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Aldossary KM, Ali LS, Abdallah MS, Bahaa MM, Elmasry TA, Elberri EI, Kotkata FA, El Sabaa RM, Elmorsi YM, Kamel MM, Negm WA, Elberri AI, Hamouda AO, AlRasheed HA, Salahuddin MM, Yasser M, Hamouda MA. Effect of a high dose atorvastatin as added-on therapy on symptoms and serum AMPK/NLRP3 inflammasome and IL-6/STAT3 axes in patients with major depressive disorder: randomized controlled clinical study. Front Pharmacol 2024; 15:1381523. [PMID: 38855751 PMCID: PMC11157054 DOI: 10.3389/fphar.2024.1381523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/08/2024] [Indexed: 06/11/2024] Open
Abstract
Background Neuroinflammation pathways have been associated with the development of major depressive disorders (MDD). The anti-inflammatory characteristics of statins have been demonstrated to have significance in the pathophysiology of depression. Aim To investigate the mechanistic pathways of high dose atorvastatin in MDD. Patients and methods This trial included 60 patients with MDD who met the eligibility requirements. Two groups of patients (n = 30) were recruited by selecting patients from the Psychiatry Department. Group 1 received 20 mg of fluoxetine plus a placebo once daily. Group 2 received fluoxetine and atorvastatin (80 mg) once daily. All patients were assessed by a psychiatrist using the Hamilton Depression Rating Scale (HDRS). A HDRS score of ≤7 indicates remission or partial remission [HDRS<17 and>7]. Response was defined as ≥ 50% drop in the HDRS score. The serum concentrations of nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP-3), interleukin-6 (IL-6), adenosine monophosphate activated protein kinase (AMPK), and signal transducer and activator of transcription factor-3 (STAT-3) were measured. Results The atorvastatin group showed a significant reduction in the levels of all measured markers along with a statistical increase in the levels of AMPK when compared to the fluoxetine group. The atorvastatin group displayed a significant decrease in HDRS when compared to its baseline and the fluoxetine group. The response rate and partial remission were higher in the atorvastatin group than fluoxetine (p = 0.03, and p = 0.005), respectively. Conclusion These results imply that atorvastatin at high doses may be a promising adjuvant therapy for MDD patients by altering the signaling pathways for AMPK/NLRP3 and IL-6/STAT-3. Clinical Trial Registration clinicaltrials.gov, identifier NCT05792540.
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Affiliation(s)
- Khlood Mohammad Aldossary
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Lashin Saad Ali
- Department of Basic Medical Science, Faculty of Dentistry, Al-Ahliyya Amman University, Amman, Jordan
- Physiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mahmoud S. Abdallah
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Sadat City (USC), Sadat City, Menoufia, Egypt
- Department of PharmD, Faculty of Pharmacy, Jadara University, Irbid, Jordan
| | - Mostafa M. Bahaa
- Pharmacy Practice Department, Faculty of Pharmacy, Horus University, New Damietta, Egypt
| | - Thanaa A. Elmasry
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Tanta University, Tanta, Al-Gharbia, Egypt
| | - Eman I. Elberri
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tanta University, Tanta, Al-Gharbia, Egypt
| | - Fedaa A. Kotkata
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tanta University, Tanta, Al-Gharbia, Egypt
| | - Ramy M. El Sabaa
- Department of Clinical Pharmacy, Faculty of Pharmacy, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Yasmine M. Elmorsi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tanta University, Tanta, Al-Gharbia, Egypt
| | - Mostafa M. Kamel
- Psychiatry Department, Faculty of Medicine, Tanta University, Egypt
| | - Walaa A. Negm
- Pharmacognosy Department, Faculty of Pharmacy, Tanta University, Tanta, Al-Gharbia, Egypt
| | - Aya Ibrahim Elberri
- Genetic Engineering and Molecular Biology Division, Department of Zoology, Faculty of Science, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Amir O. Hamouda
- Department of Biochemistry and Pharmacology, Faculty of Pharmacy, Horus University, New Damietta, Egypt
| | - Hayam Ali AlRasheed
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Muhammed M. Salahuddin
- Department of Biochemistry and Pharmacology, Faculty of Pharmacy, Horus University, New Damietta, Egypt
| | - Mohamed Yasser
- Department of Pharmaceutics, Faculty of Pharmacy, Port Said University, Port Said, Egypt
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Horus University, New Damietta, Egypt
| | - Manal A. Hamouda
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Tanta University, Tanta, Al-Gharbia, Egypt
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Halma MTJ, Tuszynski JA, Marik PE. Cancer Metabolism as a Therapeutic Target and Review of Interventions. Nutrients 2023; 15:4245. [PMID: 37836529 PMCID: PMC10574675 DOI: 10.3390/nu15194245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Cancer is amenable to low-cost treatments, given that it has a significant metabolic component, which can be affected through diet and lifestyle change at minimal cost. The Warburg hypothesis states that cancer cells have an altered cell metabolism towards anaerobic glycolysis. Given this metabolic reprogramming in cancer cells, it is possible to target cancers metabolically by depriving them of glucose. In addition to dietary and lifestyle modifications which work on tumors metabolically, there are a panoply of nutritional supplements and repurposed drugs associated with cancer prevention and better treatment outcomes. These interventions and their evidentiary basis are covered in the latter half of this review to guide future cancer treatment.
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Affiliation(s)
- Matthew T. J. Halma
- Department of Physics and Astronomy, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- EbMC Squared CIC, Bath BA2 4BL, UK
| | - Jack A. Tuszynski
- Department of Physics, University of Alberta, 11335 Saskatchewan Dr NW, Edmonton, AB T6G 2M9, Canada
- Department of Data Science and Engineering, The Silesian University of Technology, 44-100 Gliwice, Poland
- DIMEAS, Politecnico di Torino, Corso Duca degli Abruzzi 24, I-1029 Turin, Italy
| | - Paul E. Marik
- Frontline COVID-19 Critical Care Alliance, Washington, DC 20036, USA
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Taraka SKK, Pasala PK, Sahoo RK, Laddha UD, Khairnar SJ, Bendale AR, Rudrapal M. Atorvastatin ascorbic acid cocrystal strategy to improve the safety and efficacy of atorvastatin. PHARMACIA 2022. [DOI: 10.3897/pharmacia.69.e80072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The study was aimed to investigate the effect of dissolution enhancement on the hypolipidemic effect and hepatotoxicity of the drug in hyperlipidemic rats. Atorvastatin ascorbic acid cocrystals were prepared by phase solution methods and characterized by Fourier transformation infrared spectroscopy, differential scanning calorimetry, scanning electron microscopy, X-Ray powder diffraction. Results of characterization confirmed that atorvastatin ascorbic acid cocrystals exhibited particle size was 221 nm. In in vitro study, results of dissolution test showed that the release of atorvastatin was increased to 1.6 folds. From In vivo study results, it was observed that in atorvastatin ascorbic acid cocrystals treated rats, serum total cholesterol, triglycerides, liver transaminase levels were significantly decreased, and liver glutathione activity was increased. In conclusion, atorvastatin ascorbic acid cocrystals therapy exhibited less hepatotoxicity in presence of ascorbic acid when compared to atorvastatin alone therapy and also the efficacy of therapy was improved.
