techniques, 6 Avenue Victor Le Gorgeu CS 93837, 29238 Brest Cedex 3, France; Département de Cardiologie, CHRU Brest, Brest, France
| | - Karine Pichavant-Rafini
- EA 4324 ORPHY, UBO, UFR Sciences et Techniques, 6 Avenue Victor Le Gorgeu CS 93837, 29238 Brest Cedex 3, France
| | | | - Philippe Roquefort
- LIMATB, Equipe Rhéologie, EA4250 UFR Sciences et Techniques, 6 Avenue Victor Le Gorgeu CS 93837, 29238 Brest Cedex 3, France
| | - Michael Theron
- EA 4324 ORPHY, UBO, UFR Sciences et Techniques, 6 Avenue Victor Le Gorgeu CS 93837, 29238 Brest Cedex 3, France
| | - Martine Gilard
- EA 4324 ORPHY, UBO, UFR Sciences et Techniques, 6 Avenue Victor Le Gorgeu CS 93837, 29238 Brest Cedex 3, France; Département de Cardiologie, CHRU Brest, Brest, France
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Brinjikji W, Yong Hong D, Dai D, Schroeder DJ, Kallmes DF, Kadirvel R. Statins are not associated with short-term improved aneurysm healing in a rabbit model of unruptured aneurysms. J Neurointerv Surg 2016; 9:200-203. [DOI: 10.1136/neurintsurg-2016-012265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/01/2016] [Accepted: 02/04/2016] [Indexed: 11/04/2022]
Abstract
BackgroundOwing to their anti-inflammatory effects and ability to stimulate production of extracellular matrix and chemotactic migration of mesenchymal progenitor cells, statins could potentially improve aneurysm healing after endovascular treatment.ObjectiveTo test the hypothesis that systemic administration of simvastatin would improve aneurysm healing in a rabbit model of unruptured intracranial aneurysms.MethodsExperimental aneurysms were created in female rabbits and were embolized with platinum coils. Six rabbits served as controls and six rabbits received oral administration of simvastatin. Digital subtraction angiography was used to evaluate stability after embolization. Subjects were euthanized 4 weeks after coil embolization. Histologic samples were examined with a grading system (0–12) based on neck and dome features. Aneurysm occlusion data were compared using a Student t test.ResultsNo significant differences in the mean aneurysm size were found between groups. No coil compaction occurred in either group. All aneurysms in both the statin and control groups showed stable occlusion. There were no significant differences in the histologic grade of occlusion in either group (statin group 2.6±0.8 vs control group 2.7±3.2, p=0.94).ConclusionsSystemic statin administration after platinum coil embolization of unruptured aneurysms in a rabbit model does not improve aneurysm occlusion rates at 4 weeks.
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Pini R, Faggioli G, Mascoli C, Gallitto E, Freyrie A, Gargiulo M, Stella A. Influence of Statin Therapy on Type 2 Endoleak Evolution. Ann Vasc Surg 2015; 29:1167-73. [DOI: 10.1016/j.avsg.2015.03.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 03/05/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
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Mirjanić-Azarić B, Jelić-Ivanović Z, Zeljković A, Vekić J, Jürgens G, Milivojac T, Avram S, Ćorić J, Marc J, Černe D. The Pleiotropic Effects of Atorvastatin on Stable Angina Patients: Evidence by Analysis of High-Density Lipoprotein Size and Subclasses, and Plasma mRNA. J Med Biochem 2015; 34:314-322. [PMID: 28356842 PMCID: PMC4922349 DOI: 10.2478/jomb-2014-0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/14/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND High-density lipoproteins (HDL) have athero-protective biological properties: antioxidative, anti-apoptotic, anti-inflammatory, and they have the efflux capacity of cellular cholesterol. Plasma mRNA analysis can be used to investigate statin pleiotropy in vivo as a new analytical tool for non-invasive assessment of gene expression in vascular beds. The aim of this study was to assess the pleiotropic effects of atorvastatin in stable angina patients with high-risk values (group A) as compared with patients who had borderline and desirable HDL-cholesterol (HDL-C) values (group B). METHODS The atorvastatin therapy (20 mg/day) was given to forty-three patients with stable angina for 10 weeks. We investigated three statin pleiotropy-targeted genes: inter-cellular adhesion molecule-1, chemokine (C-C motif) ligand 2 and cathepsin S and assessed by gel electrophoresis gradient the effects of atorvastatin on HDL size and subclasses. RESULTS In group A, after therapy, HDL-C concentration was significantly increased but not in group B. Atorvastatin lowered plasma chemokine (C-C motif) ligand 2 and intercellular adhesion molecule-1 mRNA levels in both groups, but did not change the plasma cathepsin S mRNA levels. In group A only, baseline total bilirubin showed negative correlations with the genes of cathepsin S (r=-0.506; p=0.023) and significantly increased after therapy. CONCLUSIONS HDL-C and bilirubin can be promising therapeutic targets in the treatment of cardiovascular diseases. Analysis of cell-free mRNA in plasma might become a useful tool for estimating statin pleiotropy.
