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Zheng X, Tan L, Zhang Y. The impact of statin use on short-term and long-term mortality in patients with heart failure. Front Pharmacol 2024; 15:1397763. [PMID: 39391698 PMCID: PMC11464369 DOI: 10.3389/fphar.2024.1397763] [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: 03/08/2024] [Accepted: 09/13/2024] [Indexed: 10/12/2024] Open
Abstract
Background Heart failure (HF) is a complex disorder that has an association with increased morbidity and mortality rates globally. The association of statin use with mortality rate in individuals with HF remains unclear. Objectives To examine the association of statin use with the short-term and long-term all-cause mortality rate in critically ill individuals with HF. Methods We performed a retrospective cohort analysis based on the Medical Information Mart for Intensive Care (MIMIC)-IV database. The critically ill people with HF were assigned to a statin group and a non-statin group according to whether they had been treated with statin or not during hospitalization. The Kaplan-Meier (KM) method and Cox proportional hazard models were adopted to explore the link between statin administration and the 30-day, 90-day, as well as 1-year mortality rates. To ensure the robustness of the findings, a 1:1 nearest propensity-score matching (PSM) was also performed. Results The current research included 11,381 patients for the final analysis, with 7,561 in the statin group and 3,820 in the non-statin group. After multiple confounders were adjusted, we found that the Cox regression models revealed great beneficial effects of statin therapy on the 30-day, 90-day, as well as 1-year mortality rates among critically ill individuals with HF in the fully adjusted model. PSM also achieved consistent results. After PSM, the risk of mortality reduced by 23% for the 30-day mortality (HR = 0.77, 95%CI: 0.68-0.88, p < 0.001), 16% for the 90-day mortality rate (HR = 0.84, 95%CI: 0.75-0.93, p < 0.001), and 12% for the 1-year mortality rate (HR = 0.88, 95%CI: 0.81-0.97, p = 0.007). Patients treated with rosuvastatin had the greatest reduction in mortality rate. The 30-day, 90-day, and 1-year all-cause mortality rates were remarkably lower in patients who were treated with low-dose statins. Conclusion Our study unveiled that statin use was related to decreased short-term and long-term all-cause mortality rates in critically ill individuals with HF. Rosuvastatin was associated with the greatest reduction of all-cause mortality rates. Low-dose statins can significantly reduce short-term and long-term mortality, while high-dose statins are not significantly correlated with mortality. However, the results are not conclusive and should be interpreted with caution.
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Affiliation(s)
- Xiaoxue Zheng
- Department of Healthcare, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Long Tan
- Health Service Department, Guard Bureau of the General Office of the Central Committee of the Communist Party of China, Beijing, China
| | - Yu Zhang
- Department of Healthcare, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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2
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Braczko A, Harasim G, Kawecka A, Walczak I, Kapusta M, Narajczyk M, Stawarska K, Smoleński RT, Kutryb-Zając B. Blocking cholesterol formation and turnover improves cellular and mitochondria function in murine heart microvascular endothelial cells and cardiomyocytes. Front Physiol 2023; 14:1216267. [PMID: 37745244 PMCID: PMC10512729 DOI: 10.3389/fphys.2023.1216267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
Background: Statins and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are cornerstones of therapy to prevent cardiovascular disease, acting by lowering lipid concentrations and only partially identified pleiotropic effects. This study aimed to analyze impacts of atorvastatin and synthetic peptide PCSK9i on bioenergetics and function of microvascular endothelial cells and cardiomyocytes. Methods: Mitochondrial function and abundance as well as intracellular nucleotides, membrane potential, cytoskeleton structure, and cell proliferation rate were evaluated in mouse heart microvascular endothelial cells (H5V) and cardiomyocytes (HL-1) under normal and hypoxia-mimicking conditions (CoCl2 exposure). Results: In normal conditions PCSK9i, unlike atorvastatin, enhanced mitochondrial respiratory parameters, increased nucleotide levels, prevented actin cytoskeleton disturbances and stimulated endothelial cell proliferation. Under hypoxia-mimicking conditions both atorvastatin and PCSK9i improved the mitochondrial respiration and membrane potential in both cell types. Conclusion: This study demonstrated that both treatments benefited the endothelial cell and cardiomyocyte bioenergetics, but the effects of PCSK9i were superior.
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Affiliation(s)
- Alicja Braczko
- Department of Biochemistry, Medical University of Gdansk, Gdańsk, Poland
| | - Gabriela Harasim
- Department of Biochemistry, Medical University of Gdansk, Gdańsk, Poland
| | - Ada Kawecka
- Department of Biochemistry, Medical University of Gdansk, Gdańsk, Poland
| | - Iga Walczak
- Department of Biochemistry, Medical University of Gdansk, Gdańsk, Poland
| | | | | | - Klaudia Stawarska
- Department of Biochemistry, Medical University of Gdansk, Gdańsk, Poland
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3
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Charach L, Grosskopf I, Galin L, Guterman I, Karniel E, Charach G. Low Cholesterol Levels in Younger Heart Failure Patients May Predict Unfavorable Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1314. [PMID: 37512127 PMCID: PMC10384220 DOI: 10.3390/medicina59071314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Hypercholesterolemia is a main risk-factor leading to ischemic heart disease (IHD). However, among patients with heart failure, the use of lipid lowering drugs in the presence of low cholesterol might be dangerous. This 18-year longitudinal study of patients ≤51 years old investigated the relationship between baseline total cholesterol, low-density lipoprotein cholesterol (LDL-c) and triglyceride levels, and survival among patients with severe HF. Materials and Methods: The average NYHA score of 82 patients ≤51 years old with heart failure was 2.61. They were followed for a mean of 11.3 years (15 months-20 years). Total mortality was 22%. Patients were divided into three groups. Group 1 had plasma LDL-c levels ≤ 80 mg/dl, Group 2, 80-115 mg/dl and Group 3 > 115 mg/dl. Results: Patients with the highest baseline total cholesterol, triglyceride and LDL-c levels > 115 mg/dl had a better survival rate (83%) compared to those with LDL-c < 80 mg/dl (50% survival, p = 0.043). The association between higher LDL-c levels and lower mortality was most noticeable among patients with heart failure. Conclusion: Longitudinal follow-up found that low LDL-c levels may indicate poorer prognosis among patient with heart failure who are ≤51 years old, similar to elderly heart failure patients. Cholesterol lowering drugs in younger patients with heart failure may increase mortality.
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Affiliation(s)
- Lior Charach
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Itamar Grosskopf
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Leonid Galin
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Irit Guterman
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eli Karniel
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gideon Charach
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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4
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Niazi M, Galehdar N, Jamshidi M, Mohammadi R, Moayyedkazemi A. A Review of the Role of Statins in Heart Failure Treatment. ACTA ACUST UNITED AC 2021; 15:30-37. [PMID: 31376825 PMCID: PMC7366000 DOI: 10.2174/1574884714666190802125627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/12/2019] [Accepted: 07/07/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Heart failure is a common medical problem in the world, which has a high prevalence in both developed and developing countries. Today, among the medications used for the heart failure treatment, there are many medications with a positive cardiac contraction effect (positive inotropic such as digital glycosides, adrenergic receptor stimulants, and phosphodiesterase inhibitors), a large number of cardiac diluents (such as Angiotensin-Converting Enzyme (ACE) inhibitor group), and a few other types of drugs whose final effects are still under review. Statins are valuable drugs that are broadly prescribed in hyperlipidemia and cardiovascular patients due to their multiple properties, such as cholesterol reduction, endothelial function improvement, antioxidative, anti-inflammatory, neovascularization, and immunomodulatory activities. METHODS There is evidence that the therapeutic role of statins in HF, due to myocardial hypertrophy, show reduction in cardiomyocyte loss in the apoptosis process, oxidative stress, inflammation, and also the return of neurohormonal imbalance. However, the fact that these drugs have no sideeffects has not been confirmed in all studies, as statins prevent the production of particular beneficial and protective factors, such as coenzyme Q10 (CoQ10), while inhibiting the production of specific proteins involved in pathologic mechanisms. RESULTS Recently, it has been hypothesized that, despite the positive effects reported, high doses of statins in patients with long-term heart failure lead to progress in heart failure by inhibiting CoQ10 synthesis and intensifying hypertrophy. CONCLUSION Thus, it can be stated that the advantage of using statins depends on factors, such as stroke fraction, and the existence of other standard indications such as atherosclerotic diseases or high Low-Density Lipoprotein-C (LDL-C).