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Roy D, Mahapatra T, Manna K, Kar A, Rana MS, Roy A, Bose PK, Banerjee B, Paul S, Chakraborty S. Comparing effectiveness of high-dose Atorvastatin and Rosuvastatin among patients undergone Percutaneous Coronary Interventions: A non-concurrent cohort study in India. PLoS One 2020; 15:e0233230. [PMID: 32428019 PMCID: PMC7237007 DOI: 10.1371/journal.pone.0233230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/30/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Atorvastatin-80mg/day and Rosuvastatin-40mg/day are the commonest high-dose statin (3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors) regimes for post-PCI (Percutaneous Coronary Interventions) patients to lower (by ≥50%) blood low-density-lipoprotein cholesterol (LDL-C). Dearth of conclusive evidence from developing world, regarding overall safety, tolerability and comparative effectiveness (outcome/safety/tolerability/endothelial inflammation control) of Rosuvastatin over Atorvastatin in high-dose, given its higher cost, called for an overall and comparative assessment among post-PCI patients in a tertiary cardiac-care hospital of Kolkata, India. METHODS A record-based non-concurrent cohort study was conducted involving 942 post-PCI patients, aged 18-75 years, on high-dose statin for three months and followed up for ≥one year. Those on Atorvastatin-80mg (n = 321) and Rosuvastatin-40mg (n = 621) were compared regarding outcome (death/non-fatal myocardial infarction: MI/repeated hospitalization/target-vessel revascularisation/control of LDL and high-sensitivity C-reactive protein: hsCRP), safety (transaminitis/myopathy/myalgia/myositis/rhabdomyolysis), tolerability (gastroesophageal reflux disease: GERD/gastritis) and inflammation control adjusting for socio-demographics, tobacco-use, medications and comorbidities using SAS-9.4. RESULTS Groups varied minimally regarding distribution of age/gender/tobacco-use/medication/comorbidity/baseline (pre-PCI) LDL and hs-CRP level. During one-year post-PCI follow up, none died. One acute MI and two target vessel revascularizations occurred per group. Repeated hospitalization for angina/stroke was 2.18% in Atorvastatin group vs. 2.90% in Rosuvastatin group. At three-months follow up, GERD/Gastritis (2.18% vs 4.83%), uncontrolled hs-CRP (22.74% vs 31.08%) and overall non-tolerability (4.67% vs. 8.21%) were lower for Atorvastatin group. Multiple logistic regression did show that compared to Atorvastatin-80mg, Rosuvastatin-40mg regime had poorer control of hs-CRP (A3OR = 1.45,p = 0.0202), higher (A3OR = 2.07) adverse effects, poorer safety profile (A3OR = 1.23), higher GERD/Gastritis (A3OR = 1.50) and poorer overall tolerability (A3OR = 1.50). CONCLUSION Post-PCI high dose statins were effective, safe and well-tolerated. High dose Rosuvastatin as compared to high dose Atorvastatin were similar in their clinical efficacy. Patients treated with Atrovastatin had significantly lower number of patients with hs-CRP (high-sensitivity C-reactive protein)/C-reactive protein (CRP) level beyond comparable safe limit and relatively better tolerated as opposed to Rosuvastatin-40mg.Thus given the lower price, Atorvastatin 80mg/day appeared to be more cost-effective. A head-to-head cost-effectiveness as well as efficacy trial may be the need of the hour.
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Affiliation(s)
- Debabrata Roy
- Department of Cardiology, Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
- * E-mail:
| | - Tanmay Mahapatra
- Mission Arogya Health and Information Technology Research Foundation, Kolkata, West Bengal, India
| | - Kaushik Manna
- Department of Cardiology, Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Ayan Kar
- Department of Cardiology, Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Md Saiyed Rana
- Department of Cardiology, Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Abhishek Roy
- Department of Cardiology, Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Pallab Kumar Bose
- Department of Cardiology, Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Barnali Banerjee
- Mission Arogya Health and Information Technology Research Foundation, Kolkata, West Bengal, India
| | - Srutarshi Paul
- Mission Arogya Health and Information Technology Research Foundation, Kolkata, West Bengal, India
| | - Sandipta Chakraborty
- Mission Arogya Health and Information Technology Research Foundation, Kolkata, West Bengal, India
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Synthesis of Polysubstituted Pyrroles by the Reaction of Enaminoketones, Arylglyoxals, and N,N-Dimethylbarbituric Acid. Chem Heterocycl Compd (N Y) 2019. [DOI: 10.1007/s10593-019-02613-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Çelik H, Karahan H, Kelicen-Uğur P. Effect of atorvastatin on Aβ 1-42 -induced alteration of SESN2, SIRT1, LC3II and TPP1 protein expressions in neuronal cell cultures. ACTA ACUST UNITED AC 2019; 72:424-436. [PMID: 31846093 DOI: 10.1111/jphp.13208] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/26/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Sestrins (SESNs) and sirtuins (SIRTs) are antioxidant and antiapoptotic genes and crucial mediators for lysosomal autophagy regulation that play a pivotal role in the Alzheimer's disease (AD). Recently, statins have been linked to the reduced prevalence of AD in statin-prescribed populations yet molecular basis for the neuroprotective action of statins is still under debate. METHODS This study was undertaken whether Aβ-induced changes of SESN2 and SIRT1 protein expression, autophagy marker LC3II and lysosomal enzyme TPP1 affected by atorvastatin (Western blot) and its possible role in Aβ neurotoxicity (ELISA). KEY FINDINGS/RESULTS We showed that SESN2 and LC3II expressions were elevated, whereas SIRT1 and TPP1 expressions were decreased in the Aβ1-42 -exposed human neuroblastoma cells (SH-SY5Y). Co-administration of atorvastatin with Aβ1-42 compensates SESN2 increase and recovers SIRT1 decline by reducing oxidative stress, decreasing SESN2 expression and increasing SIRT1 expression by its neuroprotective action. Atorvastatin induced LC3II but not TPP1 level in the Aβ1-42 -exposed cells suggested that atorvastatin is effective in the formation of autophagosome but not on the expression of the specific lysosomal enzyme TPP1. DISCUSSION AND CONCLUSION Together, these results indicate that atorvastatin induced SESN2, SIRT1 and LC3II levels play a protective role against Aβ1-42 neurotoxicity.
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Affiliation(s)
- Hande Çelik
- Faculty of Pharmacy, Department of Pharmacology, Hacettepe University, Ankara, Turkey.,Acıbadem Molecular Pathology Laboratory, İstanbul, Turkey
| | - Hande Karahan
- Stark Neurosciences Research Institute, Indiana University, Indianapolis, IN, USA.,Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Pelin Kelicen-Uğur
- Faculty of Pharmacy, Department of Pharmacology, Hacettepe University, Ankara, Turkey
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Waters DD. Cholesterol Lowering Guidelines: From Whence We Came and Where We Are Now. Can J Cardiol 2018; 35:590-597. [PMID: 30454967 DOI: 10.1016/j.cjca.2018.07.477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/20/2018] [Accepted: 07/25/2018] [Indexed: 12/31/2022] Open
Abstract
Treatment guidelines have proliferated in cardiology, although most guideline recommendations are not supported by clinical trial evidence. What is considered to be a normal cholesterol level has progressively declined over the past 50 years, with the increasing realization that "normal" is far from optimal and that lower is better. The first important United States and Canadian cholesterol guidelines were published in 1988, and recommended diet for 6 months to be followed by consideration of bile acid sequestrants or nicotinic acid. Over the ensuing 25 years guidelines have changed rapidly and dramatically in response to a large number of definitive clinical trials, usually with statins. Low-density lipoprotein cholesterol targets have moved progressively lower, and in some guidelines, have been abandoned entirely. The concept of selecting patients for treatment according to the absolute risk reduction expected from treatment on the basis of clinical trial data seems to be a rational approach. For secondary prevention, some patients are still untreated or undertreated, presenting an opportunity for improving outcomes.
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Affiliation(s)
- David D Waters
- Division of Cardiology, Zuckerberg San Francisco General Hospital, and the Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
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Zhou D, Liu H, Li C, Wang F, Shi Y, Liu L, Zhao X, Liu A, Zhang J, Wang C, Chen Z. Atorvastatin ameliorates cognitive impairment, Aβ1-42 production and Tau hyperphosphorylation in APP/PS1 transgenic mice. Metab Brain Dis 2016; 31:693-703. [PMID: 26883430 DOI: 10.1007/s11011-016-9803-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/27/2016] [Indexed: 10/22/2022]
Abstract
Amyloid-beta (Aβ) interacts with the serine/threonine protein kinase AKT (also known as protein kinase B)/glycogen synthase kinase 3β (GSK3β) pathway and deactivates GSK3β signaling, which result in microtubule protein tau phosphorylation. Atorvastatin, a HMG-CoA reductase inhibitor, has been proven to improve learning and memory performance, reduce Aβ and phosphorylated tau levels in mouse model of Alzheimer's disease (AD). However, it still remains unclear whether atorvastatin is responsible for regulation of AKT/GSK3β signaling and contributes to subsequent down-regulation of Aβ1-42 and phosphorylated tau in APP/PS1 transgenic (Tg APP/PS1) mice. Herein, we aimed to investigate the possible impacts of atorvastatin (10 mg/kg, p.o.) on the memory deficit by behavioral tests and changes of AKT/GSK3β signaling in hippocampus and prefrontal cortex by western blot test in Tg APP/PS1 mice. The results showed that treatment with atorvastatin significantly reversed the memory deficit in the Tg APP/PS1 mice in a novel object recognition and the Morris water maze tests. Moreover, atorvastatin significantly attenuated Aβ1-42 accumulation and phosphorylation of tau (Ser396) in the hippocampus and prefrontal cortex of Tg APP/PS1 mice. In addition, atorvastatin treatment also increased phosphorylation of AKT, inhibited GSK3β activity by increasing phosphorylation of GSK3β (Ser9) and decreasing the beta-site APP cleaving enzyme 1 (BACE1) expression. These results indicated that the memory ameliorating effect of atorvastatin may be, in part, by regulation the AKT/GSK3β signaling which may contribute to down-regulation of Aβ1-42 and tau hyperphosphorylation.