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Affiliation(s)
- Bosa Mirjanić-Azarić
- Department of Laboratory Diagnostics, Clinical Centre Banja Luka, Bosnia and Herzegovina
- Faculty of Pharmacy, University of Ljubljana, Slovenia
| | | | | | - Jelena Vekić
- Faculty of Pharmacy, University of Belgrade, Serbia
| | - Günther Jürgens
- Institute of Physiological Chemistry, Medical University of Graz, Austria
| | | | - Sanja Avram
- Department of Laboratory Diagnostics, Clinical Centre Banja Luka, Bosnia and Herzegovina
| | - Jozo Ćorić
- Department of Clinical Chemistry and Biochemistry, Clinical Center, University of Sarajevo, Bosnia and Herzegovina
| | - Janja Marc
- Faculty of Pharmacy, University of Ljubljana, Slovenia
| | - Darko Černe
- Faculty of Pharmacy, University of Ljubljana, Slovenia
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Smith R, Solberg R, Jacobsen LL, Voreland AL, Rustan AC, Thoresen GH, Johansen HT. Simvastatin inhibits glucose metabolism and legumain activity in human myotubes. PLoS One 2014; 9:e85721. [PMID: 24416446 PMCID: PMC3885717 DOI: 10.1371/journal.pone.0085721] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/30/2013] [Indexed: 01/05/2023] Open
Abstract
Simvastatin, a HMG-CoA reductase inhibitor, is prescribed worldwide to patients with hypercholesterolemia. Although simvastatin is well tolerated, side effects like myotoxicity are reported. The mechanism for statin-induced myotoxicity is still poorly understood. Reports have suggested impaired mitochondrial dysfunction as a contributor to the observed myotoxicity. In this regard, we wanted to study the effects of simvastatin on glucose metabolism and the activity of legumain, a cysteine protease. Legumain, being the only known asparaginyl endopeptidase, has caspase-like properties and is described to be involved in apoptosis. Recent evidences indicate a regulatory role of both glucose and statins on cysteine proteases in monocytes. Satellite cells were isolated from the Musculus obliquus internus abdominis of healthy human donors, proliferated and differentiated into polynuclear myotubes. Simvastatin with or without mevalonolactone, farnesyl pyrophosphate or geranylgeranyl pyrophosphate were introduced on day 5 of differentiation. After 48 h, cells were either harvested for immunoblotting, ELISA, cell viability assay, confocal imaging or enzyme activity analysis, or placed in a fuel handling system with [14C]glucose or [3H]deoxyglucose for uptake and oxidation studies. A dose-dependent decrease in both glucose uptake and oxidation were observed in mature myotubes after exposure to simvastatin in concentrations not influencing cell viability. In addition, simvastatin caused a decrease in maturation and activity of legumain. Dysregulation of glucose metabolism and decreased legumain activity by simvastatin points out new knowledge about the effects of statins on skeletal muscle, and may contribute to the understanding of the myotoxicity observed by statins.