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Affiliation(s)
- Massumeh Niazi
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Nasrin Galehdar
- Cardiovascular Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Jamshidi
- Cardiovascular Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Rasool Mohammadi
- Department of Epidemiology and Biostatistics, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Alireza Moayyedkazemi
- Department of Internal Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Tsigkou V, Siasos G, Bletsa E, Panoilia ME, Papastavrou A, Kokosias G, Oikonomou E, Papageorgiou N, Zaromitidou M, Marinos G, Vavuranakis M, Stefanadis C, Papavassiliou AG, Tousoulis D. The Predictive Role for ST2 in Patients with Acute Coronary Syndromes and Heart Failure. Curr Med Chem 2020; 27:4479-4493. [DOI: 10.2174/0929867326666191016121630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/06/2019] [Accepted: 10/04/2019] [Indexed: 12/17/2022]
Abstract
Intensive research has shed light on the utilization of novel biomarkers which facilitate
the diagnosis and prognosis of patients with different medical problems. One of the
most important biomarkers especially in the spectrum of heart failure is soluble ST2 (sST2:
soluble Suppression of Tumorigenicity 2), which is involved in inflammation, fibrosis and
cardiac stress. In the revised 2017 ACC/AHA/HFSA, “Focused Update Guidelines for the
Management of Heart Failure” ST2 was given a class-IIa recommendation for the optimal
risk assessment in patients with heart failure. Many studies indicate that not only baseline but
also serial measurements of ST2 can accurately predict future cardiovascular events in patients
with Acute Coronary Syndromes and heart failure. Therefore, in this review, we are
going to discuss the studies about the prognostic significance of ST2 in patients with Acute
Coronary Syndromes, acute and chronic heart failure.
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Affiliation(s)
- Vasiliki Tsigkou
- Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Gerasimos Siasos
- Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evanthia Bletsa
- Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria-Evi Panoilia
- Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Angeliki Papastavrou
- Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgios Kokosias
- Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Oikonomou
- Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nikolaos Papageorgiou
- Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Marina Zaromitidou
- Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgios Marinos
- Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Manolis Vavuranakis
- Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Athanasios G. Papavassiliou
- Department of Biological Chemistry, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitris Tousoulis
- Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Sun D, Zhang F, Ma T, Zhang Y, Liang Z. Atorvastatin alleviates left ventricular remodeling in isoproterenol-induced chronic heart failure in rats by regulating the RhoA/Rho kinase signaling pathway. Pharmacol Rep 2020; 72:903-911. [PMID: 32144744 DOI: 10.1007/s43440-020-00085-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Chronic heart failure (CHF) is characterized by left ventricular dysfunction and altered autonomic control of cardiac function. This study aimed to investigate the effects of atorvastatin on left ventricular remodeling (LVR) and cardiac function in rats with isoproterenol-induced CHF and the possible mechanism. METHODS An isoproterenol-induced CHF model was established in rata, which were subsequently treated with atorvastatin. Echocardiography, hemodynamic, and left ventricular mass indexes were assessed. The mRNA expression of RhoA, Rho kinase, and endothelial nitric oxide synthase (eNOS) was determined by RT-qPCR. The protein expression of myosin-binding subunit (MBS), MBS-P, eNOS, phosphorylated-eNOS, RhoA, and Rho kinase was measured by Western blot analysis. The relative activity of NADPH oxidase, ROS, and NO was assessed by ELISA. RESULTS Isoproterenol-induced CHF rats treated with atorvastatin exhibited decreased left ventricular end-systolic dimension, left ventricular end-diastolic dimension, left ventricular end-diastolic pressure, left ventricular mass index, maximum fall rate of change in left ventricular pressure, heart rate (p < 0.001), expression of RhoA, Rho kinase, MBS and MBS-P (p < 0.01), and relative activity of NADPH oxidase, ROS and NO (p < 0.05) and increased left ventricular short axis fractional shortening, left ventricular end-systolic pressure, maximum rise rate of change in left ventricular pressure (p < 0.001) and expression of eNOS, and phosphorylated-eNOS ser1177 (all p < 0.05) compared with those of rats with isoproterenol-induced CHF. CONCLUSION We demonstrated that atorvastatin inhibits LVR and improves cardiac function in rats with isoproterenol-induced CHF through inhibition of the RhoA/Rho kinase signaling pathway.
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Affiliation(s)
- Dingjun Sun
- Department of Cardiology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital (Haikou People's Hospital), Haikou, 570208, People's Republic of China
| | - Fuwei Zhang
- Department of Cardiology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital (Haikou People's Hospital), Haikou, 570208, People's Republic of China
| | - Tianyi Ma
- Department of Cardiology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital (Haikou People's Hospital), Haikou, 570208, People's Republic of China
| | - Yixue Zhang
- Department of Cardiology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital (Haikou People's Hospital), Haikou, 570208, People's Republic of China
| | - Zhongshu Liang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, People's Republic of China.
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7
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Lotteau S, Ivarsson N, Yang Z, Restagno D, Colyer J, Hopkins P, Weightman A, Himori K, Yamada T, Bruton J, Steele D, Westerblad H, Calaghan S. A Mechanism for Statin-Induced Susceptibility to Myopathy. JACC Basic Transl Sci 2019; 4:509-523. [PMID: 31468006 PMCID: PMC6712048 DOI: 10.1016/j.jacbts.2019.03.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 12/12/2022]
Abstract
This study aimed to identify a mechanism for statin-induced myopathy that explains its prevalence and selectivity for skeletal muscle, and to understand its interaction with moderate exercise. Statin-associated adverse muscle symptoms reduce adherence to statin therapy; this limits the effectiveness of statins in reducing cardiovascular risk. The issue is further compounded by perceived interactions between statin treatment and exercise. This study examined muscles from individuals taking statins and rats treated with statins for 4 weeks. In skeletal muscle, statin treatment caused dissociation of the stabilizing protein FK506 binding protein (FKBP12) from the sarcoplasmic reticulum (SR) calcium (Ca2+) release channel, the ryanodine receptor 1, which was associated with pro-apoptotic signaling and reactive nitrogen species/reactive oxygen species (RNS/ROS)-dependent spontaneous SR Ca2+ release events (Ca2+ sparks). Statin treatment had no effect on Ca2+ spark frequency in cardiac myocytes. Despite potentially deleterious effects of statins on skeletal muscle, there was no impact on force production or SR Ca2+ release in electrically stimulated muscle fibers. Statin-treated rats with access to a running wheel ran further than control rats; this exercise normalized FKBP12 binding to ryanodine receptor 1, preventing the increase in Ca2+ sparks and pro-apoptotic signaling. Statin-mediated RNS/ROS-dependent destabilization of SR Ca2+ handling has the potential to initiate skeletal (but not cardiac) myopathy in susceptible individuals. Importantly, although exercise increases RNS/ROS, it did not trigger deleterious statin effects on skeletal muscle. Indeed, our results indicate that moderate exercise might benefit individuals who take statins.
