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Jung HW, Kim C, Hong S, Bae H, Choi JY, Ryu JK, Lee J, Lee K, Han K, Yang D, Park C, Yu G, Rhee M, Park S, Hyon M, Shin J, Hong B, Jin H, Lee S, Seol S, Lee S, Kim S, Lee K, Cho E, Nam C, Park T, Kim U, Kim K. Randomized, multicenter, parallel, open, phase 4 study to compare the efficacy and safety of rosuvastatin/amlodipine polypill versus atorvastatin/amlodipine polypill in hypertension patient with dyslipidemia. J Clin Hypertens (Greenwich) 2023; 25:828-844. [PMID: 37584254 PMCID: PMC10497028 DOI: 10.1111/jch.14715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/03/2023] [Accepted: 08/03/2023] [Indexed: 08/17/2023]
Abstract
The authors performed this study to investigate the efficacy and safety of a rosuvastatin (RSV)/amlodipine (AML) polypill compared with those of atorvastatin (ATV)/AML polypill. We included 259 patients from 21 institutions in Korea. Patients were randomly assigned to 1 of 3 treatment groups: RSV 10 mg/AML 5 mg, RSV 20 mg/AML 5 mg, or ATV 20 mg /AML 5 mg. The primary endpoint was the efficacy of the RSV 10.20 mg/AML 5 mg via percentage changes in LDL-C after 8 weeks of treatment, compared with the ATV 20 mg /AML 5 mg. There was a significant difference in the mean percentage change of LDL-C at 8 weeks between the RSV 10 mg/AML 5 mg and the ATV 20 mg/AML 5 mg (full analysis set [FAS]: -7.08%, 95% CI: -11.79 to -2.38, p = .0034, per-protocol analysis set [PPS]: -6.97%, 95% CI: -11.76 to -2.19, p = .0046). Also, there was a significant difference in the mean percentage change of LDL-C at 8 weeks between the RSV 20 mg/AML 5 mg and the ATV 20 mg/AML 5 mg (FAS: -10.13%, 95% CI: -15.41 to -4.84, p = .0002, PPS: -10.96%, 95% CI: -15.98 to -5.93, p < .0001). There was no significant difference in the adverse events rates between RSV 10 mg/AML 5 mg, RSV 20 mg/AML 5 mg, and ATV 20 mg/AML 5 mg. In conclusion, while maintaining safety, RSV 10 mg/AML 5 mg and the RSV 20 mg/AML 5 mg more effectively reduced LDL-C compared with the ATV 20 mg /AML 5 mg (Clinical trial: NCT03951207).
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Affiliation(s)
- Hae Won Jung
- Department of CardiologyDaegu Catholic University Medical CenterDaeguRepublic of Korea
| | - Chang‐Yeon Kim
- Department of CardiologyDaegu Catholic University Medical CenterDaeguRepublic of Korea
| | - Seung‐Pyo Hong
- Department of CardiologyDaegu Catholic University Medical CenterDaeguRepublic of Korea
| | - Han‐Joon Bae
- Department of CardiologyDaegu Catholic University Medical CenterDaeguRepublic of Korea
| | - Ji Yong Choi
- Department of CardiologyDaegu Catholic University Medical CenterDaeguRepublic of Korea
| | - Jae Kean Ryu
- Department of CardiologyDaegu Catholic University Medical CenterDaeguRepublic of Korea
| | - Jin‐bae Lee
- Department of CardiologyDaegu Catholic University Medical CenterDaeguRepublic of Korea
| | - Kyoung‐Hoon Lee
- Department of CardiologyGachon University Gil Medical CenterIncheonRepublic of Korea
| | - Kyoo‐Rok Han
- Department of CardiologyKangdong Sacred Heart HospitalGangdong‐guRepublic of Korea
| | - Dong‐Heon Yang
- Department of CardiologyKyungpook National University HospitalDaeguRepublic of Korea
| | - Chang‐Gyu Park
- Department of CardiologyKorea University Guro HospitalSeoulRepublic of Korea
| | - Gheol‐Woong Yu
- Department of CardiologyKorea University Anam HospitalSeoulRepublic of Korea
| | - Moo‐Yong Rhee
- Department of CardiologyDongguk University Ilsan Medical CenterGoyangRepublic of Korea
| | - Sung‐Ji Park
- Department of CardiologySamsung Medical CenterGangnam‐guRepublic of Korea
| | - Min‐Su Hyon
- Department of CardiologySoonchunhyang University Seoul HospitalSeoulRepublic of Korea
| | - Joon‐Han Shin
- Department of CardiologyAjou University HospitalSuwonRepublic of Korea
| | - Bum‐Kee Hong
- Department of CardiologyGangnam Severance HospitalRepublic of Korea
| | - Han‐Young Jin
- Department of CardiologyInje University Busan Paik HospitalSeoulRepublic of Korea
| | - Sung‐Yun Lee
- Department of CardiologyInje University Ilsan Paik HospitalGoyangRepublic of Korea
| | - Sang‐Hoon Seol
- Department of CardiologyInje University Haeundae Paik HospitalBusanRepublic of Korea
| | - Sang‐Rok Lee
- Department of CardiologyJeonbuk National University HospitalJeonjuRepublic of Korea
| | - Song‐Yi Kim
- Department of CardiologyJeju National University HospitalJejuRepublic of Korea
| | - Kwang‐Je Lee
- Department of CardiologyChung‐Ang University HospitalSeoulRepublic of Korea
| | - Eun‐Joo Cho
- Department of CardiologyCatholic University of Korea Yeouido St. Mary's HospitalYeongdeungpo‐guRepublic of Korea
| | - Chang‐Wook Nam
- Department of CardiologyKeimyung University Dongsan HospitalDaeguRepublic of Korea
| | - Tae‐Ho Park
- Department of CardiologyDong‐a University HospitalBusanRepublic of Korea
| | - Ung Kim
- Department of CardiologyYeungnam University Medical CenterDaeguRepublic of Korea
| | - Kee‐Sik Kim
- Department of CardiologyDaegu Catholic University Medical CenterDaeguRepublic of Korea
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Aleem M, Zainab A, Hameed A, Khan AB, Ali SZ, Younus S. Comparison of the Efficacy of Rosuvastatin 5 mg and 10 mg in Patients of Type 2 Diabetes Mellitus With Dyslipidemia. Cureus 2022; 14:e22595. [PMID: 35371720 PMCID: PMC8958143 DOI: 10.7759/cureus.22595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives We did this study intending to compare the efficacy of rosuvastatin 5 mg and 10 mg in patients of type 2 diabetes mellitus with dyslipidemia by validating their effect on lipid profile and the side effects. Methodology This study was carried out at the outpatient department of a tertiary care hospital in Multan. Three hundred patients of both genders were included. The research approach employed a parallel-controlled, randomized study. After taking relevant history and physical examination, each patient’s fasting venous blood samples were taken and sent to the institutional laboratory to analyze glycated hemoglobin (HbA1c), baseline lipid levels for cholesterol, triglycerides, low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), and high-density lipoprotein (HDL). Patients were divided into two groups based on the drug administered. One group was prescribed rosuvastatin 5 mg, and the other group was prescribed rosuvastatin 10 mg. Patients were followed up after six months to record the latest lipid profile. Data analysis was done through SPSS version 24. Results Patients in the two groups had similar lipid levels to start with. After six months of therapy, total serum cholesterol, triglycerides, and LDL-C were reduced to statistically significant levels in group two compared to group one. However, both groups showed a similar increase in serum levels of HDL-C. Patients treated with 10 mg rosuvastatin showed a slight decrease in BMI. Nine patients treated with 10 mg rosuvastatin reported myalgias compared to only one patient treated with a dose of 5 mg (p<0.005). Conclusion Our study concludes that both 5 mg and 10 mg of rosuvastatin exhibit the antihyperlipidemic effect, but high doses are associated with more side effects. Therefore, physicians should be aware of dose titration related to statins as it will ultimately lead to reduced cardiovascular mortality.