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Affiliation(s)
- Robert Smith
- Department of Pharmaceutical Biosciences, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- * E-mail:
| | - Rigmor Solberg
- Department of Pharmaceutical Biosciences, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Linn Løkken Jacobsen
- Department of Pharmaceutical Biosciences, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Anette Larsen Voreland
- Department of Pharmaceutical Biosciences, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Arild Christian Rustan
- Department of Pharmaceutical Biosciences, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - G. Hege Thoresen
- Department of Pharmaceutical Biosciences, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Department of Pharmacology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Harald Thidemann Johansen
- Department of Pharmacology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
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Mirjanic-Azaric B, Vekic J, Zeljkovic A, Jelic-Ivanovic Z, Djeric M, Milivojac T, Pecar Fonovic U, Marc J, Kos J, Cerne D. Interrelated Cathepsin S-Lowering and LDL Subclass Profile Improvements Induced by Atorvastatin in the Plasma of Stable Angina Patients. J Atheroscler Thromb 2014; 21:868-77. [DOI: 10.5551/jat.21410] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Parmar GM, Lowman B, Combs BR, Taylor SM, Patterson MA, Passman MA, Jordan WD. Effect of lipid-modifying drug therapy on survival after abdominal aortic aneurysm repair. J Vasc Surg 2013; 58:355-63. [DOI: 10.1016/j.jvs.2013.01.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 12/12/2012] [Accepted: 01/15/2013] [Indexed: 12/01/2022]
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Salgado JV, Souza FL, Salgado BJ. How to understand the association between cystatin C levels and cardiovascular disease: Imbalance, counterbalance, or consequence? J Cardiol 2013; 62:331-5. [PMID: 23849291 DOI: 10.1016/j.jjcc.2013.05.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 05/22/2013] [Accepted: 05/28/2013] [Indexed: 10/26/2022]
Abstract
The association of cystatin C with renal function has been studied for more than 25 years. Cystatin C has been described to have a better diagnostic performance than creatinine to assess renal function, particularly to detect small reductions in glomerular filtration rate. Recently, cystatin C has emerged as a strong predictor of incident or recurrent cardiovascular events and adverse outcomes in patients without kidney disease. Furthermore, it has been suggested that cystatin C concentrations are directly related to both inflammation and atherosclerosis. Nevertheless, the link between inflammation, atherogenesis, cardiovascular risk, and cystatin C is still poorly understood. This brief report discusses recent data, contrasting findings and possible mechanisms involved in this interaction.
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Affiliation(s)
- João Victor Salgado
- Kidney Disease Prevention Centre, Clinical Chemistry Service, Federal University of Maranhão, Brazil.
| | - Francival Leite Souza
- Kidney Disease Prevention Centre, Cardiology Service, Federal University of Maranhão, Brazil
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Abstract
PURPOSE OF REVIEW To discuss the beneficial effects of statin treatment in patients with peripheral arterial disease (PAD), abdominal aortic aneurysms (AAAs), atherosclerotic renal artery stenosis (ARAS) and carotid artery disease. RECENT FINDINGS Evidence suggests that statins may reduce the progression (or even reverse the development) of carotid artery stenosis and AAAs. Statins also improve several indices (e.g. serum creatinine) and preserve renal function in ARAS. In patients with PAD, statins are associated with improved claudication distance and time, reduced cardiovascular events, and improved graft patency rates should these patients undergo surgery. Finally, statins are associated with improved perioperative and long-term morbidity and mortality rates in all vascular patients whether they undergo surgery or endovascular procedures. SUMMARY Routine statin treatment should be implemented for all vascular patients to ensure a reduced progression of their disease, as well as a reduction in cardiovascular events.