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Key Words
- Ca2+, calcium
- FDB, flexor digitorum brevis
- FKBP12, FK506 binding protein (calstabin)
- GAS, gastrocnemius
- HADHA, hydroxyacyl-CoA dehydrogenase/3-ketoacyl-CoA thiolase/enoyl-CoA hydratase
- HMG CoA, 3-hydroxy-3-methylglutaryl coenzyme A
- L-NAME, N(ω)-nitro-L-arginine methyl ester
- NOS, nitric oxide synthase
- PGC1α, peroxisome proliferator-activated receptor γ co-activator 1α
- RNS, reactive nitrogen species
- ROS, reactive oxygen species
- RyR, ryanodine receptor
- SOD, superoxide dismutase
- SR, sarcoplasmic reticulum
- TUNEL, terminal deoxynucleotidyl transferase dUTP nick end labeling
- calcium leak
- exercise
- myopathy
- ryanodine receptor
- statin
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Affiliation(s)
- Sabine Lotteau
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Niklas Ivarsson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Zhaokang Yang
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Damien Restagno
- VetAgro Sup, APCSe, Université de Lyon, Marcy l’Etoile, France
| | - John Colyer
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Philip Hopkins
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
| | - Andrew Weightman
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, United Kingdom
| | - Koichi Himori
- Graduate School of Health Sciences, Sapporo Medical University, Chuo-ku, Sapporo, Japan
| | - Takashi Yamada
- Graduate School of Health Sciences, Sapporo Medical University, Chuo-ku, Sapporo, Japan
| | - Joseph Bruton
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Derek Steele
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Håkan Westerblad
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Sarah Calaghan
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
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Does Statin Benefits Patients with Heart Failure Undergoing Percutaneous Coronary Intervention? Findings from the Melbourne Interventional Group Registry. Cardiovasc Drugs Ther 2019; 32:57-64. [PMID: 29349644 DOI: 10.1007/s10557-018-6769-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The effectiveness of statins in improving clinical outcomes among patients with heart failure (HF) undergoing percutaneous coronary intervention (PCI) is unclear. We examined the association between use of statins and clinical outcomes in patients with HF included in the Melbourne Interventional Group registry. METHODS Patients were followed from 30 days to 1 year post-PCI for a primary composite outcome of all-cause mortality and hospitalisation for cardiovascular (CV) causes. Secondary outcomes included major adverse cardiac events (MACE, a composite of all-cause mortality, myocardial infarction and target vessel revascularisation) and hospitalisation for CV causes. Outcomes were compared between statin-treated and non-statin-treated patients (at 30 days post-PCI) using propensity scores to balance for risk factors. RESULTS Among 991 patients included in the inverse probability-weighted Cox model, statin use had no significant effect on the primary composite outcome [adjusted hazard ratio (aHR), 1.03; 95% confidence interval (CI), 0.68 to 1.56; p = 0.89], nor MACE (aHR, 0.99; 95% CI, 0.54 to 1.84; p = 0.99) or hospitalisation for CV causes (HR, 1.13; 95% CI, 0.74 to 1.72; p = 0.57). CONCLUSIONS Our results suggest that statin therapy may confer no significant benefits in patients with HF undergoing PCI. However, prospective randomised controlled trials are needed to provide more definitive answers.
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Charach G, Argov O, Nochomovitz H, Rogowski O, Charach L, Grosskopf I. A longitudinal 20 years of follow up showed a decrease in the survival of heart failure patients who maintained low LDL cholesterol levels. QJM 2018; 111:319-325. [PMID: 29733423 DOI: 10.1093/qjmed/hcy043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Treatment by statins is well established for primary and secondary prevention of cardiac events but may be hazardous for patients with heart failure (HF). AIM We studied the long-term (20 years) association between baseline low-density lipoprotein cholesterol (LDL-c) levels and clinical outcome in patients with severe HF. DESIGN Patients were divided into those with plasma LDL-c levels 110 mg/dl (Group 1) or >110 mg/dl (Group 2). METHODS The mean follow-up of 305 study patients with advanced HF who had an average NYHA score of 2.7 was 11.3 years (range 15 months to 20 years). Mortality during follow-up was 43%. RESULTS Patients with the highest baseline LDL-c levels had significantly improved outcome, whereas those with the lowest LDL-c levels had the highest mortality. This paradoxical effect was prominent in patients <70 years old. The negative association of LDL-c levels and mortality was most conspicuous among the HF patients who were treated with statins. DISCUSSION AND CONCLUSION Long-term follow-up findings showed that low LDL-c levels may predict a less favorable outcome in advanced HF, particularly in patients <70 years old and those taking statins. This negates the protocol of following an aggressive LDL-c-lowering strategy in younger patients with HF.
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Affiliation(s)
- G Charach
- From the Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - O Argov
- From the Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - H Nochomovitz
- From the Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - O Rogowski
- From the Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - L Charach
- From the Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - I Grosskopf
- From the Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
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10
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Venturi E, Lindsay C, Lotteau S, Yang Z, Steer E, Witschas K, Wilson AD, Wickens JR, Russell AJ, Steele D, Calaghan S, Sitsapesan R. Simvastatin activates single skeletal RyR1 channels but exerts more complex regulation of the cardiac RyR2 isoform. Br J Pharmacol 2018; 175:938-952. [PMID: 29278865 PMCID: PMC5825303 DOI: 10.1111/bph.14136] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 11/23/2017] [Accepted: 12/13/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Statins are amongst the most widely prescribed drugs for those at risk of cardiovascular disease, lowering cholesterol levels by inhibiting 3-hydroxy-3-methylglutaryl (HMG)-CoA reductase. Although effective at preventing cardiovascular disease, statin use is associated with muscle weakness, myopathies and, occasionally, fatal rhabdomyolysis. As simvastatin, a commonly prescribed statin, promotes Ca2+ release from sarcoplasmic reticulum (SR) vesicles, we investigated if simvastatin directly activates skeletal (RyR1) and cardiac (RyR2) ryanodine receptors. EXPERIMENTAL APPROACH RyR1 and RyR2 single-channel behaviour was investigated after incorporation of sheep cardiac or mouse skeletal SR into planar phospholipid bilayers under voltage-clamp conditions. LC-MS was used to monitor the kinetics of interconversion of simvastatin between hydroxy-acid and lactone forms during these experiments. Cardiac and skeletal myocytes were permeabilised to examine simvastatin modulation of SR Ca2+ release. KEY RESULTS Hydroxy acid simvastatin (active at HMG-CoA reductase) significantly and reversibly increased RyR1 open probability (Po) and shifted the distribution of Ca2+ spark frequency towards higher values in skeletal fibres. In contrast, simvastatin reduced RyR2 Po and shifted the distribution of spark frequency towards lower values in ventricular cardiomyocytes. The lactone pro-drug form of simvastatin (inactive at HMG-CoA reductase) also activated RyR1, suggesting that the HMG-CoA inhibitor pharmacophore was not responsible for RyR1 activation. CONCLUSION AND IMPLICATIONS Simvastatin interacts with RyR1 to increase SR Ca2+ release and thus may contribute to its reported adverse effects on skeletal muscle. The ability of low concentrations of simvastatin to reduce RyR2 Po may also protect against Ca2+ -dependent arrhythmias and sudden cardiac death.
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Affiliation(s)
- Elisa Venturi
- Department of PharmacologyUniversity of OxfordOxfordUK
| | - Chris Lindsay
- Department of PharmacologyUniversity of OxfordOxfordUK
- Department of Chemistry, Chemistry Research LaboratoryUniversity of OxfordOxfordUK
| | | | - Zhaokang Yang
- School of Biomedical SciencesUniversity of LeedsLeedsUK
| | - Emma Steer
- School of Biomedical SciencesUniversity of LeedsLeedsUK
| | | | | | - James R Wickens
- Department of Chemistry, Chemistry Research LaboratoryUniversity of OxfordOxfordUK
| | - Angela J Russell
- Department of PharmacologyUniversity of OxfordOxfordUK
- Department of Chemistry, Chemistry Research LaboratoryUniversity of OxfordOxfordUK
| | - Derek Steele
- School of Biomedical SciencesUniversity of LeedsLeedsUK
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11
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Yang O, Li J, Chen H, Li J, Kong J. Atorvastatin ameliorates endothelium-specific insulin resistance induced by high glucose combined with high insulin. Mol Med Rep 2016; 14:2791-8. [PMID: 27484094 DOI: 10.3892/mmr.2016.5564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 06/15/2016] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to establish an endothelial cell model of endothelium-specific insulin resistance to evaluate the effect of atorvastatin on insulin resistance-associated endothelial dysfunction and to identify the potential pathway responsible for its action. Cultured human umbilical vein endothelial cells (HUVECs) were pretreated with different concentrations of glucose with, or without, 10‑5 M insulin for 24 h, following which the cells were treated with atorvastatin. The tyrosine phosphorylation of insulin receptor (IR) and insulin receptor substrate-1 (IRS‑1), the production of nitric oxide (NO), the activity and phosphorylation level of endothelial NO synthase (eNOS) on serine1177, and the mRNA levels of endothelin‑1 (ET‑1) were assessed during the experimental procedure. Treatment of the HUVECs with 30 mM glucose and 10‑5 M insulin for 24 h impaired insulin signaling, with reductions in the tyrosine phosphorylation of IR and protein expression of IRS‑1 by almost 75 and 65%, respectively. This, in turn, decreased the activity and phosphorylation of eNOS on serine1177, and reduced the production of NO by almost 80%. By contrast, the mRNA levels of ET‑1 were upregulated. All these changes were ameliorated by atorvastatin. Taken together, these results demonstrated that high concentrations of glucose and insulin impaired insulin signaling leading to endothelial dysfunction, and that atorvastatin ameliorated these changes, acting primarily through the phosphatidylinositol 3-kinase/Akt/eNOS signaling pathway.