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Mueller AM, Liakoni E, Schneider C, Burkard T, Jick SS, Krähenbühl S, Meier CR, Spoendlin J. The Risk of Muscular Events Among New Users of Hydrophilic and Lipophilic Statins: an Observational Cohort Study. J Gen Intern Med 2021; 36:2639-2647. [PMID: 33751411 PMCID: PMC8390626 DOI: 10.1007/s11606-021-06651-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Statins are effective lipid-lowering drugs for the prevention of cardiovascular disease, but muscular adverse events can limit their use. Hydrophilic statins (pravastatin, rosuvastatin) may cause less muscular events than lipophilic statins (e.g. simvastatin, atorvastatin) due to lower passive diffusion into muscle cells. OBJECTIVE To compare the risk of muscular events between statins at comparable lipid-lowering doses and to evaluate if hydrophilic statins are associated with a lower muscular risk than lipophilic statins. DESIGN/SETTING Propensity score-matched cohort study using data from the United Kingdom-based Clinical Practice Research Datalink (CPRD) GOLD. PATIENTS New statin users. Cohort 1: pravastatin 20-40 mg (hydrophilic) vs simvastatin 10-20 mg (lipophilic), cohort 2: rosuvastatin 5-40 mg (hydrophilic) vs atorvastatin 10-80 mg (lipophilic), and cohort 3: simvastatin 40-80 mg vs atorvastatin 10-20 mg. MAIN MEASURES The outcome was a first record of a muscular event (myopathy, myalgia, myositis, rhabdomyolysis) during a maximum follow-up of 1 year. KEY RESULTS The propensity score-matched cohorts consisted of 1) 9,703, 2) 7,032, and 3) 37,743 pairs of statin users. Comparing the risk of muscular events between low-intensity pravastatin vs low-intensity simvastatin yielded a HR of 0.86 (95% CI 0.64-1.16). In the comparison of moderate- to high-intensity rosuvastatin vs equivalent doses of atorvastatin, we observed a HR of 1.17 (95% CI 0.88-1.56). Moderate- to high-intensity simvastatin was associated with a HR of 1.33 (95% CI 1.16-1.53), when compared with atorvastatin at equivalent doses. LIMITATIONS We could not conduct other pairwise comparisons of statins due to small sample size. In the absence of a uniform definition on the comparability of statin doses, the applied dose ratios may not fully match with all literature sources. CONCLUSIONS Our results do not suggest a systematically lower risk of muscular events for hydrophilic statins when compared to lipophilic statins at comparable lipid-lowering doses.
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Affiliation(s)
- Alexandra M Mueller
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cornelia Schneider
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Theresa Burkard
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Susan S Jick
- Boston Collaborative Drug Surveillance Program, Lexington, MA, USA.,Boston University School of Public Health, Boston, MA, USA
| | - Stephan Krähenbühl
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland.,Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland. .,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland. .,Boston Collaborative Drug Surveillance Program, Lexington, MA, USA.
| | - Julia Spoendlin
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
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4
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Deng Z, Gao S, An Y, Huang Y, Liu H, Zhu W, Lu W, He M, Xie W, Yu D, Li Y. Effects of earthworm extract on the lipid profile and fatty liver induced by a high-fat diet in guinea pigs. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:292. [PMID: 33708919 PMCID: PMC7944315 DOI: 10.21037/atm-20-5362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Non-alcoholic fatty liver disease (NAFLD), characterized by the accumulation of excess fat in the liver in people who consume little or no alcohol, is becoming increasingly common around the world, especially in developed countries. Extracts from earthworms have been used as alternative therapies for a variety of diseases but not in NAFLD. Therefore, the aim of this study was to investigate the effect of earthworm extract (EE) on diet-induced fatty liver disease in guinea pigs. Methods EE was extracted, and the effect of EE on the lipid levels and liver damage in guinea pigs fed a high-fat diet (HFD) was assessed. Thirty male guinea pigs at 3 weeks of age were allocated equally to five groups, namely, chow diet, HFD, and HFD with different dosages (0.3, 1.4 and 6.8 µg per kg bodyweight per day) of EE for 4 weeks, and their body weight was monitored throughout the experiment. Liver tissues were examined for gross morphology and histology. Serum levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), alanine transaminase (ALT) and aspartate aminotransferase (AST) were determined using an autoanalyser. Results HFD induced NAFLD in guinea pigs. HFD-fed guinea pigs that received EE treatment showed milder increases in the serum levels of TC, TG and LDL-C, as well as in the body weight growth rate, compared to the HFD group without EE supplementation. EE intervention reduced the number of lipid-containing hepatocytes, hepatocellular ballooning and sinusoidal distortion in the liver in HFD-fed animals. ALT in serum was significantly elevated by HFD. No statistically significant difference in ALT levels was found between the chow diet group and the HFD group with EE treatment. Conclusions This study demonstrates that the administration of EE suppressed the induction of serum TC, TG and LDL-C in response to HFD. EE also reduced liver damage in HFD-fed guinea pigs. These findings suggest that EE has alleviating effects on dyslipidaemia and liver damage associated with NAFLD.
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Affiliation(s)
- Zhenhan Deng
- Department of Sports Medicine, Key Laboratory of Tissue Engineering of Shenzhen, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China.,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,School of Medicine, Shenzhen University, Shenzhen, China
| | - Shanshan Gao
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Yunfei An
- Department of Animal Science, College of Animal Science and Technology, Hunan Agricultural University, Changsha, China
| | - Yong Huang
- Department of Sports Medicine, Key Laboratory of Tissue Engineering of Shenzhen, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Haifeng Liu
- Department of Sports Medicine, Key Laboratory of Tissue Engineering of Shenzhen, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Weimin Zhu
- Department of Sports Medicine, Key Laboratory of Tissue Engineering of Shenzhen, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Wei Lu
- Department of Sports Medicine, Key Laboratory of Tissue Engineering of Shenzhen, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Miao He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Wenqing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Dengjie Yu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yusheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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5
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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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Yoon DY, Park SI, Jung JA, Kim YI, Jang IJ, Chung JY. Comparison of Pharmacokinetics of a Fixed-Dose Combination of Amlodipine/Losartan/Rosuvastatin with Concomitant Administration of Amlodipine/Losartan and Rosuvastatin in Healthy Volunteers. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:661-668. [PMID: 32109991 PMCID: PMC7036667 DOI: 10.2147/dddt.s233014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/29/2020] [Indexed: 01/01/2023]
Abstract
Background A fixed-dose combination (FDC) tablet formulation of amlodipine/losartan/rosuvastatin 5/100/20 mg was developed to improve medication compliance in patients with both hypertension and dyslipidemia. The comparative pharmacokinetic study was performed to compare the profile of an FDC tablet formulation of amlodipine/losartan/rosuvastatin with that of concomitant administration of a currently marketed FDC tablet of amlodipine/losartan with a rosuvastatin tablet. Subjects and Methods A randomized, open-label, single oral dose, two-way crossover study was conducted in 60 healthy subjects. Subjects were orally administered the FDC tablet of amlodipine/losartan/rosuvastatin and a loose combination (LC) of two tablets comprising an FDC of amlodipine/losartan and rosuvastatin. Blood samples were collected for up to 144 h post dose for pharmacokinetic evaluations. Plasma concentrations of amlodipine, losartan, EXP3174 (an active metabolite of losartan), and rosuvastatin were measured by using liquid chromatography-tandem mass spectrometry. The geometric mean ratio (GMR) and its 90% confidence interval (90% CI) in the FDC treatment to LC treatment for the area under the concentration-time curve from zero to the last quantifiable time point (AUClast) and the maximum plasma concentration (Cmax) were calculated. Safety was monitored throughout the study. Results The GMR (90% CI) values of AUClast and Cmax were 0.9946 (0.9663–1.0238) and 0.9690 (0.9379–1.0011) for amlodipine, 0.9855 (0.9422–1.0308) and 0.9178 (0.8349–1.0089) for losartan, 0.9814 (0.9501–1.0136) and 0.9756 (0.9313–1.0219) for EXP3174, and 0.9448 (0.8995–0.9923) and 0.9609 (0.8799–1.0494) for rosuvastatin, respectively. No clinically significant changes were observed in any of the safety parameters, including clinical laboratory tests, vital signs, electrocardiograms, and physical examinations, between the FDC treatment and the LC treatment. Conclusion We confirmed the pharmacokinetic equivalence of the FDC and LC treatments. This triple combination FDC formulation could be a clinically useful replacement for LC therapy.