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Li X, Liu Z, Cheng Z, Cheng X. Cysteinyl cathepsins: multifunctional enzymes in cardiovascular disease. Chonnam Med J 2012; 48:77-85. [PMID: 22977747 PMCID: PMC3434795 DOI: 10.4068/cmj.2012.48.2.77] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 07/16/2012] [Indexed: 01/09/2023] Open
Abstract
Until recently, the role of lysosomal cysteine protease cathepsins in intracellular protein degradation was believed to be mainly restricted to scavenging. However, recent studies have revealed nontraditional roles for cysteine protease cathepsins in the extracellular space during the development and progression of cardiovascular disease. Although the precise mechanisms are unknown, data from animal studies suggest that members of the cathepsin family, like other extracellular proteases, contribute to extracellular matrix protein remodeling and interstitial matrix degradation, as well as to cell signaling and cell apoptosis in heart disease. Inflammatory cytokines and hormones regulate the expression and secretion of cathepsins in cultured cardiovascular cells and macrophages. Serum levels of cathepsins L, S, and K and their endogenous inhibitor cystatin C may be useful predictive biomarkers in patients with coronary artery disease and cardiac disease. Furthermore, in vivo pharmacological intervention with a synthetic cathepsin inhibitor and cardiovascular drugs (including statins and angiotensin II type 1 receptor antagonists) has the potential for pharmacologic targeting of cathepsins in cardiovascular disease. This review focuses on cathepsin biology (structure, synthesis, processing, activation, secretion, activity regulation, and function) and the involvement of cysteinyl cathepsins in the pathogenesis of several heart and vessel diseases, especially with respect to their potential application as diagnostic and prognostic markers and drug targets to prevent inappropriate proteolysis in cardiovascular disease.
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Affiliation(s)
- Xiang Li
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin Prov, China
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Raux M, Cochennec F, Becquemin JP. Statin therapy is associated with aneurysm sac regression after endovascular aortic repair. J Vasc Surg 2012; 55:1587-92. [PMID: 22459742 DOI: 10.1016/j.jvs.2011.12.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 12/09/2011] [Accepted: 12/13/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Several anatomic factors have been identified as predictive of sac behavior after endovascular aneurysm repair (EVAR). The effects of statin therapy on aneurysm sac size reduction remain controversial. This study tested the hypothesis that statin therapy enhances aneurysmal sac regression after EVAR. METHODS This monocentric retrospective study included patients with abdominal aortic aneurysms treated by EVAR using the Zenith (Cook, Bloomington, Ind) graft device. We excluded patients presenting with perioperative sac enlargement factors such as endoleaks, endotension, infectious, inflammatory, ruptured, or anastomotic aneurysms. We prospectively assessed standard clinical and anatomic data, as well as statin use, at the time of EVAR and during follow-up. The primary end point was the decrease in the largest transverse aortic diameter at 24 months compared with the preoperative diameter. RESULTS Among 166 patients treated by a Zenith device and meeting the inclusion criteria, 120 were identified as statin users and 46 as nonstatin users, with comparable characteristics. At 24 months of follow-up, statin group patients had a greater aneurysm sac reduction (25% vs 14%; P < .0001). At a threshold of 5 mm in diameter regression, statin use was a positive factor of retraction (odds ratio, 7.93; 95% confidence interval, 3.22-15.52; P < .0001). Multivariate analysis revealed statin use was an independent predictive factor of sac regression (adjusted odds ratio, 9.39; 95% confidence interval, 3.45-25.56). CONCLUSIONS This study showed that statin use was predictive of sac regression after EVAR with the Zenith graft device. This effect needs to be confirmed by larger randomized trials or by large population evaluation.
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Affiliation(s)
- Maxime Raux
- Department of Vascular Surgery, Henri Mondor Hospital, University of Paris XII, Créteil, France.