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Affiliation(s)
- Dongsheng Zhou
- Ningbo Kangning Hospital, Ningbo, Zhejiang, 315210, People's of Republic China
- Ningbo Key Laboratory of Behavioral Neuroscience, Ningbo University School of Medicine, 818 Fenghua Road, Ningbo, Zhejiang, 315211, People's of Republic China
| | - Huaxia Liu
- School of Nursing, Taishan Medical University, Taian, Shandong, 271016, People's of Republic China
| | - Chenli Li
- Ningbo Key Laboratory of Behavioral Neuroscience, Ningbo University School of Medicine, 818 Fenghua Road, Ningbo, Zhejiang, 315211, People's of Republic China
- Zhejiang Provincial Key Laboratory of Pathophysiology, Ningbo University School of Medicine, 818 Fenghua Road, Ningbo, Zhejiang, 315211, People's of Republic China
| | - Fangyan Wang
- Zhejiang Provincial Key Laboratory of Pathophysiology, Ningbo University School of Medicine, 818 Fenghua Road, Ningbo, Zhejiang, 315211, People's of Republic China
| | - Yaosheng Shi
- Ningbo Kangning Hospital, Ningbo, Zhejiang, 315210, People's of Republic China
- Ningbo Key Laboratory of Behavioral Neuroscience, Ningbo University School of Medicine, 818 Fenghua Road, Ningbo, Zhejiang, 315211, People's of Republic China
| | - Lingjiang Liu
- Ningbo Kangning Hospital, Ningbo, Zhejiang, 315210, People's of Republic China
- Ningbo Key Laboratory of Behavioral Neuroscience, Ningbo University School of Medicine, 818 Fenghua Road, Ningbo, Zhejiang, 315211, People's of Republic China
| | - Xin Zhao
- Ningbo Key Laboratory of Behavioral Neuroscience, Ningbo University School of Medicine, 818 Fenghua Road, Ningbo, Zhejiang, 315211, People's of Republic China
- Zhejiang Provincial Key Laboratory of Pathophysiology, Ningbo University School of Medicine, 818 Fenghua Road, Ningbo, Zhejiang, 315211, People's of Republic China
| | - Aiming Liu
- Ningbo Key Laboratory of Behavioral Neuroscience, Ningbo University School of Medicine, 818 Fenghua Road, Ningbo, Zhejiang, 315211, People's of Republic China
- Zhejiang Provincial Key Laboratory of Pathophysiology, Ningbo University School of Medicine, 818 Fenghua Road, Ningbo, Zhejiang, 315211, People's of Republic China
| | - Junfang Zhang
- Ningbo Key Laboratory of Behavioral Neuroscience, Ningbo University School of Medicine, 818 Fenghua Road, Ningbo, Zhejiang, 315211, People's of Republic China.
- Department of Pathophysiology, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, People's of Republic China.
| | - Chuang Wang
- Ningbo Key Laboratory of Behavioral Neuroscience, Ningbo University School of Medicine, 818 Fenghua Road, Ningbo, Zhejiang, 315211, People's of Republic China.
- Department of Pathophysiology, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, People's of Republic China.
| | - Zhongming Chen
- Ningbo Kangning Hospital, Ningbo, Zhejiang, 315210, People's of Republic China.
- Ningbo Key Laboratory of Behavioral Neuroscience, Ningbo University School of Medicine, 818 Fenghua Road, Ningbo, Zhejiang, 315211, People's of Republic China.
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Li H, Wang C, Zhang S, Sun S, Li R, Zou M, Cheng G. Safety Profile of Atorvastatin 80 mg: A Meta-Analysis of 17 Randomized Controlled Trials in 21,910 Participants. Drug Saf 2016; 39:409-19. [DOI: 10.1007/s40264-016-0394-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pathak NN, Balaganur V, Lingaraju MC, Kant V, Kumar D, Kumar D, Sharma AK, Tandan SK. Effect of atorvastatin, a HMG-CoA reductase inhibitor in monosodium iodoacetate-induced osteoarthritic pain: Implication for osteoarthritis therapy. Pharmacol Rep 2015; 67:513-9. [DOI: 10.1016/j.pharep.2014.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 02/07/2023]
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Atorvastatin Prevents Cognitive Deficits Induced by Intracerebroventricular Amyloid-β1–40 Administration in Mice: Involvement of Glutamatergic and Antioxidant Systems. Neurotox Res 2015; 28:32-42. [DOI: 10.1007/s12640-015-9527-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 03/12/2015] [Accepted: 03/19/2015] [Indexed: 12/12/2022]
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Vandresen-Filho S, França LM, Alcantara-Junior J, Nogueira LC, de Brito TM, Lopes L, Junior FM, Vanzeler ML, Bertoldo DB, Dias PG, Colla ARS, Hoeller A, Duzzioni M, Rodrigues ALS, de Lima TCM, Tasca CI, Viola GG. Statins enhance cognitive performance in object location test in albino Swiss mice: involvement of beta-adrenoceptors. Physiol Behav 2015; 143:27-34. [PMID: 25700896 DOI: 10.1016/j.physbeh.2015.02.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 12/22/2014] [Accepted: 02/16/2015] [Indexed: 12/11/2022]
Abstract
Statins are inhibitors of the 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, thereby inhibiting cell synthesis of cholesterol and isoprenoids. Moreover, several studies have been evaluating pleiotropic effects of statins, mainly because they present neuroprotective effects in various pathological conditions. However, knowledge about behavioral effects of statins per se is relatively scarce. Considering these facts, we aimed to analyze behavioral responses of atorvastatin or simvastatin-treated mice in the open field test, elevated plus maze and object location test. Atorvastatin treatment for 7 consecutive days at 1 mg/kg or 10 mg/kg (v.o.) or simvastatin 10 mg/kg or 20 mg/kg enhanced cognitive performance in object location test when compared to control group (saline-treated mice). Simvastatin effects on mice performance in the object location test was abolished by post-training infusion of the beta-adrenoceptor antagonist propranolol. Atorvastatin and simvastatin did not change the behavioral response in open field and elevated plus-maze (EPM) tests in any of the used doses. These data demonstrate the positive effects of both statins in cognitive processes in mice, without any alteration in locomotor parameters in the open field test or anxiolytic-like behavior in EPM. In conclusion, we demonstrate that atorvastatin and simvastatin per se improve the cognitive performance in a rodent model of spatial memory and this effect is related to beta-adrenergic receptors modulation.