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Affiliation(s)
- Deok Yong Yoon
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Sang-In Park
- Department of Clinical Pharmacology and Therapeutics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-A Jung
- Hanmi Pharm. Co., Ltd., Seoul, Republic of Korea
| | - Yong-Il Kim
- Hanmi Pharm. Co., Ltd., Seoul, Republic of Korea
| | - In-Jin Jang
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Jae-Yong Chung
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Bundang Hospital, Seongnam, Republic of Korea
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7
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Nabati M, Janbabai G, Esmailian J, Yazdani J. Effect of Rosuvastatin in Preventing Chemotherapy-Induced Cardiotoxicity in Women With Breast Cancer: A Randomized, Single-Blind, Placebo-Controlled Trial. J Cardiovasc Pharmacol Ther 2019; 24:233-241. [PMID: 30599756 DOI: 10.1177/1074248418821721] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Chemotherapy-induced cardiotoxicity is a major and leading cause of death in breast cancer survivors. It can present decades after chemotherapy and can manifest in different ways; some chemotherapeutic agents have a powerful dose-dependent relationship with cardiotoxicity. The aim of this study was to investigate the effect of rosuvastatin on preventing chemotherapy-induced cardiotoxicity in patients with breast cancer. METHODS Our study was a randomized, single-blind, placebo-controlled trial that involved 89 women with newly diagnosed breast cancer who were scheduled to receive chemotherapy. Patients were randomly assigned to receive rosuvastatin or a placebo in a 1:1 ratio for 6 months. Echocardiography, using 2-dimensional (2D) Doppler, tissue Doppler, and speckle-tracking methods, was used to determine the absolute changes in the left ventricular systolic ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left atrial (LA) diameter, transmitral Doppler early diastolic velocity (E wave), tissue Doppler early diastolic (e') and peak systolic (s') mitral annular velocities, E/e' ratio, and global longitudinal systolic strain. RESULTS The LVEF was significantly reduced in the placebo group at the end of the study when compared with the baseline value. However, there was no significant difference in the LVEF in the intervention group (intergroup P = .012). Furthermore, compared with the intervention group at the end of the study, there was a significant increase in the 4- and 2-chamber LVESV, LA diameter, and E/e' ratio in the placebo group (intergroup P = .019, P = .024, P < .001, and P = .021, respectively) and a significant decrease in the e' and s' velocities in the placebo group (intergroup P < .001 and P < .006, respectively). CONCLUSIONS The present study showed that the prophylactic use of rosuvastatin may prevent the development of chemotherapy-induced cardiotoxicity.
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Affiliation(s)
- Maryam Nabati
- 1 Department of Cardiology, Faculty of Medicine, Fatemeh Zahra Teaching Hospital, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ghasem Janbabai
- 2 Department of Hematology, Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jamil Esmailian
- 3 Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Cardiovascular Research Center, Sari, Iran
| | - Jamshid Yazdani
- 4 Department of Biostatistics, Cardiovascular Research center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
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Ishikawa Y, Itoh T, Satoh M, Fusazaki T, Sugawara S, Nakajima S, Nakamura M, Morino Y. Impact of Water- and Lipid-Soluble Statins on Nonculprit Lesions in Patients with Acute Coronary Syndrome. Int Heart J 2018; 59:27-34. [PMID: 29279527 DOI: 10.1536/ihj.16-587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Statins can be differentiated into two types, based on their solubility, which have potentially differing effects on the coronary artery wall. However, suspected differences in statins' effects on plaque composition have not been systemically investigated.Sixty-seven patients with acute coronary syndrome (ACS) were randomly assigned to either atorvastatin (10 mg/day) or rosuvastatin (2.5 mg/day). Intravascular ultrasound (IVUS) and integrated backscatter (IB)-IVUS, an established tool to quantify each plaque's components, were performed immediately after emergent percutaneous coronary intervention (PCI). Follow-up IVUS was performed between 6 and 12 months after PCI. Serial changes in serum lipid profiles and plaque composition volumes were compared between the two groups.Thirty-five patients were eligible for serial IB-IVUS analyses. The mean low-density lipoprotein-cholesterol level significantly decreased in the atorvastatin and rosuvastatin groups (P < 0.001); plaque volumes were also significantly reduced from 82.0 ± 46.2 to 74.9 ± 41.3 mm3 (P = 0.01) and from 74.7 ± 35.3 to 67.7 ± 27.0 mm3 (P = 0.02), respectively. IB-IVUS revealed a significant reduction in fibrous volume from 33.8 ± 20.0 to 27.5 ± 14.9 mm3 (P < 0.01) and from 29.6 ± 13.6 to 24.8 ± 7.6 mm3 (P < 0.05), respectively; however, significant changes were not noted in the volume of the lipid pool for the atorvastatin group and the rosuvastatin group, respectively.Water- and lipid-soluble statins may be similarly effective in reducing coronary plaques in patients with ACS as judged qualitatively and quantitatively. Further study is needed to determine whether differences between water- and lipid-soluble statins affect plaque components.
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Affiliation(s)
- Yu Ishikawa
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Mamoru Satoh
- Department of Internal Medicine, Division of Cardiovascular Medicine, Nephrology and Endocrinology, Iwate Medical University
| | - Tetsuya Fusazaki
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Shoma Sugawara
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Satoshi Nakajima
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Motoyuki Nakamura
- Department of Internal Medicine, Division of Cardiovascular Medicine, Nephrology and Endocrinology, Iwate Medical University
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
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Worthington HC, Cheng L, Majumdar SR, Morgan SG, Raymond CB, Soumerai SB, Law MR. The impact of a physician detailing and sampling program for generic atorvastatin: an interrupted time series analysis. Implement Sci 2017; 12:141. [PMID: 29178960 PMCID: PMC5702229 DOI: 10.1186/s13012-017-0671-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 11/13/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In 2011, Manitoba implemented a province-wide program of physician detailing and free sampling for generic atorvastatin to increase use of this generic statin. We examined the impact of this unique combined program of detailing and sampling for generic atorvastatin on the use and cost of statin medicines, market share of generic atorvastatin, the choice of starting statin for new users, and switching from a branded statin to generic atorvastatin. METHODS We conducted a retrospective study of Manitoba insurance claims data for all continuously enrolled patients who filled one or more prescriptions for a statin between 2008 and 2013. Data were linked to physician-level data on the number of detailing visits and sample provision. We used interrupted time series analyses to assess policy-related changes in the use and cost of statin medicines, market share of generic atorvastatin, the choice of starting statin for new users, and switching from a branded statin to generic atorvastatin. RESULTS The detailing program reached 31% (651/2103) of physicians who prescribed a statin during the study period. Collectively, these physicians prescribed 61% of statins dispensed in the province. Free sample cards were provided to 61% (394/651) of the detailed physicians. The program did not change the level or trend in the overall statin use rate and the total cost of statins or increase the number of patients switching from another branded statin to generic atorvastatin. We found the program had a small impact on atorvastatin's market share of new prescriptions, with a level increase of 2.6%. CONCLUSIONS Though physician detailers were skilled at targeting high-prescribing physicians, a combined program of detailing visits and sample provision for generic atorvastatin did not lower overall statin costs or lead to switching from branded statins to the generic. The preceding introduction of generic atorvastatin appeared sufficient to modify prescribing patterns and decrease costs.