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Cheng XW, Huang Z, Kuzuya M, Okumura K, Murohara T. Cysteine Protease Cathepsins in Atherosclerosis-Based Vascular Disease and Its Complications. Hypertension 2011; 58:978-86. [PMID: 21986502 DOI: 10.1161/hypertensionaha.111.180935] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Xian Wu Cheng
- From the Departments of Cardiology (X.W.C., K.O., T.M.) and Geriatrics (Z.H., M.K.), Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology (X.W.C.), Yanbian University Hospital, Yanji, Jilin Province, China; Department of Internal Medicine (X.W.C.), Kyung Hee University Hospital, Seoul, Korea
| | - Zhe Huang
- From the Departments of Cardiology (X.W.C., K.O., T.M.) and Geriatrics (Z.H., M.K.), Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology (X.W.C.), Yanbian University Hospital, Yanji, Jilin Province, China; Department of Internal Medicine (X.W.C.), Kyung Hee University Hospital, Seoul, Korea
| | - Masafumi Kuzuya
- From the Departments of Cardiology (X.W.C., K.O., T.M.) and Geriatrics (Z.H., M.K.), Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology (X.W.C.), Yanbian University Hospital, Yanji, Jilin Province, China; Department of Internal Medicine (X.W.C.), Kyung Hee University Hospital, Seoul, Korea
| | - Kenji Okumura
- From the Departments of Cardiology (X.W.C., K.O., T.M.) and Geriatrics (Z.H., M.K.), Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology (X.W.C.), Yanbian University Hospital, Yanji, Jilin Province, China; Department of Internal Medicine (X.W.C.), Kyung Hee University Hospital, Seoul, Korea
| | - Toyoaki Murohara
- From the Departments of Cardiology (X.W.C., K.O., T.M.) and Geriatrics (Z.H., M.K.), Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology (X.W.C.), Yanbian University Hospital, Yanji, Jilin Province, China; Department of Internal Medicine (X.W.C.), Kyung Hee University Hospital, Seoul, Korea
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Khan JA, Mazari FA, Abdul Rahman M, Mockford K, Chetter IC, McCollum PT. Patients' Perspective of Functional Outcome After Elective Abdominal Aortic Aneurysm Repair: A Questionnaire Survey. Ann Vasc Surg 2011; 25:878-86. [DOI: 10.1016/j.avsg.2011.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 02/17/2011] [Accepted: 05/24/2011] [Indexed: 10/17/2022]
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Rahman MNAA, Khan JA, Mazari FAK, Mockford K, McCollum PT, Chetter IC. A Randomized Placebo Controlled Trial of the Effect of Preoperative Statin Use on Matrix Metalloproteinases and Tissue Inhibitors of Matrix Metalloproteinases in Areas of Low and Peak Wall Stress in Patients Undergoing Elective Open Repair of Abdominal Aortic Aneurysm. Ann Vasc Surg 2011; 25:32-8. [DOI: 10.1016/j.avsg.2010.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 06/18/2010] [Accepted: 06/29/2010] [Indexed: 10/19/2022]
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Stern I, Marc J, Kranjec I, Zorman D, Cerne A, Cerne D. Increased plasma levels of CATS mRNA but not CATB mRNA in patients with coronary atherosclerosis. Clin Biochem 2010; 43:1427-30. [DOI: 10.1016/j.clinbiochem.2010.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 09/17/2010] [Accepted: 09/21/2010] [Indexed: 12/01/2022]
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Twine CP, Williams IM. Systematic review and meta-analysis of the effects of statin therapy on abdominal aortic aneurysms. Br J Surg 2010; 98:346-53. [DOI: 10.1002/bjs.7343] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2010] [Indexed: 11/05/2022]
Abstract
Abstract
Background
The aim was to investigate the effects of statin therapy on abdominal aortic aneurysm (AAA) disease.
Methods
PubMed, the Cochrane Library, Embase and ClinicalTrials.gov were searched for all studies on any clinical effect of statin therapy on AAA. Outcomes were selected based on their inclusion in two or more studies: AAA expansion rate, 30-day mortality, and short- and long-term postoperative mortality. The data were subjected to meta-analysis by outcome.
Results
Twelve cohort studies were selected for inclusion involving 11 933 individuals. Meta-analysis of four studies examining all-cause postoperative mortality showed a significant improvement with statin therapy at 1, 2 and 5 years (odds ratio (OR) at 5 years 0·57, 95 per cent confidence interval (c.i.) 0·42 to 0·79; P < 0·001) with minimal heterogeneity between the four included studies. There was no significant difference in 30-day mortality after AAA treatment in patients on statin therapy (OR 0·22, 0·02 to 2·90; P = 0·25). Sensitivity analysis including four high-quality studies examining AAA expansion rates showed no significant difference with statin therapy: standardized mean difference −0·14 (95 per cent c.i. −0·33 to −0·05) mm/year (P = 0·16).
Conclusion
The claim of a reduction in AAA expansion rate with statin therapy is based on low-quality evidence and was not significant on meta-analysis. However, statin therapy did appear to improve all-cause survival after AAA repair.