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Affiliation(s)
- Ou Yang
- Department of Cadre Ward, First Hospital, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinliang Li
- Department of Cardiology, Heilongjiang Provincial Hospital, Harbin, Heilongjiang 150001, P.R. China
| | - Haiyan Chen
- Department of Cadre Ward, First Hospital, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jie Li
- Department of Cadre Ward, First Hospital, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jian Kong
- Department of Cadre Ward, First Hospital, Jilin University, Changchun, Jilin 130021, P.R. China
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12
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Pugh SD, MacDougall DA, Agarwal SR, Harvey RD, Porter KE, Calaghan S. Caveolin contributes to the modulation of basal and β-adrenoceptor stimulated function of the adult rat ventricular myocyte by simvastatin: a novel pleiotropic effect. PLoS One 2014; 9:e106905. [PMID: 25211146 PMCID: PMC4161364 DOI: 10.1371/journal.pone.0106905] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/10/2014] [Indexed: 12/22/2022] Open
Abstract
The number of people taking statins is increasing across the globe, highlighting the importance of fully understanding statins' effects on the cardiovascular system. The beneficial impact of statins extends well beyond regression of atherosclerosis to include direct effects on tissues of the cardiovascular system ('pleiotropic effects'). Pleiotropic effects on the cardiac myocyte are often overlooked. Here we consider the contribution of the caveolin protein, whose expression and cellular distribution is dependent on cholesterol, to statin effects on the cardiac myocyte. Caveolin is a structural and regulatory component of caveolae, and is a key regulator of cardiac contractile function and adrenergic responsiveness. We employed an experimental model in which inhibition of myocyte HMG CoA reductase could be studied in the absence of paracrine influences from non-myocyte cells. Adult rat ventricular myocytes were treated with 10 µM simvastatin for 2 days. Simvastatin treatment reduced myocyte cholesterol, caveolin 3 and caveolar density. Negative inotropic and positive lusitropic effects (with corresponding changes in [Ca2+]i) were seen in statin-treated cells. Simvastatin significantly potentiated the inotropic response to β2-, but not β1-, adrenoceptor stimulation. Under conditions of β2-adrenoceptor stimulation, phosphorylation of phospholamban at Ser16 and troponin I at Ser23/24 was enhanced with statin treatment. Simvastatin increased NO production without significant effects on eNOS expression or phosphorylation (Ser1177), consistent with the reduced expression of caveolin 3, its constitutive inhibitor. In conclusion, statin treatment can reduce caveolin 3 expression, with functional consequences consistent with the known role of caveolae in the cardiac cell. These data are likely to be of significance, particularly during the early phases of statin treatment, and in patients with heart failure who have altered β-adrenoceptor signalling. In addition, as caveolin is ubiquitously expressed and has myriad tissue-specific functions, the impact of statin-dependent changes in caveolin is likely to have many other functional sequelae.
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Affiliation(s)
- Sara D. Pugh
- School of Biomedical Sciences, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - David A. MacDougall
- School of Biomedical Sciences, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Shailesh R. Agarwal
- Department of Pharmacology, University of Nevada Reno, Reno, Nevada, United States of America
| | - Robert D. Harvey
- Department of Pharmacology, University of Nevada Reno, Reno, Nevada, United States of America
| | - Karen E. Porter
- Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Sarah Calaghan
- School of Biomedical Sciences, University of Leeds, Leeds, West Yorkshire, United Kingdom
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13
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Khodayar MJ, Kiani M, Hemmati AA, Rezaie A, Zerafatfard MR, Rashidi Nooshabadi MR, Goudarzi M. The preventive effect of atorvastatin on paraquat-induced pulmonary fibrosis in the rats. Adv Pharm Bull 2014; 4:345-9. [PMID: 25436189 DOI: 10.5681/apb.2014.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 02/01/2014] [Accepted: 02/01/2014] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Pulmonary fibrosis is a potentially lethal inflammatory disease and there has been no effective medication for this progressive disease up to now. As a model, different therapeutic approaches have been applied for paraquat-induced pulmonary injury and fibrosis. Atorvastatin besides cholesterol-lowering effects possesses anti-inflammatory and anti-oxidant properties. The current study was designed to investigate the preventive anti-fibrotic effects of atorvastatin on paraquat-induced pulmonary fibrosis in rats. METHODS The rats were randomly divided into five experimental groups. Group I, control group (saline), group II received a single oral dose of 20 mg/kg paraquat with no treatment and III, IV and V groups received atorvastatin at the doses of 10, 20, and 40 mg/kg/day orally one week before and three weeks after paraquat administration, respectively. The rats were sacrificed 21 days after paraquat. Lung hydroxyproline and serum levels of malondialdehyde (MDA) were determined and lung indices and semi-quantitative histopathological changes were evaluated. RESULTS Paraquat could significantly increase the serum MDA and lung hydroxyproline levels. Elevated content of tissue hydroxyproline and serum levels of malondialdehyde induced by paraquat, attenuated by atorvastatin at the doses of 10, 20 and 40 mg/kg. Furthermore, histopathological findings and the amount of lung indices showed the beneficial preventive role of atorvastatin in rat pulmonary fibrosis induced by paraquat. CONCLUSION In conclusion, the present data show that atorvastatin alleviate the toxic effects of paraquat under the experimental circumstances and may be a useful agent in cases who are in contact or poisoned with paraquat.
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Affiliation(s)
- Mohammad Javad Khodayar
- Department of Pharmacology and Toxicology, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. ; Toxicology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Milad Kiani
- Department of Pharmacology and Toxicology, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Asghar Hemmati
- Department of Pharmacology and Toxicology, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Anahita Rezaie
- Department of Pathology, Faculty of Veterinary Medicine, Shahid Chamran University, Ahvaz, Iran
| | - Mohammad Rahim Zerafatfard
- Department of Pharmacology and Toxicology, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Mehdi Goudarzi
- Department of Pharmacology and Toxicology, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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14
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Tousoulis D, Oikonomou E, Siasos G, Stefanadis C. Statins in heart failure--With preserved and reduced ejection fraction. An update. Pharmacol Ther 2013; 141:79-91. [PMID: 24022031 DOI: 10.1016/j.pharmthera.2013.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 08/12/2013] [Indexed: 12/26/2022]
Abstract
HMG-CoA reductase inhibitors or statins beyond their lipid lowering properties and mevalonate inhibition exert also their actions through a multiplicity of mechanisms. In heart failure (HF) the inhibition of isoprenoid intermediates and small GTPases, which control cellular function such as cell shape, secretion and proliferation, is of clinical significance. Statins share also the peroxisome proliferator-activated receptor pathway and inactivate extracellular-signal-regulated kinase phosphorylation suppressing inflammatory cascade. By down-regulating Rho/Rho kinase signaling pathways, statins increase the stability of eNOS mRNA and induce activation of eNOS through phosphatidylinositol 3-kinase/Akt/eNOS pathway restoring endothelial function. Statins change also myocardial action potential plateau by modulation of Kv1.5 and Kv4.3 channel activity and inhibit sympathetic nerve activity suppressing arrhythmogenesis. Less documented evidence proposes also that statins have anti-hypertrophic effects - through p21ras/mitogen activated protein kinase pathway - which modulate synthesis of matrix metalloproteinases and procollagen 1 expression affecting interstitial fibrosis and diastolic dysfunction. Clinical studies have partly confirmed the experimental findings and despite current guidelines new evidence supports the notion that statins can be beneficial in some cases of HF. In subjects with diastolic HF, moderately impaired systolic function, low b-type natriuretic peptide levels, exacerbated inflammatory response and mild interstitial fibrosis evidence supports that statins can favorably affect the outcome. Under the lights of this evidence in this review article we discuss the current knowledge on the mechanisms of statins' actions and we link current experimental and clinical data to further understand the possible impact of statins' treatment on HF syndrome.