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Affiliation(s)
- Heather C. Worthington
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia Canada
- 201-2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Lucy Cheng
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia Canada
| | - Sumit R. Majumdar
- Department of Medicine, University of Alberta, Edmonton, Alberta Canada
| | - Steven G. Morgan
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia Canada
| | - Colette B. Raymond
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba Canada
| | | | - Michael R. Law
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia Canada
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Qian C, Wei B, Ding J, Wu H, Cai X, Li B, Wang Y. Meta-analysis comparing the effects of rosuvastatin versus atorvastatin on regression of coronary atherosclerotic plaques. Am J Cardiol 2015; 116:1521-6. [PMID: 26385518 DOI: 10.1016/j.amjcard.2015.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/04/2015] [Accepted: 08/04/2015] [Indexed: 12/17/2022]
Abstract
Rosuvastatin and atorvastatin both are high-intensity statins. However, which statin is more effective for the reversion of coronary atherosclerotic plaques remains inconclusive. We, therefore, conducted a meta-analysis to provide further evidence for proper statin selection. Pubmed, The Cochrane Library, Embase, Chinese BioMedicine, and China National Knowledge Infrastructure databases were systematically searched for eligible publications. We also manually reviewed the references from all relevant literature for more trials. Only studies that met our predefined inclusion criteria up to March 31, 2015, were enrolled. Five randomized controlled trials, 4 published in English and 1 in Chinese, were finally included in our study with a total of 1,556 participants, of whom 772 were in the rosuvastatin group and 784 in the atorvastatin group. The dose ratios of rosuvastatin versus atorvastatin were 1:2 in all included trials. Pooling across the studies demonstrated that compared with atorvastatin, rosuvastatin administration further reduced the total atheroma volume (weighted mean difference [WMD] -1.61 mm(3), 95% confidence interval [CI] -2.70 to -0.52; p = 0.004) and percent atheroma volume (WMD -0.34%, 95% CI -0.64 to -0.03; p = 0.03) and improved the lumen volume more significantly (WMD 2.10 mm(3), 95% CI 0.04 to 4.17; p = 0.046). The comparative regression of plaques was not different across subgroups. In conclusion, rosuvastatin is superior to atorvastatin in the reversion of coronary atherosclerotic plaques.
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11
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Hammami R, Jdidi J, Triki F, Hammami B, Abid L, Ksouda K, Hammami S, Abid D, Hentati M, Kammoun S. [Statins Use in Elderly Patients]. Therapie 2015; 78:therapie150057. [PMID: 26524698 DOI: 10.2515/therapie/2015057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 04/16/2015] [Indexed: 02/28/2024]
Abstract
The risk of cardiovascular disease in elderly is significantly higher than in young subjects; paradoxically some treatments that have proven their efficacy in reducing cardiovascular risk are often under prescribed in this age group. The benefits of statins in secondary cardiovascular prevention are well established in patients <80 years. In primary prevention, these drugs reduce the risk of myocardial infarction and stroke, but their effects on cardiovascular mortality remain uncertain. In very elderly patients, there are no randomized trials relative to the impact of statins on morbi-mortality in primary prevention as well in secondary prevention. Adverse effects in the elderly seem to be statistically similar to those occurring in young people , but the prescription in very old people should be individualized, taking into account the life expectancy, the life quality, the comorbidities, and especially the risk of drug interactions.
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Affiliation(s)
- Rania Hammami
- Service de Cardiologie de Sfax, CHU Hedi Chaker, Sfax, Tunisie
| | - Jihen Jdidi
- Service de Médecine Préventive, CHU Hedi Chaker, Sfax, Tunisie
| | - Faten Triki
- Service de Cardiologie de Sfax, CHU Hedi Chaker, Sfax, Tunisie
| | | | - Leila Abid
- Service de Cardiologie de Sfax, CHU Hedi Chaker, Sfax, Tunisie
| | - Kamilia Ksouda
- Laboratoire de Pharmacologie, Faculté de Médecine, Sfax, Tunisie
| | - Serria Hammami
- Laboratoire de Pharmacologie, Faculté de Médecine, Sfax, Tunisie
| | - Dorra Abid
- Service de Cardiologie de Sfax, CHU Hedi Chaker, Sfax, Tunisie
| | - Mourad Hentati
- Service de Cardiologie de Sfax, CHU Hedi Chaker, Sfax, Tunisie
| | - Samir Kammoun
- Service de Cardiologie de Sfax, CHU Hedi Chaker, Sfax, Tunisie
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12
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Cornier MA, Eckel RH. Non-traditional dosing of statins in statin-intolerant patients-is it worth a try? Curr Atheroscler Rep 2015; 17:475. [PMID: 25432858 DOI: 10.1007/s11883-014-0475-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In this manuscript, three manifestations of statin intolerance will be covered. The first, myopathy, is mostly subjective with variable complaints of myalgias often worsened by exercise, muscle cramping or weakness, and at times associated with a biomarker, elevations in creatine kinase (CK). A rare but serious manifestation can be rhabdomyolysis. The second, liver toxicity, is associated with reversible biochemical increases in transaminases and rarely other liver function tests. Finally, statin-related central nervous system (CNS) toxicity typically defined as cognitive impairment is quite rare and appears to be idiosyncratic. Statin dose alternatives will then be discussed and highlighted in the setting of the new cholesterol-lowering guidelines. Non-statin lipid-altering therapies as well as other alternative therapies will also be reviewed.
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Affiliation(s)
- Marc-Andre Cornier
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Mail Stop C26, 12348 E Montview Blvd, Aurora, CO, 80045, USA,
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13
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Múñoz O, García ÁA, Fernández DG, Higuera AM, Ruiz ÁJ, Aschner P, Toro JM, Arteaga JM, Merchán A, Sánchez Vallejo G, Villalba Y. Guía de práctica clínica para la prevención, detección temprana, diagnóstico, tratamiento y seguimiento de las dislipidemias: tratamiento farmacológico con estatinas. REVISTA COLOMBIANA DE CARDIOLOGÍA 2015. [DOI: 10.1016/j.rccar.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Jose J, Al-Tamimi FAA, Helal MM, Jimmy B, Al Riyami Q. Statin associated hepatic adverse effects: a retrospective review from a regional hospital in sultanate of oman. Oman Med J 2014; 29:351-7. [PMID: 25337312 PMCID: PMC4202230 DOI: 10.5001/omj.2014.93] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 08/03/2014] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE This study aimed at evaluating the prevalence, pattern and predisposing factors for hepatic adverse effects with statins in a regional hospital in Sultanate of Oman. METHODS A retrospective review of the patient files in Department of Medicine during the year 2011 was done to evaluate any hepatic dysfunction possibly related to statins among the patients. For each case of suspected statin induced hepatic effect, additional details on temporal relationship, pattern of presentation, management, final outcome and any contributing factors were obtained. Difference in the occurrence of hepatic effects based on the patient demographics and drug characteristics was additionally evaluated. RESULTS A total of 927 patients meeting the inclusion criteria were included for the study. Mean age of the evaluated patients was 63.1 ± 11.37 and median duration of use of statin in months was 22 (IQR, 43.25). In 40 (4%) of the 927 patients, there was presence of a hepatic effect considered to be statin related and only in 12 (1%) patients a significant transaminase rise (>3 times) was observed. Median duration of use of statin among those patients who developed suspected statin induced hepatic effects and those who did not was 45 (IQR,52) and 21 (IQR, 43) months, respectively and the difference observed was statistically significant. A significant difference in the prevalence of hepatic effects was observed only based on the duration of statin use. CONCLUSION There was an infrequent occurrence of significant hepatic effects associated with statins in the study population. Our results support the latest recommendations including from United States Federal Drug Administration (US FDA) that statins appear to be associated with a very low risk of serious liver injury and that routine periodic monitoring of transaminases does not appear to detect or prevent serious liver injury in association with statins.