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Affiliation(s)
- C P Twine
- Cardiff Regional Vascular Unit, University Hospital of Wales, Cardiff, UK
| | - I M Williams
- Cardiff Regional Vascular Unit, University Hospital of Wales, Cardiff, UK
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Serum cysteine proteases and their inhibitors in rheumatoid arthritis: relation to disease activity and radiographic progression. Clin Rheumatol 2010; 30:633-8. [PMID: 20924627 DOI: 10.1007/s10067-010-1585-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 08/19/2010] [Accepted: 09/23/2010] [Indexed: 10/19/2022]
Abstract
This study aims to investigate the serum levels of cysteine proteases cathepsins B and H and their inhibitors stefin A, stefin B, and cystatin C, as well as traditional inflammatory markers such as C-reactive protein in patients with rheumatoid arthritis and to correlate these markers with scores of disease activity and radiographic progression. Seventy-two patients with rheumatoid arthritis were included from two previously described cohorts of patients with chronic polyarthritis. At inclusion, disease activity was assessed by a 28-joint count, patient global assessment, and serum C-reactive protein. Erosive status of hands and wrists was expressed by the Larsen score and recorded at inclusion and after 1 year. Serum levels of cathepsin B, cathepsin H, stefin A, stefin B, and cystatin C were determined by enzyme-linked immunosorbent assay. Neither cathepsin B nor cathepsin H serum levels were associated with disease activity, presence or progression of erosive disease. Number of swollen joints correlated with serum levels of stefin A and B and correlated negatively with cystatin C serum levels. Erosive disease was associated with high serum levels of C-reactive protein and stefin A and low serum levels of cystatin C. Progression of radiographic destruction was associated with high serum levels of C-reactive protein, stefin A and B, whereas serum levels of cystatin C were not associated with radiographic progression. The findings in this study support further investigation in the regulation of the activity of cathepsins and their inhibitors in erosive rheumatoid arthritis.
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Muehling BM, Paintner A, Marx N, Barth TFE, Babiak C, Orend KH. In Vivo Study on the Expression Pattern of Resistin in Patients With Abdominal Aortic Aneurysm. Vasc Endovascular Surg 2010; 45:63-8. [DOI: 10.1177/1538574410380935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To study the expression pattern of resistin in abdominal aortic aneurysms and to correlate its plasma levels to aneurysm size and statin therapy. Patients and Methods: From 25 patients on regular and 38 patients without statin therapy tissue specimen and plasma samples were obtained for analysis. Results: Demographic data, past medical history, and body mass index showed no significant differences between the statin and no statin group. Immunohistochemistry showed positive stainings for resistin in all sections and in part colocalization to CD 68 positive cells. Patients with large aneurysms showed significant correlation of C-reactive protein (CRP) and interleukin 10 (IL-10) levels; patients on statin medication had significantly lower plasma levels of resistin and CRP. Conclusion: In contrast to IL-10 and CRP plasma levels of resistin are not correlated to aneurysm diameter; yet statin therapy results in decrease of resistin and CRP, suggesting an anti-inflammatory action in patients with abdominal aortic aneurysms (AAAs).
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Affiliation(s)
- Bernd M. Muehling
- Department of Thoracic and Vascular Surgery, University of Ulm, Ulm, Germany,
| | - Agnes Paintner
- Department of Thoracic and Vascular Surgery, University of Ulm, Ulm, Germany
| | - Nikolaus Marx
- Department of Internal Medicine, University Hospital of Aachen, Aachen, Germany
| | | | | | - Karl H. Orend
- Department of Thoracic and Vascular Surgery, University of Ulm, Ulm, Germany
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Does Medical Therapy for Thoracic Aortic Aneurysms Really Work? Are β-Blockers Truly Indicated? CON. Cardiol Clin 2010; 28:261-9. [DOI: 10.1016/j.ccl.2010.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
PURPOSE OF REVIEW Abdominal aortic aneurysm (AAA) is being diagnosed more frequently in older patients due to the increased use of abdominal imaging and the rising average age of western populations. Currently the management of this condition has two important deficiencies: inadequate methods to identify AAAs at risk of progression and rupture and the current lack of effective nonsurgical therapies. In this review recent developments in identifying new diagnostic, prognostic and therapeutic strategies for AAA are discussed. RECENT FINDINGS There are growing number of animal and human association studies which have identified markers and strategies of potential value in improving identification, monitoring and treatment of AAA. SUMMARY Selective large prospective imaging, biomarker and intervention studies are now required to clearly demonstrate the value of new management pathways for AAA.