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Affiliation(s)
- Dimitris Tousoulis
- 1st Cardiology Department, University of Athens Medical School, "Hippokration" Hospital, Athens, Greece.
| | - Evangelos Oikonomou
- 1st Cardiology Department, University of Athens Medical School, "Hippokration" Hospital, Athens, Greece
| | - Gerasimos Siasos
- 1st Cardiology Department, University of Athens Medical School, "Hippokration" Hospital, Athens, Greece
| | - Christodoulos Stefanadis
- 1st Cardiology Department, University of Athens Medical School, "Hippokration" Hospital, Athens, Greece
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15
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Influence of combined treatment with mianserin and simvastatin on selected biochemical serum parameters of liver and kidney function in rats. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2013. [DOI: 10.12923/j.2084-980x/26.3/a.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The aim of the present study was to assess the impact of combined 14-day treatment with mianserin (10 mg/kg) and simvastatin (1 or 10 mg/kg) on selected biochemical liver and kidney parameters in rats (AST and ALT activities and the concentrations of AFP, total protein, urea, creatinine and ß2-M). The results showed the increase in both transaminases activities, creatinine concentration and the decrease of AFP, total protein and ß2-M concentrations. The results indicate that 14-day combined administration of mianserin with simvastatin negatively affects the liver functioning. The observed changes in kidney biochemical parameters may suggest a risk of renal dysfunction during long-term combined treatment with these drugs.
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16
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Kumazaki M, Ando H, Ushijima K, Fujimura A. Comparative effects of statins on murine cardiac gene expression profiles in normal mice. Eur J Pharmacol 2013; 707:71-7. [DOI: 10.1016/j.ejphar.2013.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 12/01/2022]
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17
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Tousoulis D, Oikonomou E, Siasos G, Chrysohoou C, Zaromitidou M, Kioufis S, Maniatis K, Dilaveris P, Miliou A, Michalea S, Papavassiliou AG, Stefanadis C. Dose-dependent effects of short term atorvastatin treatment on arterial wall properties and on indices of left ventricular remodeling in ischemic heart failure. Atherosclerosis 2013; 227:367-72. [PMID: 23433403 DOI: 10.1016/j.atherosclerosis.2013.01.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/07/2013] [Accepted: 01/07/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Statins, beyond their lipid lowering role, exert beneficial effect on endothelial function in patients with atherosclerosis. Aim of the present study was to examine the short term pleiotropic effects of different doses of atorvastatin treatment, on endothelial function, arterial stiffness and indices of left ventricular remodeling in heart failure (HF) patients. METHODS We studied the effect of 4 weeks administration of atorvastatin in 22 patients with ischemic HF. The study was carried out on two separate arms, one with atorvastatin 40 mg/d and one with atorvastatin 10 mg/d (randomized, double-blind, cross-over design). Endothelial function was evaluated by flow mediated dilation (FMD) in the brachial artery and arterial stiffness by augmentation index (AIx). Serum levels of matrix metalloproteinase-9 (MMP-9) and intracellular adhesion molecule-1 (sICAM-1) were measured as biomarkers of left ventricular remodeling and endothelial function, respectively, while, b-type natriuretic peptide (BNP) was measured as a marker of left ventricular function. RESULTS Compared to baseline, atorvastatin 40 mg/d significantly improved FMD values (3.18 ± 3.03% vs. 5.98 ± 2.49%, p = 0.001) and AIx values (25.98 ± 8.55% vs. 23.09 ± 8.87%, p = 0.046). In addition, compared to baseline measurements, treatment with atorvastatin 40 mg/d resulted in significantly decreased levels of serum logMMP-9 levels (2.47 ± 0.23 ng/ml vs. 2.39 ± 0.24 ng/ml, p = 0.04) and of logICAM-1 levels (2.46 ± 0.13 ng/ml vs. 2.37 ± 0.16 ng/ml, p < 0.001). No significant changes were found after treatment with atorvastatin 10 mg/d in the aforementioned parameters. CONCLUSIONS Short term treatment with 40 mg/d of atorvastatin exerts beneficial impact on arterial wall properties and on indices of left ventricle remodeling in heart failure patients.
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Affiliation(s)
- Dimitris Tousoulis
- 1st Cardiology Department, University of Athens Medical School, "Hippokration" Hospital, Vasilissis Sofias 114, TK 115 28 Athens, Greece.
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18
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Tousoulis D, Papageorgiou N, Briasoulis A, Androulakis E, Charakida M, Tsiamis E, Stefanadis C. Conflicting effects of nitric oxide and oxidative stress in chronic heart failure: potential therapeutic strategies. Heart Fail Rev 2012; 17:65-79. [PMID: 21293971 DOI: 10.1007/s10741-011-9228-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chronic heart failure (CHF) is characterized by decreased nitric oxide (NO) bioavailability. In addition, the beneficial NO turns to be deleterious when it reacts with superoxide anion, leading to peroxynitrite formation. Numerous experimental and clinical studies have reported increased production of reactive oxygen species (superoxide, hydrogen peroxide, hydroxyl radical) both in animals and patients with CHF. Moreover, there are indicative data suggesting mechanisms associated with endothelial dysfunction in states of CHF, mainly attributed to decreased NO bioavailability and enhanced inactivation of the latter. Thus, such molecules appear to be potential targets in patients with CHF. These patients are strong candidates to receive a variety of therapeutic agents, some of which have known antioxidant effects. Classic treatment with statins or angiotensin converting enzyme inhibitors has been found to be beneficial in restoring NO and improving myocardial function and structure. Other agents such as sildenafil and b-blockers along with novel agents such as NO synthase transcription enhancers have been proved to be also beneficial, but their use for such a purpose is still controversial. Approaches using more-effective antioxidants or targeting myocardial oxidant-producing enzymes and oxidative or nitrosative stress might be promising strategies in the future.
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Immediate administration of atorvastatin decreased the serum MMP-2 level and improved the prognosis for acute heart failure. J Cardiol 2012; 59:374-82. [PMID: 22402418 DOI: 10.1016/j.jjcc.2012.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 01/17/2012] [Accepted: 01/20/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE We have reported that matrix metalloproteinase-2 (MMP-2) increased in acute heart failure (AHF) and better prognosis was found in patients with greater reduction in MMP-2. We assessed whether a statin decreased MMP-2 in AHF. METHODS AND RESULTS The serum MMP-2 levels were measured on admission (Day 1), Day 3, Day 7, and Day 14 in 50 AHF patients. The patients were randomized to either atorvastatin (n=25) or control group (n=25). Atorvastatin (10-20mg/day) was started within 12h after their admission and then was continued for two weeks. There were no differences in the serum levels of MMP-2 on Day 1 between atorvastatin group (1400.4±318.6ng/ml) and control group (1292.7±384.7ng/ml). MMP-2 significantly decreased in both groups on Day 3, 7, and 14. However, the MMP-2 value on Day 3 compared to Day 1 was observed to have decreased significantly in atorvastatin group (561.8±235.1ng/ml) compared to control group (272.6±270.6ng/ml; p=0.001). HF events which were defined as death from HF, readmission to hospital for HF, or prolonged hospital stay because of uncontrollable HF, occurred more in control group than in atorvastatin group. Kaplan-Meier curves showed that the prognosis of HF was significantly better in atorvastatin group as compared with control group (log-rank test, p=0.037). CONCLUSION In addition to conventional HF therapy, an early start of atorvastatin caused a great decrease in MMP-2 and also improved HF events in AHF.
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20
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Abstract
Heart failure (HF) is a clinical syndrome manifested by signs and symptoms of low cardiac output, pulmonary, and/or systemic congestion. Immunologically, HF is defined as a state of immune activation and persistent inflammation, especially the circulatory levels of inflammatory cytokines have been found to increase. Traditional drugs used in HF have expressed immunomodulatory and/or anticytokine activities that may participate in their therapeutic efficacy in the disease. The angiotensin-converting enzyme inhibitors like captopril and enalapril as well as the angiotensin II receptor antagonist losartan indicated in HF exerted reducing effects on the inflammatory cytokines such as tumor necrosis factor-alpha and interleukin-6 at experimental and clinical levels. Aldosterone antagonists like spironolactone when administered concomitantly with losartan can attenuate angiotensin II-enhanced cytokine production in HF. Carvedilol beta-adrenergic blockers showed a wider spectrum of anti-inflammatory/anticytokine activity that proved to be associated with improvement of cardiac function and ejection fraction in patients with HF. The poor prognosis in HF despite the long experience with its treatment necessitated thinking about new drugs to be added to the traditional ones. Methotrexate and statins are examples of these drugs, especially because they exert immunologic effects. A low dose of methotrexate has been considered as a hopeful adjunct therapy in chronic HF, but large long-term clinical trials are required. Statins showed conflicting results, although they might be useful early after acute ischemic events associated with left ventricular dysfunction or failure, especially in younger patients with less advanced HF.