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Affiliation(s)
- Samuel Vandresen-Filho
- Programa de Pós-graduação em Neurociências, Universidade Federal de Santa Catarina, Trindade, Florianópolis, SC, Brazil; Departamento de Ciências Básicas em Saúde, Universidade Federal de Mato Grosso, Boa Esperança, Cuiabá, MT, Brazil
| | - Lucas Moreira França
- Departamento de Ciências Básicas em Saúde, Universidade Federal de Mato Grosso, Boa Esperança, Cuiabá, MT, Brazil
| | - José Alcantara-Junior
- Departamento de Ciências Básicas em Saúde, Universidade Federal de Mato Grosso, Boa Esperança, Cuiabá, MT, Brazil
| | - Lucas Caixeta Nogueira
- Departamento de Ciências Básicas em Saúde, Universidade Federal de Mato Grosso, Boa Esperança, Cuiabá, MT, Brazil
| | - Thiago Marques de Brito
- Departamento de Ciências Básicas em Saúde, Universidade Federal de Mato Grosso, Boa Esperança, Cuiabá, MT, Brazil
| | - Lousã Lopes
- Departamento de Ciências Básicas em Saúde, Universidade Federal de Mato Grosso, Boa Esperança, Cuiabá, MT, Brazil
| | - Fernando Mesquita Junior
- Departamento de Ciências Básicas em Saúde, Universidade Federal de Mato Grosso, Boa Esperança, Cuiabá, MT, Brazil
| | - Maria Luzinete Vanzeler
- Departamento de Ciências Básicas em Saúde, Universidade Federal de Mato Grosso, Boa Esperança, Cuiabá, MT, Brazil
| | - Daniela Bohn Bertoldo
- Departamento de Bioquímica, Universidade Federal de Santa Catarina, Trindade, 88040-900 Florianópolis, SC, Brazil
| | - Paula Gomes Dias
- Departamento de Bioquímica, Universidade Federal de Santa Catarina, Trindade, 88040-900 Florianópolis, SC, Brazil; Laboratório de Genética do Comportamento, Departamento de Biologia Celular, Embriologia e Genética, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - André R S Colla
- Programa de Pós-graduação em Neurociências, Universidade Federal de Santa Catarina, Trindade, Florianópolis, SC, Brazil
| | - Alexandre Hoeller
- Departamento de Farmacologia, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Trindade, Florianópolis, SC, Brazil
| | - Marcelo Duzzioni
- Departamento de Farmacologia, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Trindade, Florianópolis, SC, Brazil
| | - Ana Lúcia S Rodrigues
- Programa de Pós-graduação em Neurociências, Universidade Federal de Santa Catarina, Trindade, Florianópolis, SC, Brazil; Departamento de Bioquímica, Universidade Federal de Santa Catarina, Trindade, 88040-900 Florianópolis, SC, Brazil
| | - Thereza C M de Lima
- Departamento de Farmacologia, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Trindade, Florianópolis, SC, Brazil
| | - Carla Inês Tasca
- Programa de Pós-graduação em Neurociências, Universidade Federal de Santa Catarina, Trindade, Florianópolis, SC, Brazil; Departamento de Bioquímica, Universidade Federal de Santa Catarina, Trindade, 88040-900 Florianópolis, SC, Brazil
| | - Giordano Gubert Viola
- Programa de Pós-graduação em Neurociências, Universidade Federal de Santa Catarina, Trindade, Florianópolis, SC, Brazil; Programa de Pós-graduação em Ciências Fisiológicas, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil.
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Artom N, Montecucco F, Dallegri F, Pende A. Carotid atherosclerotic plaque stenosis: the stabilizing role of statins. Eur J Clin Invest 2014; 44:1122-34. [PMID: 25231921 DOI: 10.1111/eci.12340] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 09/14/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Both pathophysiology and treatments of carotid atherosclerotic plaque stenosis represent two interesting fields of strong scientific investigation. Among different drugs, safety and efficacy of statin treatment have been widely investigated and proved. MATERIALS AND METHODS This narrative review is based on the material searched for and obtained via MEDLINE and PubMed up to March 2014. The search terms we used were: 'carotid plaque, intima-media thickness, plaque burden, stroke' in combination with 'statins, pleiotropic effects, HMG-CoA reductase inhibitors, lipid-lowering drugs'. RESULTS Carotid stenosis represents both a useful parameter to evaluate the atherosclerotic burden and a target for therapeutic (medical or surgical) decisions. Statins do not only improve the lipid profile, but also induce some 'pleiotropic' anti-inflammatory activities that contribute to carotid plaque stabilization. Statin-mediated protective activities are under active investigation at subclinical levels with the potential benefit of advanced imaging techniques. However, considering that some new techniques (excepted B-mode ultrasound) remain quite expensive, they can have for the moment an important role in research, but not in the clinical field. CONCLUSIONS Emerging evidence suggests that statin treatment improves carotid atherosclerosis, inducing a partial regression of plaque inflammation and size. Innovative imaging techniques might also ameliorate the identification of patients at high risk of cerebrovascular and coronary events, for which preventive statin treatments might be essential.
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Affiliation(s)
- Nathan Artom
- Clinic of Internal Medicine 1, Department of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV 6, 16132, Genoa, Italy
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14
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Abstract
Statins are widely used and have been proven to be effective in the prevention of atherosclerotic vascular disease events, primarily by reducing plasma low-density lipoprotein cholesterol concentrations. Although statins are generally well tolerated and present an excellent safety profile, adverse effects from muscle toxicity and liver enzyme abnormalities may occur in some patients. Myopathy and rhabdomyolysis are rare with statin monotherapy at the approved dose ranges, but the risk increases with use of higher doses, interacting drugs and genetic predisposition. Asymptomatic increases in liver transaminases with statin treatment do not seem to be associated with an increased risk of liver disease. Therefore, statin treatment can be safely used in patients with mild to moderately abnormal liver tests that are potentially attributable to nonalcoholic fatty liver disease and can improve liver tests and reduce cardiovascular morbidity in this group of patients. The risks of other unfavorable effects such as the slightly increased risk of new-onset diabetes and potentially increased risk of haemorrhagic stroke are much smaller than the cardiovascular benefits with the use of statins.
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Affiliation(s)
- Miao Hu
- Division of Clinical Pharmacology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Bernard M Y Cheung
- Division of Clinical Pharmacology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Brian Tomlinson
- Division of Clinical Pharmacology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Atorvastatin prevents amyloid-β peptide oligomer-induced synaptotoxicity and memory dysfunction in rats through a p38 MAPK-dependent pathway. Acta Pharmacol Sin 2014; 35:716-26. [PMID: 24793311 DOI: 10.1038/aps.2013.203] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/27/2013] [Indexed: 12/23/2022] Open
Abstract
AIM To investigate whether atorvastatin treatment could prevent Aβ1-42 oligomer (AβO)-induced synaptotoxicity and memory dysfunction in rats, and to elucidate the mechanisms involved in the neuroprotective actions of atorvastatin. METHODS SD rats were injected with AβOs (5 nmol, icv). The rats were administrated with atorvastatin (10 mg·kg(-1)·d(-1), po) for 2 consecutive weeks (the first dose was given 5 d before AβOs injection). The memory impairments were evaluated with Morris water maze task. The expression of inflammatory cytokines in the hippocampus was determined using ELISA assays. The levels of PSD-95 and p38MAPK proteins in rat hippocampus were evaluated using Western blot analysis. For in vitro experiments, cultured rat hippocampal neurons were treated with AβOs (50 nmol/L) for 48 h. The expression of MAP-2 and synaptophysin in the neurons was detected with immunofluorescence. RESULTS The AβO-treated rats displayed severe memory impairments in Morris water maze tests, and markedly reduced levels of synaptic proteins synaptophysin and PSD-95, increased levels of inflammatory cytokines (IL-1β, IL-6 and TNF-α) and p38MAPK activation in the hippocampus. All these effects were prevented or substantially attenuated by atorvastatin administration. Pretreatment of cultured hippocampal neurons with atorvastatin (1 and 5 μmol/L) concentration-dependently attenuated the AβO-induced synaptotoxicity, including the loss of dendritic marker MAP-2, and synaptic proteins synaptophysin and PSD-95. Pretreatment of the cultured hippocampal neurons with the p38MAPK inhibitor SB203580 (5 μmol/L) blocked the AβO-induced loss of synaptophysin and PSD-95. CONCLUSION Atorvastatin prevents AβO-induced synaptotoxicity and memory dysfunction through a p38MAPK-dependent pathway.
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Pathak NN, Balaganur V, Lingaraju MC, Kant V, Latief N, More AS, Kumar D, Kumar D, Tandan SK. Atorvastatin attenuates neuropathic pain in rat neuropathy model by down-regulating oxidative damage at peripheral, spinal and supraspinal levels. Neurochem Int 2014; 68:1-9. [DOI: 10.1016/j.neuint.2014.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/28/2014] [Accepted: 01/30/2014] [Indexed: 01/06/2023]
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17
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A reappraisal of the risks and benefits of treating to target with cholesterol lowering drugs. Drugs 2014; 73:1025-54. [PMID: 23754124 DOI: 10.1007/s40265-013-0072-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Atherosclerotic cardiovascular disease (CVD) is the number one cause of death globally, and lipid modification, particularly lowering of low density lipoprotein cholesterol (LDLc), is one of the cornerstones of prevention and treatment. However, even after lowering of LDLc to conventional goals, a sizeable number of patients continue to suffer cardiovascular events. More aggressive lowering of LDLc and optimization of other lipid parameters like triglycerides (TG) and high density lipoprotein cholesterol (HDLc) have been proposed as two potential strategies to address this residual risk. These strategies entail use of maximal doses of highly potent HMG CoA reductase inhibitors (statins) and combination therapy with other lipid modifying agents. Though statins in general are fairly well tolerated, adverse events like myopathy are dose related. There are further risks with combination therapy. In this article, we review the adverse effects of lipid modifying agents used alone and in combination and weigh these effects against the evidence demonstrating their efficacy in reducing cardiovascular events, cardiovascular mortality, and all cause mortality. For patients with established CVD, statins are the only group of drugs that have shown consistent reductions in hard outcomes. Though more aggressive lipid lowering with high dose potent statins can reduce rates of non fatal events and need for interventions, the incremental mortality benefits remain unclear, and their use is associated with a higher rate of drug related adverse effects. Myopathy and renal events have been a significant concern with the use of high potency statin drugs, in particular simvastatin and rosuvastatin. For patients who have not reached target LDL levels or have residual lipid abnormalities on maximal doses of statins, the addition of other agents has not been shown to improve clinical outcomes and carries an increased risk of adverse events. The clinical benefits of drugs to raise HDLc remain unproven. In patients without known cardiovascular disease, there is conflicting evidence as to the benefits of aggressive pursuit of numerical lipid targets, particularly with respect to all cause mortality. Certainly, in statin intolerant patients, alternative agents with a low side effect profile are desirable. Bile acid sequestrants are an effective and safe choice for decreasing LDLc, and omega-3 fatty acids are safe agents to decrease TG. There remains an obvious need to design and carry out large scale studies to help determine which agents, when combined with statins, have the greatest benefit on cardiovascular disease with the least added risk. These studies should be designed to assess the impact on clinical outcomes rather than surrogate endpoints, and require a comprehensive assessment and reporting of safety outcomes.