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Different effects of commonly prescribed statins on abdominal aortic aneurysm wall biology. Eur J Vasc Endovasc Surg 2010; 39:569-76. [PMID: 20226696 DOI: 10.1016/j.ejvs.2010.01.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 01/26/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pharmaceutical stabilisation of the abdominal aortic aneurysm (AAA) wall can delay surgery and improve outcome. Observational studies indicate statins can be used to reduce AAA growth but mechanistic data are scarce. In this study, our aim was to determine the pleiotropic effects of different statins on AAA wall composition. METHODS We included 216 patients undergoing open AAA repair, of which 60 used simvastatin, 52 atorvastatin and 23 pravastatin. The AAA wall histology and protein expression (IL 1beta,2,4,5,6,8,10,12, interferon-gamma (IFNgamma), tumour necrosis factor (TNF)alpha,beta, matrix metalloproteinase (MMP)2 and 9 activities, total MMP8,9 and cathepsin A and B levels) between statin users and non-users were compared as also among the use of different statins. RESULTS As far as histological inflammation goes, the AAA walls of statin users did not differ from those not using them. After multivariate adjustment for risk factors, pravastatin use was associated with tendencies of increased MMP8 (p = 0.022), active MMP9 (p = 0.040) and higher cathepsin B (p = 0.056) levels. The AAA walls of simvastatin and atorvastatin users showed no differences in proteases or cytokines in multivariate analyses. CONCLUSIONS The use of statins was not associated with a decrease in protease levels or inflammation. The trends of elevated protease levels associated with pravastatin use suggest pleiotropic differences among the various statins, supporting the need for further research to target pharmaceutical AAA treatment.
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Association of statin prescription with small abdominal aortic aneurysm progression. Am Heart J 2010; 159:307-13. [PMID: 20152231 DOI: 10.1016/j.ahj.2009.11.016] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Accepted: 11/18/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Statins have been suggested to reduce expansion of abdominal aortic aneurysms (AAAs) independent of lipid-lowering effects. METHODS We assessed the association of statin treatment and serum low-density lipoprotein (LDL) concentrations with small AAA expansion. Six hundred fifty-two patients undergoing surveillance of small AAAs were entered into the study from 5 vascular centers. In a subset, fasting lipids (n = 451) and other biomarkers (n = 216) were measured. The AAA diameter was followed by ultrasound surveillance for a median of 5 years. RESULTS Three hundred forty-nine (54%) of the patients were prescribed statins. Adjusting for other risk factors, statin prescription was not associated with AAA growth (odds ratio [OR] 1.23, 95% CI 0.86-1.76). Above-median AAA growth was positively associated with initial diameter (OR 1.78 per 4.35-mm-larger initial aortic diameter, 95% CI 1.49-2.14) and negatively associated with diabetes (OR 0.37, 95% CI 0.22-0.62). Above-median serum LDL concentration was not associated with AAA growth. Patients receiving statins had lower serum C-reactive protein concentrations but similar matrix metalloproteinase-9 and interleukin-6 concentrations to those not prescribed these medications. CONCLUSIONS We found no association between statin prescription or LDL concentration with AAA expansion. The results do not support the findings of smaller studies and suggest that statins may have no benefit in reducing AAA progression.
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Saratzis A, Kitas GD, Saratzis N, Melas N. Can statins suppress the development of abdominal aortic aneurysms? A review of the current evidence. Angiology 2009; 61:137-44. [PMID: 19625274 DOI: 10.1177/0003319709335514] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Statins possess several pleiotropic effects and have been shown in vitro and in vivo to inhibit the expression of inflammatory mediators and downregulate molecules involved in extracellular matrix (ECM) degradation. Recent observational studies in humans suggest that statins may have a role in abdominal aortic aneurysm (AAA) prevention or may even inhibit aneurysm expansion. In this review, we summarize the effects of statins on the vessel wall of aneurysmal aortas and currently available data concerning their inhibitory effects on aneurysm progression.