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Affiliation(s)
- Jimmy Jose
- Assistant Dean (Research) and Associate Professor, School of Pharmacy, College of Pharmacy and Nursing, University of Nizwa,P.B No 33, PO 616, Birkat Al Mouz, Nizwa, Sultanate of Oman
| | - Faisal Abdullah Ali Al-Tamimi
- Senior Consultant, Physician & Rheumatologist, Department of Medicine, Nizwa Hospital, Ministry of Health, Sultanate of Oman
| | - Manal Mahmoud Helal
- Senior Specialist, Department of Medicine, Nizwa Hospital, Ministry of Health, Sultanate of Oman, and Associate Professor, General Medicine, Cairo University, Egypt
| | - Beena Jimmy
- Lecturer, School of Pharmacy, College of Pharmacy and Nursing, University of Nizwa, Nizwa, Sultanate of Oman
| | - Qasim Al Riyami
- Assistant Dean (Training) School of Pharmacy, College of Pharmacy and Nursing, University of Nizwa, Nizwa, Sultanate of Oman
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15
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Translational insight into statin-induced muscle toxicity: from cell culture to clinical studies. Transl Res 2014; 164:85-109. [PMID: 24530275 DOI: 10.1016/j.trsl.2014.01.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 01/15/2014] [Accepted: 01/17/2014] [Indexed: 02/06/2023]
Abstract
Statins are lipid-lowering drugs used widely to prevent and treat cardiovascular and coronary heart diseases. These drugs are among the most commonly prescribed medicines intended for long-term use. In general, statins are well tolerated. However, muscular adverse effects appear to be the most common obstacle that limits their use, resulting in poor patient compliance or even drug discontinuation. In addition, rare but potentially fatal cases of rhabdomyolysis have been reported with the use of these drugs, especially in the presence of certain risk factors. Previous reports have investigated statin-induced myotoxicity in vivo and in vitro using a number of cell lines, muscle tissues, and laboratory animals, in addition to randomized clinical trials, observational studies, and case reports. None of them have compared directly results from laboratory investigations with clinical observations of statin-related muscular adverse effects. To the best of our knowledge this is the first review article that combines laboratory investigation with clinical aspects of statin-induced myotoxicity. By reviewing published literature of in vivo, in vitro, and clinically relevant studies of statin myotoxicity, we aim to translate this important drug-related problem to establish a clear picture of proposed mechanisms that explain the risk factors and describe the diagnostic approaches currently used for evaluating the degree of muscle damage induced by these agents. This review provides baseline novel translational insight that can be used to enhance the safety profile, to minimize the chance of progression of these adverse effects to more severe and potentially fatal rhabdomyolysis, and to improve the overall patient compliance and adherence to long-term statin therapy.
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16
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Arshad AR. Comparison of low-dose rosuvastatin with atorvastatin in lipid-lowering efficacy and safety in a high-risk pakistani cohort: an open-label randomized trial. J Lipids 2014; 2014:875907. [PMID: 24800084 PMCID: PMC3985301 DOI: 10.1155/2014/875907] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 01/12/2023] Open
Abstract
Background. Treatment of hyperlipidemia is helpful in both primary and secondary prevention of coronary heart disease and stroke. Aim. To compare lipid-lowering efficacy of rosuvastatin with atorvastatin. Methodology. This open-label randomized controlled trial was carried out at 1 Mountain Medical Battalion from September 2012 to August 2013 on patients with type 2 diabetes, hypertension, myocardial infarction, or stroke, meriting treatment with a statin. Those with secondary causes of dyslipidemia were excluded. Blood samples for estimation of serum total cholesterol, triglycerides, HDL-C, and LDL-C were collected after a 12-hour fast. Patients were randomly allocated to receive either atorvastatin 10 mg HS or rosuvastatin 5 mg HS daily. Lipid levels were rechecked after six weeks. Results. Atorvastatin was used in 63 patients and rosuvastatin in 66. There was a greater absolute and percent reduction in serum LDL-C levels with rosuvastatin as compared to atorvastatin (0.96 versus 0.54 mg/dL; P = 0.011 and 24.34 versus 13.66%; P = 0.045), whereas reduction in all other fractions was equal. Myalgias were seen in 5 (7.94%) patients treated with atorvastatin and 8 (12.12%) patients treated with rosuvastatin (P: 0.432). Conclusion. Rosuvastatin produces a greater reduction in serum LDL-C levels and should therefore be preferred over atorvastatin.
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Affiliation(s)
- Abdul Rehman Arshad
- Department of Medicine, 1 Mountain Medical Battalion, Bagh, Azad Kashmir 12500, Pakistan
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17
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Wiklund O, Pirazzi C, Romeo S. Monitoring of lipids, enzymes, and creatine kinase in patients on lipid-lowering drug therapy. Curr Cardiol Rep 2014; 15:397. [PMID: 23888382 PMCID: PMC3751280 DOI: 10.1007/s11886-013-0397-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A number of plasma lipid parameters have been used to estimate cardiovascular risk and to be targets for treatment to reduce risk. Most risk algorithms are based on total cholesterol (T-C) or low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), and most intervention trials have targeted the LDL-C levels. Emerging measures, which in some cases may be better for risk calculation and as alternative treatment targets, are apolipoprotein B and non-HDL-C. Other lipid measures that may contribute in risk analysis are triglycerides (TG), lipoprotein(a), and lipoprotein-associated phospholipase A2. The primary treatment target in cardiovascular prevention is LDL-C, and potential alternative targets are apoB and non-HDL-C. In selected individuals at high cardiovascular (CV) risk, TG should be targeted, but HDL-C, Lp(a), and ratios such as LDL-C/HDL-C or apoB/apoAI are not recommended as treatment targets. Lipids should be monitored during titration to targets. Thereafter, lipids should be checked at least once a year or more frequently to improve treatment adherence if indicated. Monitoring of muscle and liver enzymes should be done before the start of treatment. In stable conditions during treatment, the focus should be on clinical symptoms that may alert muscle or liver complications. Routine measurement of CK or ALT is not necessary during treatment with statins.
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Affiliation(s)
- Olov Wiklund
- Wallenberg Laboratory, Department of Experimental and Clinical Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, 413 45, Göteborg, Sweden.