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Wierzbicki AS. Doubling up: maximising statin therapy as opposed to adding other drugs for cardiovascular disease prevention. Int J Clin Pract 2013; 67:391-3. [PMID: 23574098 DOI: 10.1111/ijcp.12102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 12/04/2012] [Indexed: 11/29/2022] Open
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Feng Q, Wilke RA, Baye TM. Individualized risk for statin-induced myopathy: current knowledge, emerging challenges and potential solutions. Pharmacogenomics 2012; 13:579-94. [PMID: 22462750 DOI: 10.2217/pgs.12.11] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Skeletal muscle toxicity is the primary adverse effect of statins. In this review, we summarize current knowledge regarding the genetic and nongenetic determinants of risk for statin induced myopathy. Many genetic factors were initially identified through candidate gene association studies limited to pharmacokinetic (PK) targets. Through genome-wide association studies, it has become clear that SLCO1B1 is among the strongest PK predictors of myopathy risk. Genome-wide association studies have also expanded our understanding of pharmacodynamic candidate genes, including RYR2. It is anticipated that deep resequencing efforts will define new loci with rare variants that also contribute, and sophisticated computational approaches will be needed to characterize gene-gene and gene-environment interactions. Beyond environment, race is a critical covariate, and its influence is only partly explained by geographic differences in the frequency of known pharmacodynamic and PK variants. As such, admixture analyses will be essential for a full understanding of statin-induced myopathy.
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Affiliation(s)
- QiPing Feng
- Department of Medicine, Vanderbilt University Medical Center, Oates Institute for Experimental Therapeutics, Nashville, TN, USA
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21
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Continued statin therapy could improve the outcome after spontaneous intracerebral hemorrhage. Neurosurg Rev 2012; 36:279-87; discussion 287. [DOI: 10.1007/s10143-012-0431-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 05/26/2012] [Accepted: 07/15/2012] [Indexed: 11/27/2022]
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Pérez A, González Blanco C, Hernández-Presa MÁ, Chaves J. [Therapeutic approach to dyslipidemia and goal achievement in a Spanish population with type 2 diabetes without cardiovascular disease]. ACTA ACUST UNITED AC 2011; 58:283-90. [PMID: 21641286 DOI: 10.1016/j.endonu.2011.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 03/28/2011] [Accepted: 03/28/2011] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the therapeutic approach and lipid goal achievement in a spanish diabetic population at high cardiovascular risk. SUBJECTS AND METHODS A multicenter, descriptive, cross-sectional study consecutively recruited the first 10 patients who attended the primary care office and had been seen in the 12 months prior to the study visit. Inclusion criteria were type 2 diabetes without cardiovascular disease, LDL cholesterol levels ≤160mg/dL, triglyceride levels ≤600mg/dL, and at least one of the following: retinopathy, albuminuria, current smoking, or hypertension. RESULTS A total of 2412 patients were evaluated (aged 61.3±8.3 years, 46.8% women, diabetes duration 8.6±7.4 years). As compared to the previous visit (8.1±5 months before), the proportion of patients who achieved LDL-C levels <100mg/dL (22.7% vs 28.6%), non-HDL-C levels <130mg/dL (27.7% vs 33.8%) and both goals (17.6% vs 22.1%) significantly increased at the time of assessment. Statins were the most widely prescribed lipid-lowering drugs (65.5%) and the lipid-lowering drug was changed from the previous visit in 38.7% of patients, drug dosage was increased in 17.3%, and another drug was added in 5%. CONCLUSION Use of more potent statins and higher statin doses were the most commonly used therapeutic strategies for improving control of dyslipidemia in patients with type 2 diabetes, but these changes were clearly inadequate to achieve lipid goals in most patients with type 2 diabetes.
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Affiliation(s)
- Antonio Pérez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
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23
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Martinez-Hervas S, Carmena R, Ascaso JF. Significance of LDL-C lowering therapy in diabetic patients. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/clp.11.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
HMG-CoA inhibitors have been widely used in primary and secondary prevention of atherosclerosis for more than 30 years. The evidence base for statins includes dozens of randomized clinical trials (RCT), involving hundreds of thousands patients. According to the results of the latest meta-analyses, reducing low-density lipoprotein cholesterol (LDL-CH) level by 1 mmol/l in statin-treated patients could decrease cardiovascular risk by 0,8 %. Atorvastatin (Liprimar®) is a modern synthetic statin, which has been thoroughly studied in several RCTs over the last 15 years. These trials demonstrated its effectiveness and tolerability in patients with chronic coronary heart disease, acute coronary syndrome (ACS), Type 2 diabetes mellitus, and arterial hypertension. In the studies comparing atorvastatin (10-80 mg/d) to other statins, baseline LDL-CH levels were reduced by 53 % in atorvastatintreated patients. Atorvastatin therapy was also well tolerated. Compared to placebo, atorvastatin therapy in the dose of 10 and 80 mg/d was associated with the incidence of hepatic transaminase elevation of 0,1 % and 0,6 %, respectively. This evidence base (in particular, the results of the trials on 80 mg/d atorvastatin therapy in ACS patients) has been a cornerstone of modern clinical guidelines, recommending target LDL-CH levels of 2 mmol/l. Currently, atorvastatin is the most widely prescribed statin in the majority of both developed and developing countries. Increasing initial dose and prescribing high-dose atorvastatin therapy (40-80 mg/d) could facilitate an improvement in treatment quality and a reduction in high levels of cardiovascular mortality inRussia.
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Affiliation(s)
- A. V. Susekov
- A.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Research Complex
| | - N. V. Khokhlova
- A.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Research Complex
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25
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Wierzbicki AS. Statin wars: efficacy vs. cost. Int J Clin Pract 2011; 65:108-11. [PMID: 21235691 DOI: 10.1111/j.1742-1241.2010.02586.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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26
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Millán Núñez-Cortés J, Montoya JPB, Salas XP, Hernández Mijares A, Carey VJ, Hermans MP, Sacks FM, Fruchart JC. [The REALIST (REsiduAl risk, LIpids and Standard Therapies) study: an analysis of residual risk attributable to lipid profile in acute coronary syndrome]. ACTA ACUST UNITED AC 2011; 58:38-47. [PMID: 21208833 DOI: 10.1016/j.endonu.2010.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 10/06/2010] [Accepted: 10/08/2010] [Indexed: 01/04/2023]
Abstract
The R3i Foundation (Residual Risk Reduction Initiative), an independent, multinational and academic organization, is conducting the REALIST (Residual Risk, Lipids and Standard Therapies) study in 40 centers in different countries. This is a retrospective epidemiological study, designed to provide new data on the residual risk of major coronary events attributable to lipid abnormalities in patients receiving the current standard treatment. The initial results are expected in mid 2010, and the overall results at the end of 2010.