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Feng L, Zhou L, Sun Y, Gui J, Wang X, Wu P, Wan J, Ren Y, Qiu S, Wei X, Li J. Specific inhibitions of annonaceous acetogenins on class II 3-hydroxy-3-methylglutaryl coenzyme A reductase from Streptococcus pneumoniae. Bioorg Med Chem 2011; 19:3512-9. [PMID: 21550257 DOI: 10.1016/j.bmc.2011.04.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 04/08/2011] [Accepted: 04/10/2011] [Indexed: 11/15/2022]
Abstract
3-Hydroxy-3-methylglutaryl coenzyme A reductase (class II HMGR) could serve as a potential target to discover drugs fighting against the invasive diseases originated from Streptococcus pneumoniae, one of the major causes of bacterial disease in human. However, no strongly effective inhibitors of class II HMGR have been found so far. In the present study, for the first time, four annonaceous acetogenins (ACGs) were explored for the inhibition on S. pneumoniae HMGR. The results showed that the ACGs had higher inhibitory activities against S. pneumoniae HMGR with K(i) values in the range of 6.45-20.49 μM than the statin drug lovastatin (K(i)=116.25 μM), a classical inhibitor of class I HMGR. Then, three-dimensional modeling and docking simulations analyzed the possible binding mode of ACGs to S. pneumoniae HMGR and suggested a kind of novel structural and binding mode for designing promising inhibitor candidates of the targeted enzyme S. pneumoniae II HMGR.
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Affiliation(s)
- Lingling Feng
- Key Laboratory of Pesticide & Chemical Biology (CCNU), Ministry of Education, College of Chemistry, Central China Normal University, Wuhan 430079, PR China.
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Tousoulis D, Andreou I, Tentolouris C, Antoniades C, Papageorgiou N, Gounari P, Kotrogiannis I, Miliou A, Charakida M, Trikas A, Stefanadis C. Comparative effects of rosuvastatin and allopurinol on circulating levels of matrix metalloproteinases and tissue inhibitors of metalloproteinases in patients with chronic heart failure. Int J Cardiol 2010; 145:438-43. [DOI: 10.1016/j.ijcard.2009.05.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Revised: 05/15/2009] [Accepted: 05/22/2009] [Indexed: 10/20/2022]
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Low-density lipoprotein cholesterol level in patients with acute myocardial infarction having percutaneous coronary intervention (the cholesterol paradox). Am J Cardiol 2010; 106:1061-8. [PMID: 20920639 DOI: 10.1016/j.amjcard.2010.06.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 06/02/2010] [Accepted: 06/02/2010] [Indexed: 11/22/2022]
Abstract
The relation between low-density lipoprotein (LDL) cholesterol levels and clinical outcomes after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has not been described. A total of 9,571 eligible patients (mean age 62.6 ± 12.5 years, 6,967 men) who underwent PCI with a final diagnosis of AMI from the Korea Acute Myocardial Infarction Registry (KAMIR) were divided into 5 groups according to LDL cholesterol level: < 70, 70 to 99, 100 to 129, 130 to 159, and ≥ 160 mg/dl. Clinical outcomes in hospital and 1 and 12 months after PCI in patients with AMI were examined. Age and co-morbidities decreased as LDL cholesterol increased. Patients with higher LDL cholesterol levels had favorable hemodynamic status and laboratory findings. Lifesaving medications, including lipid-lowering drugs, were underused in patients with lower LDL cholesterol levels. Clinical outcomes in hospital and 1 and 12 months after PCI showed better results as LDL cholesterol increased, except for patients with LDL cholesterol levels ≥ 160 mg/dl. In a Cox proportional-hazards model, LDL cholesterol level was not an independent predictor of mortality at 12 months, after adjusting for clinical characteristics including demographics and biologic data. In conclusion, the cholesterol paradox in patients with AMI is related to confounding by baseline characteristics associated with survival. More intensive treatment including lipid-lowering therapy for AMI in patients with lower LDL cholesterol level may result in better clinical outcomes.
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Sadowitz B, Seymour K, Costanza MJ, Gahtan V. Basic Science Review Section: Statin Therapy—Part II: Clinical Considerations for Cardiovascular Disease. Vasc Endovascular Surg 2010; 44:421-33. [DOI: 10.1177/1538574410363833] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, commonly known as statins, are the medical treatment of choice for hypercholesterolemia. In addition to achieving a therapeutic decrease in serum cholesterol levels, statin therapy appears to promote pleiotropic effects that are independent of changes in serum cholesterol. These cholesterol lowering and pleiotropic effects are beneficial not only for the coronary circulation, but for the myocardium and peripheral arterial system as well. Patients receiving statin therapy must be carefully monitored, however, as statins potentially have harmful side effects and drug interactions. This article is part II of a 2-part review, and it focuses on the clinical aspects of statin therapy in cardiovascular disease.
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Affiliation(s)
- Benjamin Sadowitz
- Division of Vascular Surgery and Endovascular Services, SUNY Upstate Medical University, Syracuse, NY, USA, Department of Veterans Affairs, VA Healthcare Network Upstate New York at Syracuse, Syracuse, NY, USA
| | - Keri Seymour
- Division of Vascular Surgery and Endovascular Services, SUNY Upstate Medical University, Syracuse, NY, USA, Department of Veterans Affairs, VA Healthcare Network Upstate New York at Syracuse, Syracuse, NY, USA
| | - Michael J. Costanza
- Division of Vascular Surgery and Endovascular Services, SUNY Upstate Medical University, Syracuse, NY, USA, , Department of Veterans Affairs, VA Healthcare Network Upstate New York at Syracuse, Syracuse, NY, USA
| | - Vivian Gahtan
- Division of Vascular Surgery and Endovascular Services, SUNY Upstate Medical University, Syracuse, NY, USA, Department of Veterans Affairs, VA Healthcare Network Upstate New York at Syracuse, Syracuse, NY, USA
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Voulgari C, Moyssakis I, Papazafiropoulou A, Perrea D, Kyriaki D, Katsilambros N, Tentolouris N. The impact of metabolic syndrome on left ventricular myocardial performance. Diabetes Metab Res Rev 2010; 26:121-7. [PMID: 20131336 DOI: 10.1002/dmrr.1063] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) is common and is associated with increased cardiovascular morbidity and mortality. Recent prospective studies suggested that MetS is associated with increased risk of heart failure. In the present cross-sectional study, we examined the association between left ventricular myocardial performance with MetS. MATERIALS AND METHODS A total of 550 non-diabetic subjects, 275 without MetS and 275 with MetS, matched for gender, age and body mass index and free of clinically apparent macrovascular disease were studied. MetS was diagnosed using the NCEP-ATP III criteria. Left ventricular myocardial performance was assessed using the Tei index. RESULTS Both men and women with MetS had higher values of the Tei index, indicating worse myocardial performance, in comparison with those without MetS (p < 0.001). Participants with a cluster of more components of the MetS had higher Tei index values than those with fewer components of the MetS. In addition, among normotensive subjects, those with MetS had significantly higher Tei index values than subjects without MetS. Multivariate linear regression analysis, after adjustment for age and body mass index, demonstrated that MetS status and from the individual components of the MetS, high fasting blood glucose levels, higher blood pressure, low high density lipoprotein levels and high waist circumference were associated with worse myocardial performance. CONCLUSION MetS is associated with subclinical myocardial dysfunction in both men and women. Strategies to reduce the cardiovascular burden and the risk of heart failure associated with MetS should aim at prevention of the MetS and its related conditions.
