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Strand LN, Young RL, Bertoni AG, Bluemke DA, Burke GL, Lima JA, Sotoodehnia N, Psaty BM, McClelland RL, Heckbert SR, Delaney JA. New statin use and left ventricular structure: Estimating long-term associations in the Multi-Ethnic Study of Atherosclerosis (MESA). Pharmacoepidemiol Drug Saf 2018; 27:570-580. [PMID: 29380457 PMCID: PMC5984180 DOI: 10.1002/pds.4389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 11/16/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Only small and short-term studies have evaluated statins in relation to changes in heart structure. We estimated the association between new statin use and 10-year remodeling of the left ventricle. METHODS The Multi-Ethnic Study of Atherosclerosis collected data on statin use over approximately 10 years, conducting cardiac magnetic resonance (CMR) imaging at baseline and the 10-year exam. Participants were free of baseline cardiovascular disease, and we excluded users of statins at baseline. Statin initiation was defined as a report of current use at any of the 4 subsequent exams. Primary outcomes were the change in left ventricular mass index (LVMI; % predicted by height, weight, and sex) and mass-to-volume ratio. Associations were estimated in a propensity score-matched analysis. RESULTS A total of 3113 participants (53% female; 40% European-American, 25% African-American, 22% Hispanic-American, and 13% Chinese-American) were eligible; 2431 returned for follow-up CMR imaging after a median of 9.4 years. Statin therapy (moderate dose, 76%) was started by 36% of participants (N = 872). We excluded 42 participants with incident myocardial infarction. Compared with nonuse, statin use was associated with less 10-year progression in LVMI (-2.35 percentage points; 95% CI, -4.24 to -0.47; P = .01) and mass-to-volume ratio (-0.03 absolute difference; 95% CI, -0.07 to -0.00; P = .02); effects were small in magnitude. A dose response was observed: Higher statin dose was associated with less LVMI progression. CONCLUSIONS In contrast to previous small studies, we found very modest associations between statin use and indices of left ventricular remodeling over 10 years in this prospective study of a diverse cohort.
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Affiliation(s)
| | - Rebekah L Young
- Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Alain G Bertoni
- Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David A Bluemke
- National Institutes of Health Clinical Center, Bethesda, MD, USA
- National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Gregory L Burke
- Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joao A Lima
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Cardiology, University of Washington, Seattle, WA, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | - Robyn L McClelland
- Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Joseph A Delaney
- Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Abstract
The risks associated with hypertension emerge through a series of complex interactions. Myocardial ischemia is the major contributor to this risk. The mechanisms driving ischemia reflect many of the key factors in hypertension, including endothelial and neurohumoral factors, fibrosis, and hemodynamics. Left ventricular hypertrophy and fibrosis are of fundamental importance and together with hemodynamics provide an optimal template for myocardial ischemia. Understanding the pathophysiology has aided a more rational management approach but challenges remain which, if surmounted, will have an impact on the morbidity and mortality caused by myocardial ischemia in patients with hypertension.
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Affiliation(s)
- Tony Stanton
- Nambour Hospital, School of Medicine, University of Queensland, Medical Suites, Level 2, Nambour, Queensland 4556, Australia
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Aftab W, Gazallo J, Motabar A, Varadrajan P, Deedwania PC, Pai RG. Survival Benefit of Statins in Hemodialysis Patients Awaiting Renal Transplantation. Int J Angiol 2015; 24:105-12. [PMID: 26060381 DOI: 10.1055/s-0035-1547373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
End-stage renal disease (ESRD) patients have extraordinarily high cardiovascular risk and mortality, yet the benefit of statins in this population remains unclear based on the randomized trials. We investigated the prognostic value of statins in a large, pure cohort of prospectively recruited patients with ESRD awaiting renal transplantation, and being followed up in a dedicated cardiac clinic. We prospectively collected demographic, clinical, laboratory, and pharmacological data on 423 consecutive ESRD patients on hemodialysis awaiting renal transplantation. Survival analysis was performed as a function of statin therapy. The baseline characteristics were as follows: age 57 ± 11 years, males 64%, diabetes mellitus in 68%, known coronary artery disease in 30%, left ventricular (LV) ejection fraction 61 ± 11%. Over a mean follow-up of 2 years, there were 43 deaths. Adjusted for age, gender, hypertension, body mass index, diabetes mellitus, coronary artery disease, smoking, and treatment with angiotensin converting enzyme inhibitor, β blocker, and antiplatelet medications, statin use was a predictor of lower mortality (hazard ratio 0.30, 95% confidence interval 0.11-0.79, p = 0.01). This beneficial effect of statin was supported by propensity score analysis (p = 0.02) and was consistent across all clinical subgroups. The benefit of statins seemed to be greater in those with LV hypertrophy and smoking. Statin therapy in hemodialysis patients awaiting renal transplant is independently associated with better survival supporting its use in this high-risk population.
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Affiliation(s)
- Waqas Aftab
- Division of Cardiovascular Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Juliana Gazallo
- Division of Cardiovascular Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Ali Motabar
- Division of Cardiovascular Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Padmini Varadrajan
- Division of Cardiovascular Medicine, Loma Linda University Medical Center, Loma Linda, California
| | | | - Ramdas G Pai
- Division of Cardiovascular Medicine, Loma Linda University Medical Center, Loma Linda, California
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Anagnostis P, Katsiki N, Athyros VG, Karagiannis A. Adiponectin and Aldosterone in Left Ventricular Hypertrophy: An Intriguing Interplay. Angiology 2014; 69:745-748. [PMID: 24687414 DOI: 10.1177/0003319714527785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Panagiotis Anagnostis
- 1 Division of Endocrinology, Police Medical Centre, Thessaloniki, Greece.,2 Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Niki Katsiki
- 2 Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Vasilios G Athyros
- 2 Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Asterios Karagiannis
- 2 Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Takaoka H, Funabashi N, Takahashi M, Uchimura Y, Sairaku A, Kobayashi Y. Left-atrial wall thickening may be an important-response in systemic hypertension as well as left-ventricular hypertrophy and more remarkable than left-ventricular diastolic dysfunction and left-atrial enlargement. Int J Cardiol 2013; 168:598-600. [PMID: 23452886 DOI: 10.1016/j.ijcard.2013.01.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/18/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan
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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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