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Heeba GH, Abd-Elghany MI. Effect of combined administration of ginger (Zingiber officinale Roscoe) and atorvastatin on the liver of rats. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2010; 17:1076-81. [PMID: 20576411 DOI: 10.1016/j.phymed.2010.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 03/07/2010] [Accepted: 04/27/2010] [Indexed: 05/29/2023]
Abstract
Ginger is known to possess hypolipidemic, antioxidant and hepatoprotective properties. Combination therapy often takes advantage of complementary effects of different agents. This study investigated the combined effect of ginger extract (GE) and atorvastatin on lipid profile and on atorvastatin-induced hepatic injury. Rats were randomized into: control; GE (400 mg/kg); atorvastatin (20 mg/kg) alone or with GE or vitamin E, and atorvastatin (80 mg/kg) alone or with GE or vitamin E. Administration of 80 mg/kg atorvastatin for 4 weeks had major hepatotoxic effect whereas the lower dose (20 mg/kg) seems to cause mild liver injury. Besides lowering serum total cholesterol and hepatic superoxide dismutase (SOD) and catalase (CAT), atorvastatin significantly increased serum aminotransferases, hepatic malondialdehyde (MDA) and nitric oxide (NO). Concurrent administration of GE and atorvastatin had the opposite effect. Histopathological study revealed that GE reduced liver lesions induced by atorvastatin. The results indicate that the ability of ginger to lower serum cholesterol and to decrease aminotransferases, MDA and NO is clinically important, because its chronic administration will neither lead to side-effects nor to hepatic changes as occurs with high atorvastatin doses. Therefore, combination regimens containing GE and low dose of statins could be advantageous in treating hypercholesterolemic patients which are susceptible to liver function abnormalities.
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Affiliation(s)
- Gehan H Heeba
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Minia University, El-Minia 61111, Egypt.
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Atorvastatin prevents hippocampal cell death, neuroinflammation and oxidative stress following amyloid-β1–40 administration in mice: Evidence for dissociation between cognitive deficits and neuronal damage. Exp Neurol 2010; 226:274-84. [DOI: 10.1016/j.expneurol.2010.08.030] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 08/24/2010] [Accepted: 08/26/2010] [Indexed: 01/27/2023]
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The effects of atorvastatin on memory deficit and seizure susceptibility in pentylentetrazole-kindled rats. Epilepsy Behav 2010; 19:284-9. [PMID: 20888302 DOI: 10.1016/j.yebeh.2010.07.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 07/21/2010] [Accepted: 07/26/2010] [Indexed: 11/22/2022]
Abstract
Deficits in memory function have been observed in pentylentetrazole (PTZ)-kindled rats. In the present study we examined the effects of atorvastatin ((3-hydroxy-3-methylglutaryl-coenzyme A [HMG-CoA] reductase inhibitor) on PTZ kindling and related memory deficits in rats trained with the passive avoidance test. Subconvulsive PTZ doses rendered a gradual increase in seizure activity. PTZ kindling caused long-term memory to deteriorate. Atorvastatin per se and in PTZ-kindled rats improved learning and memory functions. It also prolonged latency (time to appearance of spike potentials) and diminished the amplitude and frequency of spike potentials, which indicate epileptic discharges. These novel findings suggest that the favorable effect of the atorvastatin on memory deficits provoked by PTZ kindling might be of clinical utility.
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Athyros VG, Tziomalos K, Karagiannis A, Mikhailidis DP. Atorvastatin: safety and tolerability. Expert Opin Drug Saf 2010; 9:667-74. [PMID: 20553090 DOI: 10.1517/14740338.2010.495385] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE OF THE FIELD Atorvastatin is the most widely used statin administered in a variety of settings, including primary and secondary prevention of cardiovascular events, in the elderly, in patients with chronic kidney disease and in diabetic patients. Therefore, the safety and tolerability of atorvastatin is of paramount importance. AREAS COVERED IN THIS REVIEW We searched MEDLINE for literature published between 1997 and 2010 on the safety and tolerability of atorvastatin. We retrieved data from randomized controlled trials, meta-analyses, post-marketing studies, reports to regulatory bodies and case reports of rare adverse events. WHAT THE READER WILL GAIN The reader will gain insight into the incidence, severity, prevention and management of the major adverse effects of atorvastatin (i.e., liver function abnormalities and muscle-related side effects) overall and in special populations. TAKE HOME MESSAGE The existing data suggest that atorvastatin is generally well tolerated across the range of its therapeutic dosage (10 - 80 mg/day).
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Affiliation(s)
- Vasilios G Athyros
- Aristotle University of Thessaloniki, Hippokration Hospital, Medical School, Second Propedeutic Department of Internal Medicine, 15 Marmara St, Thessaloniki 551 32, Greece.
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31
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Colivicchi F, Tubaro M, Santini M. Clinical implications of switching from intensive to moderate statin therapy after acute coronary syndromes. Int J Cardiol 2010; 152:56-60. [PMID: 20674999 DOI: 10.1016/j.ijcard.2010.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 05/31/2010] [Accepted: 07/02/2010] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Intensive statin therapy represents an effective option after acute coronary syndromes (ACS). Despite evidence, switching to less effective statins frequently occurs in practice. Aim of this observational study was to assess the impact of switching from intensive to moderate statin therapy on clinical outcomes after ACS. METHODS AND RESULTS A cohort of 1321 consecutive ACS patients (886 men, age 71 ± .8 years) discharged on atorvastatin 80 mg/d in a 6.5 year period was followed for 12 months after discharge. During follow-up, 557 patients (42%) were switched by primary care physicians to moderate statin therapy, either for side effects (56%) or for safety concerns (44%). No major adverse reaction was reported. Increasing age (HR 1.52 per 10-year increase, 95% CI 1.23-1.78, p=0.01), and female gender (HR 1.11, 95% CI 1.06-1.23, p=0.02) were associated with a higher probability of switch. Patients following a cardiac rehabilitation program (HR 0.64 95% CI 0.49-0.86, p=0.02) and diabetic subjects (HR 0.81, 95% CI 0.67-0.92, p=0.02) were more likely to continue atorvastatin 80 mg/d. During follow-up, a major adverse clinical event occurred in 331 patients (one-year probability 0.25, 95% CI 0.22-0.27). Multivariate analysis with Cox proportional hazards method, including statin switching as a time-dependent covariate, demonstrated that, after adjustment for demographic and clinical variables, reduction from intensive to moderate statin therapy was an independent predictor of adverse clinical outcomes (HR 2.7, 95% CI 1.7-5.1, p=0.004). CONCLUSION Switching from intensive to moderate statin therapy after ACS is associated with an increased incidence of adverse clinical events.
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Affiliation(s)
- Furio Colivicchi
- Cardiology Division, Cardiovascular Department, “San Filippo Neri” Hospital, Rome, Italy.
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Medeiros CACX, Leitão RFC, Macedo RN, Barboza DRMM, Gomes AS, Nogueira NAP, Alencar NMN, Ribeiro RA, Brito GAC. Effect of atorvastatin on 5-fluorouracil-induced experimental oral mucositis. Cancer Chemother Pharmacol 2010; 67:1085-100. [PMID: 20661736 DOI: 10.1007/s00280-010-1409-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Accepted: 07/11/2010] [Indexed: 12/21/2022]
Abstract
PURPOSE Oral mucositis (OM) is a frequent side effect in patients with cancer. We investigate the effect of atorvastatin (ATV), a cholesterol-lowering drug, on OM induced by 5-fluorouracil (5-FU) in hamsters. METHODS OM was induced by the i.p. administration of 5-FU, with excoriations of the cheek pouch mucosa. The animals were pretreated with i.p. ATV 1, 5 or 10 mg/kg or vehicle (saline and 5% (vol/vol) ethanol) 30 min before 5-FU injection and daily for 5 or 10 days. Samples of cheek pouches and main organs were removed for histopathological analysis, determination of TNF-α, IL-1β, nitrite, non-protein sulfhydryl group (NP-SH) levels, myeloperoxidase (MPO) assay and immunohistochemistry for induced nitric oxide synthase (iNOS). Blood was collected for a leukogram analysis of biochemical parameters and analysis of bacteremia. RESULTS ATV at doses of 1 and 5 mg/kg reduced mucosal damage and inflammation, as well as the levels of cytokines, nitrite and myeloperoxidase activity on the 5th and 10th day of OM and immunostaining for iNOS on the 5th day of OM.ATV at 1 mg/kg increased cheek pouch NP-SH when compared to 5-FU groups on the 10th day of OM. The association between ATV 5 mg/kg and 5-FU decreased the survival rate, amplified the leukopenia of animals, increased transaminase serum levels and caused liver lesions. We also detected the presence of Gram-negative bacillus in the blood of 100% of the animals treated with ATV 5 mg/kg + 5-FU. CONCLUSIONS Atorvastatin prevented mucosal damage and inflammation associated with 5-FU-induced OM, but the association of a higher dose of ATV with 5-FU induced hepatotoxicity and amplified leukopenia.
