1
|
Said S, Dardik A, Ochoa Chaar CI. What are the benefits and drawbacks of statins in carotid artery disease? A perspective review. Expert Rev Cardiovasc Ther 2023; 21:763-777. [PMID: 37994875 DOI: 10.1080/14779072.2023.2286011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION The prevalence of carotid artery stenosis in the general population is approximately 3%, but approximately 20% among people with acute ischemic stroke. Statins are recommended by multiple international guidelines as the drug of choice for lipid control in people with asymptomatic or symptomatic carotid artery stenosis due to their lipid-lowering and other pleiotropic effects. AREAS COVERED This review discusses the guidelines for statin usage as a cornerstone in the prevention and management of atherosclerotic carotid artery disease and the impact of statins on stroke incidence and mortality. Statin side effects, alternative therapy, and genetic polymorphisms are reviewed. EXPERT OPINION Statin therapy is associated with a decreased incidence of stroke and mortality as well as improved outcomes for patients treated with carotid revascularization. Statins are a safe and effective class of medications, but the initiation of therapy warrants close monitoring to avoid rare and potentially serious side effects. Lack of clinical efficacy or the presence of side effects suggests a need for treatment with an alternative therapy such as PCSK9 inhibitors. Understanding the interplay between the mechanisms of statins and PCSK9 inhibition therapies will allow optimal benefits while minimizing risks. Future research into genetic polymorphisms may improve patient selection for personalized therapy.
Collapse
Affiliation(s)
- Shreef Said
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Alan Dardik
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, VA Connecticut Healthcare Systems, West Haven, CT, USA
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
2
|
Wijekoon N, Wijekoon S, Bulugahapitiya U, Pathirana N, Wickramasinghe M, Paranavitane S, Kottage A, Wijayawardena S, Karunarathne M, Samarasinghe M, Sumanadasa S, Herath Y. Tolerability and effectiveness of every-other-day atorvastatin compared to daily atorvastatin in patients with muscle symptoms: A randomized controlled clinical trial. Contemp Clin Trials Commun 2020; 20:100685. [PMID: 33319120 PMCID: PMC7726662 DOI: 10.1016/j.conctc.2020.100685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 11/01/2020] [Accepted: 12/01/2020] [Indexed: 01/31/2023] Open
Abstract
Despite limited evidence, non-daily dosing of statins is recommended for managing muscle symptoms associated with statin therapy. We assessed the tolerability and effectiveness of every-other-day atorvastatin compared to daily atorvastatin in patients having muscle symptoms associated with atorvastatin therapy. A parallel-group, outcome-assessment-blinded, randomized controlled clinical trial was conducted at Colombo South Teaching Hospital, Sri Lanka. Patients with muscle pain, tenderness or cramps alone or in combination for ≥2 weeks while on daily atorvastatin for ≥1 month, with no alternative cause, were recruited. Patient's regular atorvastatin dose was given every-other-day to those in intervention group (IG) and daily to those in control group (CG). Primary outcomes were assessed at 24 weeks and included composite of myalgia and myositis, LDL-cholesterol level and percentage reduction of LDL-cholesterol from baseline. Number recruited was 49 to IG (women:79.6%; mean-age:60.6 ± 8.7years) and 52 to CG (women:73.1%; mean-age:61.7 ± 9.8years). Mean atorvastatin dose per day was 8.6 mg (SD = 4 mg) and 17.6 mg (SD = 8.4 mg) in IG and CG, respectively. Composite of myalgia and myositis at 24 weeks was 79.6% in IG and 69.2% in CG (OR = 1.7, 95% CI 0.7-4.3; p = 0.234). IG failed to show noninferiority for mean LDL-cholesterol (difference:0.31 mmol/L; upper limit 97.5% CI:0.61 mmol/L; p for noninferiority = 0.989) and for mean percentage reduction of LDL-cholesterol from baseline (difference:3.13%; upper limit 97.5% CI:15.5%; p for noninferiority = 0.718). At 24 weeks, mean creatine kinase and discomfort due to muscle symptoms (assessed with Visual Analogue Scale) were not different between the two groups. Findings of this study do not favor every-other-day atorvastatin as an option for managing patients with muscle symptoms associated with atorvastatin therapy.
