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Kosmas CE, Skavdis A, Sourlas A, Papakonstantinou EJ, Peña Genao E, Echavarria Uceta R, Guzman E. Safety and Tolerability of PCSK9 Inhibitors: Current Insights. Clin Pharmacol 2020; 12:191-202. [PMID: 33335431 PMCID: PMC7737942 DOI: 10.2147/cpaa.s288831] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022] Open
Abstract
The current era of preventive cardiology continues to emphasize on low-density lipoprotein cholesterol (LDL-C) reduction to alleviate the burden of atherosclerotic cardiovascular disease (ASCVD). In this regard, the pharmacological inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) enzyme via monoclonal antibodies has emerged as a novel lipid-lowering therapy, leading to a marked reduction in circulating LDL-C levels and subsequent improvement of cardiovascular outcomes. As these agents are increasingly used in current clinical practice, mounting scientific and clinical evidence supports that PCSK9 inhibitors offer an excellent safety and tolerability profile with a low incidence of adverse events. Notably, the most frequently reported side effects are injection-site reactions. In contrast to statins, PCSK9 inhibitors do not appear to exert a detrimental effect on glycemic control or to increase the incidence of new-onset diabetes mellitus. Accumulating evidence also indicates that PCSK9 inhibitors are a safe, well-tolerated and effective therapeutic strategy for patients with statin intolerance. On the other hand, as PCSK9 inhibitors reduce LDL-C to unprecedented low levels, a large body of current research has examined the effects of their long-term administration on neurocognition and on levels of vitamin E and other fat-soluble vitamins, providing encouraging results. This review aims to present and discuss the current clinical and scientific evidence pertaining to the safety and tolerability of PCSK9 inhibitors.
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Affiliation(s)
- Constantine E Kosmas
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | | | | | | | | | | | - Eliscer Guzman
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
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Veronese N, Koyanagi A, Stubbs B, Cooper C, Guglielmi G, Rizzoli R, Schofield P, Punzi L, Al-Daghri N, Smith L, Maggi S, Reginster JY. Statin Use and Knee Osteoarthritis Outcomes: A Longitudinal Cohort Study. Arthritis Care Res (Hoboken) 2019; 71:1052-1058. [PMID: 30144308 DOI: 10.1002/acr.23735] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/21/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Statins have several pleiotropic effects, but the literature regarding the possible relationship between use of statins and outcomes in knee osteoarthritis (OA) is limited. The aim of this study was to investigate whether statin use is associated with a lower risk of radiographic OA (ROA), radiographic symptomatic knee OA, and pain in North American individuals. METHODS A total of 4,448 community-dwelling adults from the Osteoarthritis Initiative were followed for 4 years. Statin use (including the time from baseline and the type of statin) was defined through self-report information and confirmed by a trained interviewer. Knee OA outcomes included incident ROA, symptomatic knee OA (new onset of a combination of a painful knee and ROA), and knee pain worsening (i.e., a Western Ontario and McMaster Universities Osteoarthritis Index difference between baseline and each annual examination ≥14%). RESULTS At baseline, 1,127 participants (25.3% of the total population) used statins. Based on a multivariable Poisson regression analysis with robust variance estimators, any use of statins was not associated with a lower risk of pain worsening (relative risk [RR] 0.97, 95% confidence interval [95% CI] 0.93-1.02), incident ROA, or symptomatic knee OA. However, statin use for more than 5 years (RR 0.91, 95% CI 0.83-0.997) and use of atorvastatin (RR 0.95, 95% CI 0.91-0.996) were associated with a reduced risk of developing pain, while rosuvastatin use was associated with a higher risk (RR 1.18, 95% CI 1.12-1.24). Analysis with adjustment for the propensity score confirmed these findings. CONCLUSION The effect of statin use on knee OA outcomes remains unclear, although in our study, a significantly lower risk of developing knee pain was observed in individuals using statins for >5 years and those using atorvastatin.