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Affiliation(s)
- C A C X Medeiros
- Department of Biomedical Sciences, State University of Rio Grande do Norte, Mossoró, Brazil
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Ascaso JF. [Advances in cholesterol-lowering interventions]. ACTA ACUST UNITED AC 2010; 57:210-9. [PMID: 20451478 DOI: 10.1016/j.endonu.2010.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 03/12/2010] [Accepted: 03/16/2010] [Indexed: 12/29/2022]
Abstract
Numerous epidemiological and prospective studies have shown a direct relationship between total cholesterol and low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease (cardiovascular morbidity and mortality). In many intervention studies with more than 100,000 subjects, statins have shown a powerful and significant reduction of cardiovascular events and a decrease in cardiovascular and overall mortality, far superior to those produced by any other lipid-lowering group. Consequently statins are considered to be safe and well tolerated and are the first choice in the treatment of hypercholesterolemia and in cardiovascular disease prevention. If targets are not reached, other pharmacological groups must be associated (resins, nicotinic acid, ezetimibe, fibrates, etc.). Moreover, when hypercholesterolemia is associated with low concentrations of high-density lipoprotein (HDL)-cholesterol and high triglyceride levels, the association of statins with nicotinic acid, fibrates or omega-3 should be considered. Some questions remain to be answered: what LDL-C levels are desirable in secondary prevention? Which individuals might benefit from treatment in primary prevention? Which lipid-lowering drug is the most suitable to combine with statins and diminish cardiovascular risk in each situation? The present article reviews these important points.
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Affiliation(s)
- Juan F Ascaso
- Servicio de Endocrinología y Nutrición, Departamento de Medicina, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain.
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The role of statins in neurosurgery. Neurosurg Rev 2010; 33:259-70; discussion 270. [DOI: 10.1007/s10143-010-0259-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 01/22/2010] [Accepted: 03/06/2010] [Indexed: 12/20/2022]
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Evidence-based guidelines for cardiovascular risk reduction: the safety and efficacy of high-dose statin therapy. J Cardiovasc Nurs 2010; 24:429-38. [PMID: 19786883 DOI: 10.1097/jcn.0b013e3181b4bab4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Current clinical guidelines for management of low-density lipoprotein cholesterol (LDL-C) have evolved to reflect the findings of numerous randomized clinical trials and represent an important opportunity to effectively improve the cardiovascular (CV) risk profile of a wide range of patients. Implementation of guideline-recommended LDL-C management strategies facilitates the appropriate use of all available treatments, including lifestyle and dietary changes and pharmacotherapy. Where intensive lowering of LDL-C is required, suboptimal use of statins is a major contributor to the significant number of patients who remain at an unnecessarily increased risk of CV disease as a consequence of failing to reach their guideline-recommended LDL-C goals. This underuse may be explained by concerns over the safety and efficacy of high-dose statin regimens in certain populations. These issues are explored in the context of current, evidence-based clinical guidelines for LDL-C management and, through 3 hypothetical case studies, selection of appropriate starting doses of statins, and titration to a higher dose or switching to a more potent statin, to ensure that patients reach their individual LDL-C goals and reduce their overall CV risk, is also examined.
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Budinski D, Arneson V, Hounslow N, Gratsiansky N. Pitavastatin compared with atorvastatin in primary hypercholesterolemia or combined dyslipidemia. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/clp.09.20] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Atorvastatin prevents hippocampal cell death due to quinolinic acid-induced seizures in mice by increasing Akt phosphorylation and glutamate uptake. Neurotox Res 2009; 16:106-15. [PMID: 19526287 DOI: 10.1007/s12640-009-9057-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 03/24/2009] [Accepted: 04/15/2009] [Indexed: 10/20/2022]
Abstract
Statins are cholesterol-lowering agents due to the inhibition of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. Recent studies have shown statins possess pleiotropic effects, which appear to be independent from its cholesterol-lowering action. In this study, we investigated whether atorvastatin would have protective effects against hippocampal cell death promoted by quinolinic acid (QA)-induced seizures in mice. Mice were pretreated with Atorvastatin (1 or 10 mg/kg) or vehicle (saline, 0.9%), orally, once a day for 7 days before the intracerebroventricular (i.c.v.) QA infusion (36.8 nmol/site). Atorvastatin treatment with 1 mg/kg/day did not significantly prevent QA-induced seizures (13.34%). However, administration of atorvastatin 10 mg/kg/day prevented the clonic and/or tonic seizures induced by QA in 29.41% of the mice. Additionally, administration of atorvastatin 10 mg/kg/day significantly prevented QA-induced cell death in the hippocampus. Atorvastatin treatment promoted an increased Akt phosphorylation, which was sustained after QA infusion in both convulsed and non-convulsed mice. Moreover, atorvastatin pretreatment prevented the reduction in glutamate uptake into hippocampal slices induced by QA i.c.v. infusion. These results show that atorvastatin attenuated QA-induced hippocampal cellular death involving the Akt pathway and glutamate transport modulation. Therefore, atorvastatin treatment might be a useful strategy in the prevention of brain injury caused by the exacerbation of glutamatergic toxicity in neurological diseases such as epilepsy.
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Lee ST, Chu K, Park JE, Hong NH, Im WS, Kang L, Han Z, Jung KH, Kim MW, Kim M. Atorvastatin attenuates mitochondrial toxin-induced striatal degeneration, with decreasing iNOS/c-Jun levels and activating ERK/Akt pathways. J Neurochem 2008; 104:1190-200. [DOI: 10.1111/j.1471-4159.2007.05044.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Cleves AE, Jain AN. Effects of inductive bias on computational evaluations of ligand-based modeling and on drug discovery. J Comput Aided Mol Des 2007; 22:147-59. [PMID: 18074107 DOI: 10.1007/s10822-007-9150-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 11/12/2007] [Indexed: 11/28/2022]
Abstract
Inductive bias is the set of assumptions that a person or procedure makes in making a prediction based on data. Different methods for ligand-based predictive modeling have different inductive biases, with a particularly sharp contrast between 2D and 3D similarity methods. A unique aspect of ligand design is that the data that exist to test methodology have been largely man-made, and that this process of design involves prediction. By analyzing the molecular similarities of known drugs, we show that the inductive bias of the historic drug discovery process has a very strong 2D bias. In studying the performance of ligand-based modeling methods, it is critical to account for this issue in dataset preparation, use of computational controls, and in the interpretation of results. We propose specific strategies to explicitly address the problems posed by inductive bias considerations.
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Affiliation(s)
- Ann E Cleves
- BioPharmics LLC, 36 Avila Road, San Mateo, CA 94402, USA
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Frudakis TN, Thomas MJ, Ginjupalli SN, Handelin B, Gabriel R, Gomez HJ. CYP2D6*4 polymorphism is associated with statin-induced muscle effects. Pharmacogenet Genomics 2007; 17:695-707. [PMID: 17700359 DOI: 10.1097/fpc.0b013e328012d0a9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Statin use is associated with a variety of overtly related muscle symptoms including muscle pain, myalgia, creatine kinase elevations without pain with myolysis and myositis (rhabdomyolysis), a potentially fatal side effect that led to the withdrawal of cerivastatin in 2001. Unintended drug response phenotypes have an impact on patient compliance and sometimes patient health and the assessment of risk on an individual basis could enhance therapeutic benefit. We therefore investigated whether common single nucleotide polymorphisms were associated with the expression of broadly grouped atorvastatin-induced muscle events in a case-control study (n=263 samples, n=388 SNPs). Of a number of associations identified in a discovery sample (51 atorvastatin-induced muscle and 55 normal) only those corresponding to the CYP2D6*4 allele were significantly associated in the sample (24 atorvastatin-induced muscle and 133 normal) (Discovery P=0.004, odds ratio=3.6; Validation P=0.036, odds ratio=2.7; total P=0.001, odds ratio=2.5). The frequency of the CYP2D6*4 allele was about 50% in atorvastatin-induced muscle patients but only 28% in controls, similar to that of other patient types (28.5%). The association was independent of various demographic variables and not explained by gross demographic, clinical or population-structure differences among cases and controls. Surprisingly, the CYP2D6*4 allele appeared similarly distributed among controls and patients expressing simvastatin-induced muscle events (n=169, frequency in case participants=49.2%, P=0.067, odds ratio=1.7). Our results suggest that the CYP2D6*4 allele is associated with broadly related muscle events caused by at least two structurally dissimilar HMG-CoA reductase inhibitors, and as such, may have implications for a better understanding of this statin-wide phenomena.