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A meta-analysis of randomized head-to-head trials for effects of rosuvastatin versus atorvastatin on apolipoprotein profiles. Am J Cardiol 2014; 113:292-301. [PMID: 24230979 DOI: 10.1016/j.amjcard.2013.08.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 11/23/2022]
Abstract
To determine which statin will better improve the apolipoprotein (Apo) profiles (ApoA-I levels, ApoB levels, and ApoB/A-I ratios), we performed a meta-analysis of randomized head-to-head trials of rosuvastatin versus atorvastatin therapy. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through December 2012 using Web-based search engines (PubMed and OVID). The search terms included "apolipoprotein," "rosuvastatin," "atorvastatin," "randomized," "randomly," and "randomization." Of 42 potentially relevant studies initially screened, 25 reports of randomized trials enrolling 14,283 patients were included. A pooled analysis for the percentage of changes in ApoA-I demonstrated a benefit of rosuvastatin versus atorvastatin in the comparison of all rosuvastatin/atorvastatin dose ratios (mean difference 2.97%, 3.39%, 5.77%, and 6.25%). For the percentage of changes in ApoB, a benefit was seen for rosuvastatin versus atorvastatin in the 1/1 (-6.06%) and 1/2 dose ratio (-1.80%). However, a benefit was seen for atorvastatin versus rosuvastatin in the 1/4 (2.38%) and 1/8 dose ratio (6.59%). The pooled analysis for the percentage of changes in the Apo B/A-I ratios demonstrated a benefit for rosuvastatin versus atorvastatin in the 1/1 (-7.22%) and 1/2 dose ratio (-3.51%), with no difference in the 1/4 dose ratio. In contrast, a benefit was seen for atorvastatin versus rosuvastatin in the 1/8 dose ratio (4.03%). In conclusion, rosuvastatin might increase Apo A-I levels at all dose ratios and decrease ApoB levels and ApoB/A-I ratios in the 1/1 and 1/2 dose ratio versus atorvastatin. Only higher dose atorvastatin appeared to be more effective for the reduction in ApoB levels (1/4 and 1/8 dose ratio) and Apo B/A-I ratios (1/8 dose ratio).
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Affiliation(s)
- Huseyin Naci
- From the LSE Health, London School of Economics and Political Science, London, United Kingdom (H.N.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (J.B.); and .School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (T.A.)
| | - Jasper Brugts
- From the LSE Health, London School of Economics and Political Science, London, United Kingdom (H.N.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (J.B.); and .School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (T.A.)
| | - Tony Ades
- From the LSE Health, London School of Economics and Political Science, London, United Kingdom (H.N.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (J.B.); and .School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (T.A.)
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20
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Talavera JO, Martinez G, Cervantes JL, Marin JA, Rodriguez-Briones I, Gonzalez JG, Ocampo R, Sanchez-Mijangos H, Bernal-Rosales LP, Polanco A. A double-blind, double-dummy, randomized, placebo-controlled trial to evaluate the effect of statin therapy on triglyceride levels in Mexican hypertriglyceridemic patients. Curr Med Res Opin 2013; 29:379-86. [PMID: 23323877 DOI: 10.1185/03007995.2013.766590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The most prevalent dyslipidemias in Mexico are low high-density lipoprotein (HDL) and high triglyceride (TG) levels. Hypertriglyceridemia (HTG) has been considered an independent risk factor for cardiovascular disease (CVD). The aim of this study was to evaluate the efficacy of rosuvastatin (RSV) in reducing TG levels in Mexican patients. METHODS A randomized, double-blind, double-dummy, parallel-group, placebo-controlled, multicenter, phase IV study was conducted. Patients were of both genders, ≥ 18 years old, with basal TG levels between 200 and 800 mg/dl, LDL levels ≤ 190 mg/dl. Patients were randomized to receive rosuvastatin 10 mg (Group 1), 20 mg (Group 2) or placebo (Group 3) once daily for 8 weeks. Primary efficacy was TG level; secondary efficacy was non-HDL; HDL, low-density lipoprotein (LDL), total cholesterol (TC), Apo (apolipoprotein) A1, and ApoB. Safety data were evaluated up to 30 days after the last dose of medication. The Mann-Whitney U-test was performed to contrast each RSV groups against placebo; p < 0.05 was considered significant. Trial registry number is NCT00473655. RESULTS A total of 334 patients were randomized: Group 1 = 111, Group 2 = 112, and Group 3 = 111. Basal TG median value levels were 278 mg/dl, 266 mg/dl, 279 mg/dl with median reduction (MdR) at 8 weeks of 26.6%, 32.19% and 7.58%, respectively, (Group 1 vs. Group 3 p = 0.002, and Group 2 vs. Group 3 p < 0.0001). Basal non-HDL values were 179 mg/dl, 180 mg/dl and 179 mg/dl with a MdR of 27%, 32% and 8%, respectively (Group 1 vs. Group 3 p < 0.0001, and Group 2 vs. Group 3 p < 0.0001); basal LDL vales were 130 mg/dl, 130 mg/dl and 127 mg/dl with MdR 35%, 44% and -4% (Group 1 vs. Group 3 p < 0.0001, Group 2 vs. Group 3 p < 0.0001); basal ApoB values were 114 mg/dl, 115 mg/dl and 110.5 mg/dl with MdR 25%, 33% and -0.5% (Group 1 vs. Group 3 p < 0.0001, Group 2 vs. Group 3 p < 0.001). CONCLUSION Rosuvastatin 10 and 20 mg/day significantly reduced triglycerides and improved atherogenic lipid profile in HTG Mexican patients. The main limitation was the short follow-up time period.
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Affiliation(s)
- Juan-Osvaldo Talavera
- Clinical Research Training Center, National Medical Center, XXI Century, Social Security Mexican Institute, F.D., Mexico
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Naci H, Brugts JJ, Fleurence R, Ades AE. Dose-comparative effects of different statins on serum lipid levels: a network meta-analysis of 256,827 individuals in 181 randomized controlled trials. Eur J Prev Cardiol 2013; 20:658-70. [DOI: 10.1177/2047487313483600] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Huseyin Naci
- London School of Economics & Political Science, London, UK
| | | | | | - AE Ades
- University of Bristol, Bristol, UK
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Glasgow RE, Vinson C, Chambers D, Khoury MJ, Kaplan RM, Hunter C. National Institutes of Health approaches to dissemination and implementation science: current and future directions. Am J Public Health 2012; 102:1274-81. [PMID: 22594758 PMCID: PMC3478005 DOI: 10.2105/ajph.2012.300755] [Citation(s) in RCA: 520] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2012] [Indexed: 12/20/2022]
Abstract
To address the vast gap between current knowledge and practice in the area of dissemination and implementation research, we address terminology, provide examples of successful applications of this research, discuss key sources of support, and highlight directions and opportunities for future advances. There is a need for research testing approaches to scaling up and sustaining effective interventions, and we propose that further advances in the field will be achieved by focusing dissemination and implementation research on 5 core values: rigor and relevance, efficiency, collaboration, improved capacity, and cumulative knowledge.
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Affiliation(s)
- Russell E Glasgow
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20852, USA.
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Impact of Statins on the Coagulation Status of Type 2 Diabetes Patients Evaluated by a Novel Thrombin-Generation Assay. Cardiovasc Drugs Ther 2012; 26:301-9. [DOI: 10.1007/s10557-012-6388-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Alberton M, Wu P, Druyts E, Briel M, Mills EJ. Adverse events associated with individual statin treatments for cardiovascular disease: an indirect comparison meta-analysis. QJM 2012; 105:145-57. [PMID: 21920996 DOI: 10.1093/qjmed/hcr158] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Statins are the most widely prescribed drug available. Due to this reason, it is important to understand the risks involved with the drug class and individual statins. AIM We conducted a meta-analysis and employed indirect comparisons to identify differing risk effects across statins. DESIGN We included any randomized clinical trial (RCT) of atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin and simvastatin used for cardiovascular disease event prevention. The main outcome was adverse events [all-cause mortality, cancers, rhabdomylosis, diabetes, aspartate and alanine aminotransferase (AST/ALT), and creatinine kinase (CK) increases beyond the upper limit of normal]. In order to evaluate the relative effects of each drug on adverse events, we calculated adjusted indirect comparisons of the adverse-event outcomes. RESULTS Seventy-two trials involving 159,458 patients met our inclusion criteria. Overall, statin treatments significantly increased the rate of diabetes when compared to controls (OR: 1.09; 95% CI: 1.02-1.16) and elevated AST (OR: 1.31; 95% CI: 1.04-1.66) and ALT (OR: 1.28; 95% CI: 1.11-1.48) levels when compared to controls. Using indirect comparisons, we also found that atorvastatin significantly elevated AST levels compared to pravastatin (OR: 2.21; 95% CI: 1.13-4.29) and simvastatin significantly increased CK levels when compared to rosuvastatin (OR: 4.39; 95% CI: 1.01-19.07). Higher dose studies had increased risk of AST elevations. DISCUSSION Although statins are generally well tolerated, there are risks associated with almost all drugs. With few exceptions, statins appear to exert a similar risk across individual drugs.