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Affiliation(s)
- Athanasios Saratzis
- 1st Department of General Surgery and Vascular Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece. a_saratzis@ yahoo.gr
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Muehling B, Oberhuber A, Schelzig H, Bischoff G, Marx N, Sunder-Plassmann L, Orend KH. Effect of statin therapy on serum activity of proteinases and cytokines in patients with abdominal aortic aneurysm. Vasc Health Risk Manag 2009; 4:1433-7. [PMID: 19337556 PMCID: PMC2663432 DOI: 10.2147/vhrm.s3855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background and aims: Metalloproteinases (MMPs) are considered to be key enzymes in the pathogenesis of abdominal aortic aneurysms (AAA), with elevated levels in diseased aorta and in patient sera. Statins seem to exert an inhibitory effect on MMP activity in the aortic wall. No data exist on the effect of statins on serum activity of MMPs and inflammatory cytokines (interleukins, IL). Methods: The serum activities of MMP2 and MMP9, osteoprotegerin (OPG), and IL6 and IL10 in 63 patients undergoing elective infrarenal aneurysm repair were measured on the day before surgery. Levels were correlated to statin therapy and aneurysm diameter. Results: There was no significant difference between the two groups in the activity of circulating levels of MMP2/9, OPG, and IL6/10 in patients with infrarenal aortic aneurysm. IL6 levels in patients with AAA larger than 6 cm were significantly elevated; differences in serum activities of MMP2/9, OPG, and IL10 were not related to AAA diameter. Conclusion: Serum activities of MMP2/9, OPG, and IL6/10 are not correlated to statin therapy; IL6 levels are higher in patients with large aneurysms. Hence the effect of statin therapy in the treatment of aneurismal disease remains to be elucidated.
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Affiliation(s)
- Bernd Muehling
- Department of Thoracic and Vascular Surgery, University of Ulm, Steinhövelstrasse 9, Ulm, Germany.
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Jagadesham VP, Scott DJA, Carding SR. Abdominal aortic aneurysms: an autoimmune disease? Trends Mol Med 2008; 14:522-9. [PMID: 18980864 DOI: 10.1016/j.molmed.2008.09.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 09/29/2008] [Accepted: 09/29/2008] [Indexed: 11/26/2022]
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Truijers M, Kurvers HAJM, Bredie SJH, Oyen WJG, Blankensteijn JD. In vivo imaging of abdominal aortic aneurysms: increased FDG uptake suggests inflammation in the aneurysm wall. J Endovasc Ther 2008; 15:462-7. [PMID: 18729562 DOI: 10.1583/08-2447.1] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To study the potential of integrated positron emission tomography and computed tomography (PET/CT) to identify aneurysm wall inflammation. METHODS The level of F18-fluorodeoxyglucose (FDG) uptake was studied in aneurysmal and normal-sized aortas of 34 male patients [17 with abdominal aortic aneurysm (AAA) and 17 age-matched controls] identified in a database of 278 consecutive patients evaluated for staging of primary lung cancer. The maximal standardized uptake value (SUV) was calculated to quantify FDG uptake in the AAA wall. RESULTS AAAs showed significantly higher FDG uptake than the normal-sized aorta in age-matched controls (SUV 2.52+/-0.52 versus 1.78+/-0.45, respectively; p<0.001). The level of FDG uptake did not correlate with maximal aneurysm diameter (r=0.09; 95% CI -0.42 to 0.56; p=0.7). CONCLUSION FDG-PET/CT is a promising technique to identify inflammation of the aneurysm wall. Irrespective of aneurysm diameter, asymptomatic AAAs show more FDG uptake and more inflammatory activity in the wall than the non-dilated abdominal aorta of sex/age-matched controls. Future studies will be directed at the predictive value of increased FDG uptake for aneurysm wall strength, rupture risk, and the utility of FDG-PET/CT in assessing the effect of medical interventions.
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Affiliation(s)
- Maarten Truijers
- Department of Vascular Surgery, Radboud University Nijmegen Medical Centre, The Netherlands.
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