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Butler R, Wainwright J. Intensive statin regimens. Lancet 2007; 369:1787-1788. [PMID: 17531880 DOI: 10.1016/s0140-6736(07)60809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rob Butler
- Department of Cardiology, City General Hospital, University Hospital of North Staffordshire, Stoke on Trent ST4 6QG, UK.
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Ito DT, Molina HM, Andriolo A, Borges DR. The combination of atorvastatin and ethanol is not more hepatotoxic to rats than the administration of each drug alone. Braz J Med Biol Res 2007; 40:343-8. [PMID: 17334531 DOI: 10.1590/s0100-879x2007000300009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Accepted: 01/05/2007] [Indexed: 11/22/2022] Open
Abstract
Animal studies and premarketing clinical trials have revealed hepatotoxicity of statins, primarily minor elevations in serum alanine aminotransferase levels. The combined chronic use of medicines and eventual ethanol abuse are common and may present a synergistic action regarding liver injury. Our objective was to study the effect of the chronic use of atorvastatin associated with acute ethanol administration on the liver in a rat model. One group of rats was treated daily for 5 days a week for 2 months with 0.8 mg/kg atorvastatin by gavage. At the end of the treatment the livers were perfused with 72 mM ethanol for 60 min. Control groups (at least 4 animals in each group) consisted of a group of 2-month-old male Wistar EPM-1 rats exposed to 10% ethanol (v/v) ad libitum replacing water for 2 months, followed by perfusion of the liver with 61 nM atorvastatin for 60 min, and a group of animals without chronic ethanol treatment whose livers were perfused with atorvastatin and/or ethanol. The combination of atorvastatin with ethanol did not increase the release of injury marker enzymes (alanine aminotransferase, aspartate aminotransferase, and lactic dehydrogenase) from the liver and no change in liver function markers (bromosulfophthalein clearance, and oxygen consumption) was observed. Our results suggest that the combination of atorvastatin with ethanol is not more hepatotoxic than the separate use of each substance.
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Affiliation(s)
- D T Ito
- Departamento de Bioquímica, Escola Paulista de Medicina, Universidade Federal de São Paulo, Av. Dr. Enéas C. Aguiar, 05403-000 São Paulo, SP, Brazil
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Conforti A, Magro L, Moretti U, Scotto S, Motola D, Salvo F, Ros B, Leone R. Fluvastatin and hepatic reactions: a signal from spontaneous reporting in Italy. Drug Saf 2007; 29:1163-72. [PMID: 17147462 DOI: 10.2165/00002018-200629120-00007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Signal detection is a crucial element in recognising new adverse drug reactions (ADRs) as soon as possible. HMG-CoA reductase inhibitors ('statins'), the most potent cholesterol-lowering drugs, are generally well tolerated but can occasionally lead to liver toxicity. Pre- and postmarketing studies on statins revealed an incidence of 0.1-3% elevation in hepatic transaminase levels. However, these elevations are asymptomatic, reversible, dose related or probably due to other causes. Postmarketing studies clearly showed the lack of evidence of hepatotoxicity from statins, apart from some isolated case reports of serious hepatic damage described in the literature. It is still unclear whether serious hepatic reactions are dose related and more frequent than the expected rate in the general population. OBJECTIVE In this study, the hypothesis that fluvastatin could cause serious liver injuries more than the other statins is investigated, in the light of a quantitative and qualitative signal analysis, drug consumption data and evidence from the literature. METHODS The Italian Interregional Group of Pharmacovigilance (Gruppo Interregionale di Farmacovigilanza; GIF) is an example of signal detection within the Italian spontaneous ADR reporting system. The GIF database holds reports of suspected ADRs submitted by five Italian pharmacovigilance regional centres. In the GIF database, all reports of suspected ADRs are classified according to the WHO criteria for causality assessment. The reactions are coded according to the WHO Adverse Reaction Terminology and classified as serious or non-serious events on the basis of the WHO Critical Term List. Every 6 months the GIF database is analysed to extract potential signals through a qualitative case-by-case analysis and using a quantitative methodology called proportional reporting ratio (PRR). This methodology permitted us to identify the potential signal 'fluvastatin and hepatic reactions'. RESULTS At 31 December 2004, the GIF database contained 35 757 reports with an annual reporting rate of 170 reports per million inhabitants. We found a total of 1260 reports of ADRs related to statins, including 178 of hepatic reactions. Sixty-nine reports were attributed to fluvastatin, which showed the highest PRR in comparison with the other statins. Fluvastatin was associated with 33 serious reactions, mainly hepatitis and cholestatic hepatitis. The number of reports of severe hepatotoxicity associated with fluvastatin started to increase from 2002. About half of them did not report other suspected or concomitant drugs and in one third the hepatotoxicity occurred after <1 month of therapy. Twenty-seven out of 33 patients were female, and fluvastatin was administered at 80 mg/day in 81% of cases reporting complete data on drug dosage. CONCLUSION In the literature, serious hepatic reactions are rarely described in patients taking statins; however, data gathered by GIF suggest that cases of hepatotoxicity are reported more often than expected. In addition, GIF data seem to reveal that fluvastatin is more likely to cause hepatic reactions than the other statins. However, this is a preliminary signal and future evaluations are certainly needed to confirm it and to quantify this possible risk.
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Affiliation(s)
- Anita Conforti
- Clinical Pharmacology Unit, Reference Centre for Education and Communication, WHO Programme for International Drug Monitoring, University of Verona, Verona, Italy
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Statins in Sepsis and Acute Lung Injury. Intensive Care Med 2007. [DOI: 10.1007/978-0-387-49518-7_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW Statins are effective lipid-lowering agents used extensively in medical practice. This review summarizes the evidence for statin treatment of cardiovascular patients in the intensive care unit and briefly discusses the role of statins in prevention and treatment of sepsis as a potential future application of statins in critical care. RECENT FINDINGS Recent studies have extended the use of statin therapy to the acute manifestations of cardiovascular disease and have suggested cholesterol-independent therapeutic benefits, termed pleiotropic effects, which have added a wide scope of potential targets for statin therapy. SUMMARY Statin therapy should be continued in intensive-care patients in whom statin therapy is warranted due to underlying cardiovascular disease or significant risk thereof. In acute coronary syndromes, statin therapy should be initiated within 24-96 h regardless of pretreatment cholesterol levels. Patients undergoing vascular surgery should receive peri-operative statin therapy. Placebo-controlled clinical trials are required to consolidate the experimental and observational evidence for prevention and treatment of sepsis.
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Affiliation(s)
- Marc W Merx
- Department of Cardiology, RWTH Aachen University, Germany
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Dunkelgrun M, Schouten O, Feringa HH, Vidakovic R, Poldermans D. Beneficial effects of statins on perioperative cardiovascular outcome. Curr Opin Anaesthesiol 2006; 19:418-22. [PMID: 16829724 DOI: 10.1097/01.aco.0000236142.53969.7e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review evaluates clinical and experimental articles that have recently been published on the cardioprotective effect of perioperative statin therapy. RECENT FINDINGS Perioperative statin therapy improves short and long-term cardiac outcome following noncardiac surgery. This cardiovascular protection has been attributed to the so-called pleiotropic effects, which have a positive effect on plaque stability. With no clinical studies reporting an increased incidence of adverse effects of perioperative statin use, it appears to be a safe and helpful therapeutic option. SUMMARY Perioperative statin therapy may stabilize coronary plaques due to pleiotropic effects and results in a reduction of perioperative cardiovascular complications.
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Raffel OC, White HD. Drug Insight: statin use in the elderly. ACTA ACUST UNITED AC 2006; 3:318-28. [PMID: 16729010 DOI: 10.1038/ncpcardio0558] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Accepted: 03/15/2006] [Indexed: 11/09/2022]
Abstract
The elderly represent a notable proportion of patients who present with myocardial infarction or acute coronary syndromes. This subgroup of patients also experiences a higher incidence of adverse outcomes than younger age-groups, and, therefore, has more to gain from effective, evidence-based therapies. The efficacy of statins in secondary cardiovascular disease prevention is firmly established. The starting of therapy soon after an acute coronary event has been shown to provide added benefit. Uncertainties about the effectiveness of statins in the elderly, however, have resulted in their underuse in this population. In this review we evaluate the evidence for statin use in this important and increasingly large group of patients.
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Affiliation(s)
- O Christopher Raffel
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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