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Affiliation(s)
- M Alberton
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Effect of Oral Atorvastatin on CD4+CD25+ Regulatory T Cells, FoxP3 Expression, and Prognosis in Patients With ST-Segment Elevated Myocardial Infarction Before Primary Percutaneous Coronary Intervention. J Cardiovasc Pharmacol 2011; 57:536-41. [DOI: 10.1097/fjc.0b013e318211d016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Saku K, Zhang B, Noda K. Randomized head-to-head comparison of pitavastatin, atorvastatin, and rosuvastatin for safety and efficacy (quantity and quality of LDL): the PATROL trial. Circ J 2011; 75:1493-505. [PMID: 21498906 DOI: 10.1253/circj.cj-10-1281] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atorvastatin, rosuvastatin and pitavastatin are available for intensive, aggressive low-density lipoprotein cholesterol (LDL-C)-lowering therapy in clinical practice. The objective of the Randomized Head-to-Head Comparison of Pitavastatin, Atorvastatin, and Rosuvastatin for Safety and Efficacy (Quantity and Quality of LDL) (PATROL) Trial was to compare the safety and efficacy of atorvastatin, rosuvastatin and pitavastatin head to head in patients with hypercholesterolemia. This is the first prospective randomized multi-center trial to compare these strong statins (UMIN Registration No: 000000586). METHODS AND RESULTS Patients with risk factors for coronary artery disease and elevated LDL-C levels were randomized to receive atorvastatin (10mg/day), rosuvastatin (2.5mg/day), or pitavastatin (2mg/day) for 16 weeks. Safety was assessed in terms of adverse event rates, including abnormal clinical laboratory variables related to liver and kidney function and skeletal muscle. Efficacy was assessed by the changes in the levels and patterns of lipoproteins. Three hundred and two patients (from 51 centers) were enrolled, and these 3 strong statins equally reduced LDL-C and LDL particles, as well as fast-migrating LDL (modified LDL) by 40-45%. Newly developed pitavastatin was non-inferior to the other 2 statins in lowering LDL-C. There were no differences in the rate of adverse drug reactions among the 3 groups, but HbA(1c) was increased while uric acid was decreased in the atorvastatin and rosuvastatin groups. CONCLUSIONS The safety and efficacy of these 3 strong statins are equal. It is suggested that the use of these 3 statins be completely dependent on physician discretion based on patient background.
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Affiliation(s)
- Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.
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Ara R, Pandor A, Stevens J, Rafia R, Ward SE, Rees A, Durrington PN, Reynolds TM, Wierzbicki AS, Stevenson M. Prescribing high-dose lipid-lowering therapy early to avoid subsequent cardiovascular events: is this a cost-effective strategy? Eur J Prev Cardiol 2011; 19:474-83. [PMID: 21460076 DOI: 10.1177/1741826711406616] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND While evidence shows high-dose statins reduce cardiovascular events compared with moderate doses in individuals with acute coronary syndrome (ACS), many primary care trusts (PCT) advocate the use of generic simvastatin 40 mg/day for these patients. METHODS AND RESULTS Data from 28 RCTs were synthesized using a mixed treatment comparison model. A Markov model was used to evaluate the cost-effectiveness of treatments taking into account adherence and the likely reduction in cost for atorvastatin when the patent expires. There is a clear dose-response: rosuvastatin 40 mg/day produces the greatest reduction in low-density lipoprotein cholesterol (56%) followed by atorvastatin 80 mg/day (52%), and simvastatin 40 mg/day (37%). Using a threshold of £20,000 per QALY, if adherence levels in general practice are similar to those observed in RCTs, all three higher dose statins would be considered cost-effective compared to simvastatin 40 mg/day. Using the net benefits of the treatments, rosuvastatin 40 mg/day is estimated to be the most cost-effective alternative. If the cost of atorvastatin reduces in line with that observed for simvastatin, atorvastatin 80 mg/day is estimated to be the most cost-effective alternative. CONCLUSION Our analyses show that current PCT policies intended to minimize primary care drug acquisition costs result in suboptimal care.
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Affiliation(s)
- R Ara
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK.
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Yanagi K, Monden T, Ikeda S, Matsumura M, Kasai K. A crossover study of rosuvastatin and pitavastatin in patients with type 2 diabetes. Adv Ther 2011; 28:160-71. [PMID: 21222064 DOI: 10.1007/s12325-010-0098-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The effects of a low dose of rosuvastatin (ROS) and pitavastatin (PIT) on lipid profiles and inflammation markers were assessed in subjects with type 2 diabetes mellitus. METHODS A total of 90 Japanese type 2 diabetes patients with hyperlipidemia (low-density lipoprotein cholesterol [LDL-C] ≥140 mg/dL) were enrolled in this study. They were randomly assigned to four groups with open-label treatment with ROS (2.5 mg daily) or PIT (2 mg daily); two groups were sequentially treated with both drugs, with crossover of medication after 12 weeks, and the other two groups underwent treatment with either ROS or PIT for 24 weeks. The primary endpoints were the percentage changes in LDL-C, high-density lipoprotein cholesterol (HDL-C) and triglyceride, and the LDL-C/HDL-C ratio. RESULTS Both ROS and PIT lowered LDL-C and triglyceride, and increased HDL-C. In particular, significantly greater reduction in LDL-C was seen with ROS (-44.1%) than with PIT (-36.9%, P<0.01) in the crossover group from ROS to PIT, and the same result was detected in the crossover group from PIT (-34.8%) to ROS (-44.7%). The ratio of LDL-C/HDL-C was significantly reduced with ROS treatment (from 3.45 to 1.85) compared with that with PIT (from 3.45 to 2.22, P<0.01). Both ROS and PIT lowered plasma levels of high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor (TNF)-alpha, and plasminogen activator inhibitor-1 (PAI-1). In addition, the hsCRP level with the administration of ROS was significantly improved compared with the administration of PIT. There was no significant correlation between changes in LDL-C and hsCRP, TNF-alpha, and PAI-1 levels. ROS and PIT did not have an adverse effect on glycemic control in type 2 diabetes patients. CONCLUSION Therapy with both statins improved lipid profiles and reduced proinflammatory responses; however, 2.5 mg of ROS have a potent LDL-C-lowering and hsCRP-lowering effect compared with 2 mg of PIT in patients with diabetes.