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Affiliation(s)
- Christina Voulgari
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, 33 Lakonias Street, Athens, Greece
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Park DJ, Jeong MH, Park KH, Sim DS, Hong YJ, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Clinical Effects of Statin in Elderly Patients with Acute Myocardial Infarction and Left Ventricular Dysfunction Who underwent Percutaneous Coronary Intervention. Chonnam Med J 2010. [DOI: 10.4068/cmj.2010.46.2.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dong Jin Park
- The Heart Center of Chonnam National University Hospital, Heart Research Center designated by Health, Welfare and Family Affairs, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Heart Research Center designated by Health, Welfare and Family Affairs, Gwangju, Korea
| | - Keun-Ho Park
- The Heart Center of Chonnam National University Hospital, Heart Research Center designated by Health, Welfare and Family Affairs, Gwangju, Korea
| | - Doo Sun Sim
- The Heart Center of Chonnam National University Hospital, Heart Research Center designated by Health, Welfare and Family Affairs, Gwangju, Korea
| | - Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Heart Research Center designated by Health, Welfare and Family Affairs, Gwangju, Korea
| | - Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Heart Research Center designated by Health, Welfare and Family Affairs, Gwangju, Korea
| | - Youngkeun Ahn
- The Heart Center of Chonnam National University Hospital, Heart Research Center designated by Health, Welfare and Family Affairs, Gwangju, Korea
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital, Heart Research Center designated by Health, Welfare and Family Affairs, Gwangju, Korea
| | - Jong Chun Park
- The Heart Center of Chonnam National University Hospital, Heart Research Center designated by Health, Welfare and Family Affairs, Gwangju, Korea
| | - Jung Chaee Kang
- The Heart Center of Chonnam National University Hospital, Heart Research Center designated by Health, Welfare and Family Affairs, Gwangju, Korea
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27
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Charach G, George J, Roth A, Rogowski O, Wexler D, Sheps D, Grosskopf I, Weintraub M, Keren G, Rubinstein A. Baseline low-density lipoprotein cholesterol levels and outcome in patients with heart failure. Am J Cardiol 2010; 105:100-4. [PMID: 20102899 DOI: 10.1016/j.amjcard.2009.08.660] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Revised: 08/12/2009] [Accepted: 08/12/2009] [Indexed: 11/20/2022]
Abstract
The incidence of heart failure (HF) is constantly increasing in the Western world. Treatment with statins is well established for the primary and secondary prevention of cardiac events by lowering low-density lipoprotein (LDL) cholesterol levels. There are conflicting reports on the role of LDL cholesterol as an adverse prognostic predictor in patients with advanced HF. The aim of this study was to investigate the association between LDL cholesterol levels and clinical outcomes in 297 patients with severe HF (average New York Heart Association class 2.8). The mean follow-up period was 3.7 years (range 8 months to 11.5 years), and 37% of the patients died during follow-up. The mean time to first hospital admission for HF was 25 +/- 17 months. The study group was divided according to plasma LDL level < or =89, >89 to < or =115, >115 mg/dl. Patients with the highest baseline LDL cholesterol levels had significantly improved outcomes, whereas those with the lowest LDL cholesterol levels had the highest mortality. When analyzed with respect to statin use, it emerged that the negative association between LDL cholesterol level and mortality was present only in the patients with HF who were treated with statins. In conclusion, lower LDL cholesterol levels appear to predict less favorable outcomes in patients with HF, particularly those taking statins, raising questions about the need for aggressive LDL cholesterol-lowering strategy in patients with HF, regardless of its cause.
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Affiliation(s)
- Gideon Charach
- Department of Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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28
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Andreou I, Tousoulis D, Miliou A, Tentolouris C, Zisimos K, Gounari P, Siasos G, Papageorgiou N, Papadimitriou CA, Dimopoulos MA, Stefanadis C. Effects of rosuvastatin on myeloperoxidase levels in patients with chronic heart failure: a randomized placebo-controlled study. Atherosclerosis 2009; 210:194-8. [PMID: 19962701 DOI: 10.1016/j.atherosclerosis.2009.10.046] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 10/29/2009] [Accepted: 10/29/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studies indicate that myeloperoxidase (MPO) is associated with disease progression and severity in heart failure (HF), while it may provide a mechanistic link between inflammation and adverse cardiac remodeling. The mechanisms that regulate MPO are unclear, while it is unknown whether specific treatments such as HMG-CoA reductase inhibitors and xanthine oxidase inhibitors may modify MPO. Therefore in the present study we examined the effects of rosuvastatin and allopurinol on MPO levels in patients HF. METHODS Sixty clinically stable patients with systolic HF were randomized to receive rosuvastatin 10mg/day, allopurinol 300mg/day or placebo and followed up for 1 month. Plasma levels of MPO and serum levels of soluble CD40 ligand, interleukin-6, and oxidized LDL were determined using ELISA. All measurements were made before and after 1-month treatment. RESULTS Rosuvastatin significantly reduced plasma levels of MPO (p=0.003), which remained unchanged in the other groups. Furthermore, the change of MPO levels in the rosuvastatin-treated group was significantly different compared with the other groups (p<0.05). Rosuvastatin administration also led to a significant decrease in oxidized LDL (p=0.009), while the other inflammatory markers remained unchanged in all groups. In the total population, a significant correlation was observed between the baseline levels of MPO and hsCRP (r=0.275, p=0.027), fibrinogen (r=0.278, p=0.025), and sCD40L (r=0.288, p=0.021). CONCLUSIONS Short-term treatment with rosuvastatin regulates inflammatory process in patients with heart failure by significantly reducing plasma levels of MPO. This finding reveals a novel pleiotropic effect of statins in patients with heart failure, and provides further insights into the pathophysiological mechanisms of MPO in heart failure.
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Affiliation(s)
- Ioannis Andreou
- A' Cardiology Department, Hippokration Hospital, Athens University Medical School, 11528 Athens, Greece
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Liu T, Li G, Korantzopoulos P, Goudevenos JA. Statins and prevention of atrial fibrillation in patients with heart failure. Int J Cardiol 2009; 135:e83-4. [PMID: 18625529 DOI: 10.1016/j.ijcard.2008.04.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 04/24/2008] [Indexed: 12/11/2022]
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30
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Hadi HA, Mahmeed WA, Suwaidi JA, Ellahham S. Pleiotropic effects of statins in atrial fibrillation patients: the evidence. Vasc Health Risk Manag 2009; 5:533-51. [PMID: 19590588 PMCID: PMC2704895 DOI: 10.2147/vhrm.s4841] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Indexed: 01/15/2023] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. The understanding of the pathophysiology of AF has changed during the last several decades, and a significant role of inflammation and of the renin-angiotensin-aldosterone system has been postulated both experimentally and clinically. There is emerging evidence of an association between inflammation and AF, and mounting evidence links increased C-reactive protein levels not only to already existing AF but also to the risk of developing future AF. The beneficial effects of statins on AF have been reported in several studies. Several randomized clinical and large observational studies have shown similar result that show the beneficial effect of statins in AF. In clinical studies, statins were considered effective in preventing AF after electrical cardioversion, post-ablation, and after permanent pacemaker and implantable cardioverter defibrillator insertion. The antiarrhythmic mechanisms of statins regarding AF prevention in patients with heart failure are still not clear. Perioperative statin use has been associated with favorable postoperative outcome in both cardiovascular and noncardiovascular conditions. Despite a growing body of evidence that drugs with anti-inflammatory properties such as statins may prevent AF, the observed positive effects of statins on the burden of AF appeared to be independent of their cholesterol-reducing properties. However, further data from large-scale randomized trials are clearly needed.
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Affiliation(s)
- Hadi Ar Hadi
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
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31
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Tousoulis D, Antonopoulos AS, Antoniades C, Saldari C, Stefanadi E, Siasos G, Stougianos P, Plastiras A, Korompelis P, Stefanadis C. Role of depression in heart failure--choosing the right antidepressive treatment. Int J Cardiol 2009; 140:12-8. [PMID: 19501922 DOI: 10.1016/j.ijcard.2009.05.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 05/07/2009] [Accepted: 05/11/2009] [Indexed: 11/30/2022]
Abstract
Major depression is a common feature of heart failure patients and possibly stems from their common biochemical background. Depression and heart failure co-morbidity has several clinical implications on the prognosis of these patients. Furthermore antidepressive drugs have known cardiovascular side effects, while their safety and efficacy in heart failure has not been fully elucidated yet. The right choice of antidepressive treatment in heart failure constitutes an issue of high importance as it can affect the clinical outcome of these patients. In this article we highlight the role of major depression in heart failure and demonstrate their common biochemical background. Moreover we review the acquired so far knowledge on the use of the various categories of antidepressants in heart failure by reference to the existing clinical studies on antidepressants efficacy and safety in heart failure. Even though certain conclusions cannot be drawn yet, evidence suggests that the use of selective serotonin reuptake inhibitors may have a beneficial effect on clinical outcome of heart failure patients.