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Affiliation(s)
| | - Ai Koyanagi
- Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain, and Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Cyrus Cooper
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield, Nuffield Orthopaedic Centre, University of Oxford, UK
| | - Giuseppe Guglielmi
- University of Foggia, and Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Foggia, Italy
| | - Renè Rizzoli
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | | | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Cambridge, UK
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Hoffmeister M, Jansen L, Rudolph A, Toth C, Kloor M, Roth W, Bläker H, Chang-Claude J, Brenner H. Statin use and survival after colorectal cancer: the importance of comprehensive confounder adjustment. J Natl Cancer Inst 2015; 107:djv045. [PMID: 25770147 DOI: 10.1093/jnci/djv045] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Statins have been associated with moderate reductions in mortality among colorectal cancer (CRC) patients, but these studies lacked adjustment for some potentially relevant factors associated with statin use. We aimed to provide more detailed results on this association from a population-based patient cohort study. METHODS Use of statins and other risk or protective factors were assessed in standardized interviews with 2697 patients from southern Germany with a diagnosis of incident CRC between 2003 and 2009 (Darmkrebs: Chancen der Verhütung durch Screening [DACHS] study). Follow-up included assessment of therapy details, recurrence, vital status, and cause of death. Information about molecular pathological subtypes of CRC was available for 1209 patients. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs). All statistical tests were two-sided. RESULTS Patients were age 68 years on average, 412 used statins (15%), and 769 died during follow-up (29%). After a median follow-up time of 3.4 years, use of statins was not associated with overall (HR = 1.10, 95% CI = 0.85 to 1.41), CRC-specific (HR = 1.11, 95% CI = 0.82 to 1.50), or recurrence-free survival (HR = 0.90, 95% CI = 0.63 to 1.27). Analyses in relevant subgroups also showed no association of statin use with overall and CRC-specific survival, and no associations were observed after stratifying for major pathological subtypes. Among stage I and II patients, statin use was associated with better recurrence-free but not with better CRC-specific survival. CONCLUSIONS Statin use was not associated with reduced mortality among CRC patients. Effects reported in previous studies might reflect incomplete control for stage at diagnosis and other factors associated with the use of statins.
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Affiliation(s)
- Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr).
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr)
| | - Anja Rudolph
- Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr)
| | - Csaba Toth
- Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr)
| | - Matthias Kloor
- Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr)
| | - Wilfried Roth
- Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr)
| | - Hendrik Bläker
- Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr)
| | - Jenny Chang-Claude
- Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr)
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr)
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Burgazli KM, Behrendt MA, Mericliler M, Chasan R, Parahuleva M, Erdogan A. The impact of statins on FGF-2-stimulated human umbilical vein endothelial cells. Postgrad Med 2014; 126:118-28. [PMID: 24393759 DOI: 10.3810/pgm.2014.01.2732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM To determine the effects of different types of statins on proliferative and migrative behaviors of basic fibroblastic growth factor (FGF)-2-stimulated endothelial cells. MATERIALS AND METHODS Human umbilical vein endothelial cells (HUVECs) were isolated and cultured. Groups were arranged in order to observe the impact of each individual substance alone, or under stimulation with statin on FGF-2-stimulated endothelial cells. Endothelial cells were stimulated with human growth factor (HGF), statins, methyl-β-cyclodextrin (β-MCD), and either farnesyl pyrophosphate (FPP) ammonium salt, or geranylgeranyl-pyrophosphate (GGPP), respectively. Cell proliferation analyses were performed 48 hours after stimulation and gaps between migration borders were used in migration analyses. RESULTS The statins showed significant antiproliferative and anti-migrative effects and inhibited the proliferative behavior of FGF-2. However, endothelial cell proliferation and migration were significantly increased after mevalonate co-incubation. Experiments with β-MCD indicated that the destruction of lipid rafts had a negative impact on the action of FGF-2. Stimulation of statin-incubated cells with FPP had no additional effect on proliferation or migration. Notably, although FGF-2 exerted a pro-migrative effect, the effect was not shown in the FPP + FGF-2 group. The anti-migrative actions of statins along with disruption of membrane integrity were reversed by the addition of GGPP. CONCLUSION The angiogenic effect of FGF-2 is suppressed through inhibition of the intracellular cholesterol biosynthesis via statins. Inhibitory effects of statins on FGF-2-stimulated HUVECs were observed to result from both the inhibition of isoprenylation and the destruction of lipid rafts on the cell membrane.
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Affiliation(s)
- Kamil Mehmet Burgazli
- Department of Internal Medicine and Angiology, Wuppertal Research and Medical Center, Wuppertal, Germany.
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