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Affiliation(s)
- Kazunori Yanagi
- Department of Endocrinology and Metabolism, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
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Affiliation(s)
- J. David Spence
- Stroke Prevention & Atherosclerosis Research Centre
Robarts Research Institute
University of Western Ontario
London, Ontario, Canada (Spence,Hackam)
| | - Daniel G. Hackam
- Stroke Prevention & Atherosclerosis Research Centre
Robarts Research Institute
University of Western Ontario
London, Ontario, Canada (Spence,Hackam)
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Use of ultra high performance liquid chromatography-tandem mass spectrometry to demonstrate decreased serum statin levels after extracorporeal LDL-cholesterol elimination. J Biomed Biotechnol 2010; 2011:912472. [PMID: 21076535 PMCID: PMC2975081 DOI: 10.1155/2011/912472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 09/19/2010] [Accepted: 10/13/2010] [Indexed: 11/24/2022] Open
Abstract
Background. Using our statin analysis method, it was possible to uncover a significant drop in statin levels (atorvastatin, simvastatin, and metabolites) after extracorporeal LDL-cholesterol elimination (EE) in severe familial hypercholesterolemia (FH). The purpose of this work was to identify the mechanism underlying this drop and its clinical significance as well as to propose measures to optimize a pharmacotherapeutical regimen that can prevent the loss of statins. Methods. Ultra High Performance Liquid Chromatography (UHPLC) connected to the triple quadrupole MS/MS system was used. Patients. A group of long-term treated patients (3–12 years of treatment) with severe FH (12 patients) and treated regularly by LDL-apheresis (immunoadsorption) or haemorheopheresis (cascade filtration) were included in this study. Results. After EE, the level of statins and their metabolites decreased (atorvastatin before/after LDL-apheresis: 8.83/3.46 nmol/l; before/after haemorheopheresis: 37.02/18.94 nmol/l). A specific loss was found (concentration of atorvastatin for LDL-apheresis/haemorheopheresis: 0.28/3.04 nmol/l in washing fluids; 11.07 nmol/l in filters). To prevent substantial loss of statin concentrations, a pharmacotherapeutic regimen with a longer time interval between the dose of statins and EE is recommended (15 hours). Conclusions. A specific loss of statins was found in adsorbent columns and filters. The decrease can be prevented by the suggested dosage scheme.
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Feher A, Pusch G, Koltai K, Tibold A, Gasztonyi B, Szapary L, Feher G. Statintherapy in the primary and the secondary prevention of ischaemic cerebrovascular diseases. Int J Cardiol 2010; 148:131-8. [PMID: 20843571 DOI: 10.1016/j.ijcard.2010.08.012] [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] [Received: 03/15/2010] [Revised: 05/14/2010] [Accepted: 08/08/2010] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Stroke is a major public health problem. It is the third leading cause of death worldwide and results in hospital admissions, morbidity, and long-term disability. Despite the inconsistent or weak association between cholesterol and stroke, statins can reduce the incidence of stroke in high-risk populations and in patients with a stroke or transient ischaemic attack. METHODS The aim of our study was to review the efficacy of statin therapy in both primary and secondary stroke prevention. We also reviewed the effectiveness and cost-effectiveness among different statins and we also reviewed the possible effect of treatment added to statin monotherapy. RESULTS There is evidence that statin therapy in both primary and secondary prevention significantly reduces subsequent major coronary events but only marginally reduces the risk of stroke recurrence. There is no clear evidence of beneficial effect from statins in those with previous haemorrhagic stroke and it is unclear whether statins should be started immediately post stroke or later. There is a pressing need for direct evidence, from head-to-head trials, to determine whether individual statins provide differing protection from clinically important events in stroke prevention. It is possible that combinations of lipid-lowering agents did not improve clinical outcomes more than high-dose statin monotherapy, although clinical trials are still ongoing.
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Affiliation(s)
- Andrea Feher
- Department of Neurology, University of Pecs, School of Medicine, Pecs, Hungary
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Chatzizisis YS, Koskinas KC, Misirli G, Vaklavas C, Hatzitolios A, Giannoglou GD. Risk Factors and Drug Interactions Predisposing to Statin-Induced Myopathy. Drug Saf 2010; 33:171-87. [DOI: 10.2165/11319380-000000000-00000] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Charland SL, Malone DC. Prediction of cardiovascular event risk reduction from lipid changes associated with high potency dyslipidemia therapy. Curr Med Res Opin 2010; 26:365-75. [PMID: 19995326 DOI: 10.1185/03007990903484802] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Epidemiological data suggests for every 1% reduction in LDL-C there is a corresponding 1-1.5% reduction in cardiovascular events (CVEs). Additionally, for every 2-3% increase in HDL-C there is a reduction in CVEs by 2-4% that is independent of LDL-C. With numerous treatment options for managing dyslipidemia, it is important to evaluate agents that result in the greatest reduction of CVEs. OBJECTIVE To compare current high-potency dyslipidemia pharmacotherapy with respect to changes in LDL-C and HDL-C and estimate risk reductions for CVEs. METHODS This study is an analysis of existing published studies for dyslipidemia products marketed in the US. Literature searches were conducted using Medline, International Pharmaceutical Abstracts, Embase, and CINAH to identify trials for niacin extended-release and lovastatin (NER/L); niacin extended-release and simvastatin (NER/S); rosuvastatin (R); and, ezetimibe/simvastatin (E/S) from database inception to 1 May 2009. Demographics and changes from baseline in LDL-C and HDL-C were abstracted and HDL-C to LDL-C change (%Delta-lipids) was created for each therapy. Using a previously validated model the percent reduction in CVEs was estimated for each treatment strategy. RESULTS Data for 177 treatment arms (120 unique reports), accounting for drug and dose were abstracted. The range in mean +/- SD %Delta-lipids depending on drug dose was: E/S, 58 +/- 6 to 67 +/- 3; R, 51 +/- 5 to 65 +/- 5; NER/L, 33 +/- 7 to 75 +/- 7; and NER/S, 48 to 77 +/- 4. Risk reductions were greatest for NER/statin combinations, with percent risk reductions greater than 77% for NER/S, 2000 mg/10 mg and 83% NER/S, 2000 mg/40 mg. Ignoring medication strengths, reductions in CVEs ranged from 58% for R, 60% for E/S, 61% for NER/L, and 72% for NER/S. LIMITATIONS There are several potential limitations associated with this study including: publication bias, English only search, limited published studies with NER in combination with L or S, adherent populations, and aggregation of multiple populations. CONCLUSION The results of the analysis suggest that greater risk reductions in CVEs occur with combination therapies, especially those including niacin extended-release (NER). Up to an 83% risk reduction was estimated for the highest doses of NER and simvastatin (NER/S).
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Affiliation(s)
- Scott L Charland
- School of Pharmacy, University of Colorado, 258 Leland Creek Circle, Box 1941, Winter Park, CO 80482-1941, USA.
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Fonseca FAH, Izar MCO. Primary prevention of vascular events in patients with high levels of C-reactive protein: the JUPITER study. Expert Rev Cardiovasc Ther 2009; 7:1041-56. [PMID: 19764857 DOI: 10.1586/erc.09.93] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) study was the first large-scale, prospective study to examine the benefits of statin therapy in subjects with elevated levels of high-sensitivity C-reactive protein but with low-to-normal LDL-cholesterol levels, who were not qualified for lipid-lowering treatment according to the current guidelines for primary prevention. The JUPITER study aimed to determine whether rosuvastatin 20 mg daily would reduce the rate of first major cardiovascular events, including cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, hospitalization for unstable angina or arterial revascularization. Rosuvastatin reduced LDL-cholesterol levels by 50% and high-sensitivity C-reactive protein by 37%. Compared with placebo, the combined primary end point was reduced in 44% (p < 0.00001), and total mortality in 20% (p = 0.02). The trial confirmed the relationship between the rates of major cardiovascular events with both high-sensitivity C-reactive protein and LDL-cholesterol levels achieved after statin treatment. Interestingly, this was the first large, prospective statin trial to show benefit in the reduction of venous thromboembolism.
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Affiliation(s)
- Francisco A H Fonseca
- Lipids, Atherosclerosis and Vascular Biology Section, Discipline of Cardiology, Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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