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32
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Yang Y, Mou Y, Hu SJ, Fu M. Beneficial effect of rosuvastatin on cardiac dysfunction is associated with alterations in calcium-regulatory proteins. Eur J Heart Fail 2009; 11:6-13. [PMID: 19147451 DOI: 10.1093/eurjhf/hfn002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The normal expression of Ca(2+)-regulatory protein is critical for efficient myocardial function. The present study tested the hypothesis that rosuvastatin treatment may attenuate left ventricular (LV) remodelling and dysfunction in the failing heart, which may be associated with alterations of Ca(2+)-regulatory protein. METHODS AND RESULTS We investigated the change of LV remodelling and function in a rat model of cardiac dysfunction due to myocardial infarction (MI) with or without rosuvastatin (10 mg/kg/day) treatment for 10 weeks. The protein expression of sarcoplasmic reticulum Ca(2+) ATPase (SERCA)2a, phospholamban (PLB), and phospho-PLB at serine-16 (pSer16-PLB), as well as SERCA activity, interleukin (IL)-6, and IL-10 levels were evaluated. After rosuvastatin treatment, LV remodelling and dysfunction were prevented. Rosuvastatin prevented the decrease of SERCA2a and pSer16-PLB expression, increased SERCA activity, but showed no effect on PLB expression. Furthermore, rosuvastatin reduced the increased IL-6 level and further elevated IL-10 level in the peri-infarct and remote zones of MI. Serum lipid levels remained unchanged. CONCLUSION Rosuvastatin is effective in preventing LV remodelling and dysfunction in the failing heart. The molecular mechanism may be related to normalization of SERCA2a expression, SERCA activity, and pSer16-PLB levels, as well as through cytokine alterations independent of its lipid-lowering effect.
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Affiliation(s)
- Ying Yang
- Institute of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, P.R. China
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Cheng X, Ding Y, Xia C, Tang T, Yu X, Xie J, Liao M, Yao R, Chen Y, Wang M, Liao YH. Atorvastatin Modulates Th1/Th2 Response in Patients With Chronic Heart Failure. J Card Fail 2009; 15:158-62. [DOI: 10.1016/j.cardfail.2008.10.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Revised: 09/21/2008] [Accepted: 10/03/2008] [Indexed: 11/17/2022]
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34
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Coats AJ. The top papers by download and citations from the International Journal of Cardiology in 2007. Int J Cardiol 2008; 131:e1-3. [DOI: 10.1016/j.ijcard.2008.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Accepted: 11/02/2008] [Indexed: 12/29/2022]
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35
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Short-term effects of fluvastatin therapy on plasma interleukin-10 levels in patients with chronic heart failure. Coron Artery Dis 2008; 19:513-9. [DOI: 10.1097/mca.0b013e32830d27d2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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36
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Zinman L, Sadeghi R, Gawel M, Patton D, Kiss A. Are statin medications safe in patients with ALS? ACTA ACUST UNITED AC 2008; 9:223-8. [PMID: 18608105 DOI: 10.1080/17482960802031092] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Statin medications for elevated cholesterol are one of the most commonly prescribed medications worldwide. The aim of this study was to determine if statin medications affect the rate of disease progression, the severity and frequency of muscle cramping, and serum CK levels in patients with ALS. We conducted a prospective cohort study in patients diagnosed with ALS with statin medication as the predetermined exposure variable and the rate of decline of the ALS Functional Rating Scale-Revised (ALSFRS-R) as the primary outcome. One hundred and sixty-four consecutive patients with laboratory supported probable, clinically probable, or clinically definite ALS were evaluated from January 2006 to September 2007. Thirty-two patients (20%) were taking statin medications and 132 were in the control group. After adjusting for covariates, we found a highly significant increase in the rate of decline in the ALSFRS-R for the statin group (1.71 units/month) compared to the control group (1.05 units/month, pB0.0001) representing a 63% increase in the rate of functional decline. Patients on statin therapy also reported a significant increase in muscle cramp frequency and severity (pB0.0001). This study has demonstrated a strong association between statin medications and an increased rate of functional decline and muscle cramping in patients with ALS. Although this association does not prove a causal relationship, it is prudent to exercise caution and discuss discontinuation or replacement of statin medications in patients with ALS.
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Affiliation(s)
- Lorne Zinman
- ALS/Neuromuscular Clinic, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
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37
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Abstract
Despite many post hoc analyses of cardiovascular databases in recent years suggesting a benefit of statins in the prevention and treatment of congestive heart failure (HF), a prospective study of statin therapy on two clinically relevant end points--HF morbidity and survival--had not been reported until 2007. However, a large-scale prospective trial, Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA), has just reported its primary results. These results somewhat surprisingly show no survival benefit in a group of patients with ischemic systolic HF given low-dose rosuvastatin. In addition to this uncertainty generated by the results of CORONA, there remains additional uncertainty in the existing, predominantly retrospective data on statins because of the potential bias in study designs, use of post hoc subgroup analyses, and lack of mechanistic data. This review critically evaluates the recent literature in this area.
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Affiliation(s)
- Jennifer Martin
- Royal Brisbane Women's Hospital Department of Medicine/Diamantina Institute, University of Queensland, 4006, Australia.
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38
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Atorvastatin Attenuates Cardiomyocyte Loss in Adult Rats From Protein-Restricted Dams. J Card Fail 2008; 14:151-60. [DOI: 10.1016/j.cardfail.2007.10.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 10/04/2007] [Accepted: 10/12/2007] [Indexed: 01/09/2023]
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39
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Athyros VG, Kakafika AI, Tziomalos K, Karagiannis A, Mikhailidis DP. CORONA, Statins, and Heart Failure: Who Lost the Crown? Angiology 2008; 59:5-8. [DOI: 10.1177/0003319707313882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vasilios G. Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece,
| | - Anna I. Kakafika
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece, Department of Clinical Biochemistry (Vascular Prevention Clinic), Royal Free Hospital, Royal Free, University College Medical School, University College London (University of London), London, United Kingdom
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Prevention Clinic), Royal Free Hospital, Royal Free, University College Medical School, University College London (University of London), London, United Kingdom
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40
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Affiliation(s)
- Wook Bum Pyun
- Cardiovascular Center, Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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41
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Skoglund B. Linköping University Medical Dissertation No. 1033. Following the mevalonate pathway to bone heal alley. ACTA ORTHOPAEDICA. SUPPLEMENTUM 2007; 78:3-22. [PMID: 18283564 DOI: 10.1080/17453670710046549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Björn Skoglund
- Department of Clinical and Experimental Medicine, Materials in Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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42
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Velavan P, Huan Loh P, Clark A, Cleland JGF. The Cholesterol Paradox in Heart Failure. ACTA ACUST UNITED AC 2007; 13:336-41. [DOI: 10.1111/j.1527-5299.2007.07211.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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43
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Abstract
HMG-CoA (3-hydroxy-3-methylglutaryl-CoA) reductase inhibitors (statins) are well-established therapies in the prevention and treatment of cardiovascular disease, reducing all-cause mortality and cardiovascular events in many disease states. Studies have also suggested that statins given to patients after myocardial infarction improve event-free survival even in short time frames; however, evidence for the benefit of statins in established HF (heart failure) has not been demonstrated with the same rigour of a randomized clinical trial setting. In fact, clinical data examining the effect of statins in HF have been limited by the retrospective or observational nature of these analyses, examination of incompletely validated surrogate end points, small prospective studies in subgroups of HF subjects, and non-uniform doses and different statins being used. In this review, we examine the evidence for the effect of statins on mortality in HF, taking into account theoretical arguments, appropriateness of surrogate markers, animal data and analysis of the predominantly retrospective clinical data that is currently available.
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Affiliation(s)
- Jennifer H Martin
- University of Melbourne Department of Medicine, St Vincent's Hospital, Melbourne, VIC, Australia.
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