Collapse
Affiliation(s)
- Nirmala Wijekoon
- Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Sanjeewa Wijekoon
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.,Colombo South Teaching Hospital, Kalubowila, Sri Lanka
| | | | - Nethrani Pathirana
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Malintha Wickramasinghe
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | | | | | - Supun Wijayawardena
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Mihipali Karunarathne
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Madusha Samarasinghe
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | | | | |
Collapse
|
3
|
Roh JW, Chun KH, Kang M, Lee CJ, Oh J, Shim CY, Ahn CM, Kim JS, Kim BK, Park S, Chang HJ, Hong GR, Ko YG, Kang SM, Choi D, Ha JW, Hong MK, Jang Y, Lee SH. PRavastatin Versus FlUVastatin After Statin Intolerance: The PRUV-Intolerance Study With Propensity Score Matching. Am J Med 2019; 132:1320-1326.e1. [PMID: 31278931 DOI: 10.1016/j.amjmed.2019.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/01/2019] [Accepted: 06/12/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Limited data are available on the relapse of statin intolerance after resumption of statins. We aimed to evaluate the relapse rates of statin intolerance in patients who subsequently received pravastatin or fluvastatin and to identify associated factors. METHODS This retrospective, propensity score-matched cohort study screened data obtained from a tertiary university hospital between 2006 and 2015. Of 8073 patients screened, 488 with statin intolerance who received pravastatin or fluvastatin with regular follow-up were enrolled. After propensity score matching of patients, 384 were finally analyzed. The primary outcome variables were relapse of statin intolerance and stopping (ie, discontinuation or switching to other statins) rate for the 2 statins. RESULTS During the median follow-up period of 37 months, the rate of relapse of intolerance was 10.4% and 18.2% among users of pravastatin and fluvastatin, respectively (P = 0.04). However, the log-rank test showed no difference in the relapse-free rates between the 2 groups (P = 0.34). The stopping rates of the 2 statins were 36.5% and 42.2% (P = 0.30), respectively, for various reasons, including low efficacy of the drugs. After adjustment, chronic kidney disease (hazard ratio [HR] 1.83, P = 0.03) and previous creatine kinase elevation (HR 3.13, P = 0.001) were identified as independent determinants of relapse. Older age (HR 1.03, P = 0.057) and female sex (HR 1.70, P = 0.059) were associated, but not significantly, with relapse. CONCLUSION Although a small proportion of patients taking pravastatin or fluvastatin experienced a relapse of intolerance, many patients eventually discontinued or changed these agents. Chronic kidney disease and history of creatine kinase elevation were independent determinants of relapse.
Collapse
Affiliation(s)
- Ji Woong Roh
- Division of Cardiology, Bucheon St. Mary's Hospital, The Catholic University College of Medicine, Bucheon, Korea
| | - Kyeong-Hyeon Chun
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moonjong Kang
- Department of Biostatistics and Computing, the Graduate School, Yonsei University, Seoul, Korea
| | - Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jaewon Oh
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chi-Young Shim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sungha Park
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Won Ha
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Hak Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
4
|
Harrison TN, Hsu JWY, Rosenson RS, Levitan EB, Muntner P, Cheetham TC, Wei R, Scott RD, Reynolds K. Unmet Patient Need in Statin Intolerance: the Clinical Characteristics and Management. Cardiovasc Drugs Ther 2019; 32:29-36. [PMID: 29417422 DOI: 10.1007/s10557-018-6775-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE A substantial percentage of patients report intolerance or side effects of statin treatment leading to treatment changes or discontinuation. The purpose of this study was to examine statin therapy changes and subsequent effects on low-density lipoprotein cholesterol (LDL-C) among patients with statin intolerance (SI). METHODS We identified 45,037 adults from Kaiser Permanente Southern California with SI documented between 2006 and 2012. Changes in statin therapy in the year before and after the SI index date were examined. We categorized patients into those who initiated statin therapy, discontinued, up-titrated, down-titrated, or did not switch therapy. We calculated the percentage change in LDL-C from the year before to the year after SI, and the percentage of patients attaining LDL-C < 100 and < 70 mg/dL. RESULTS In the year prior to the SI date, 77.8% of patients filled a statin prescription. Following SI, 44.6% had no treatment change, 25.5% discontinued, and 30.0% altered their statin therapy. Of those who altered statin therapy, 52.6% down-titrated and 17.2% up-titrated their dose. Rhabdomyolysis was documented in < 1% of the cohort. The largest changes in LDL-C were experienced by patients who were on a high-intensity statin then discontinued treatment (35.6% increase) and those who initiated a high-intensity statin (25.5% decrease). The proportion of patients achieving LDL-C < 100 mg/dL and LDL-C < 70 mg/dL was the lowest among those who discontinued therapy. CONCLUSIONS Although adjustments to the statin dosage may be appropriate upon documentation of SI, many of these patients will have high LDL-C. Strategies for LDL-C reduction in patients with SI may be necessary.
Collapse
Affiliation(s)
- Teresa N Harrison
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Jin-Wen Y Hsu
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Robert S Rosenson
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA
| | - Emily B Levitan
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Muntner
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Rong Wei
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Ronald D Scott
- West Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA.
| |
Collapse
|
5
|
Ruscica M, Macchi C, Pavanello C, Corsini A, Sahebkar A, Sirtori CR. Appropriateness of statin prescription in the elderly. Eur J Intern Med 2018; 50:33-40. [PMID: 29310996 DOI: 10.1016/j.ejim.2017.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/15/2017] [Accepted: 12/22/2017] [Indexed: 12/19/2022]
Abstract
Statins, the most widely used drugs in the Western world, have become a pivotal component in the primary and secondary prevention of vascular diseases. Although benefits have been well documented in younger-than-75-year-old individuals, the value of statins in people aged >75years and over is controversial. The CTT meta-analysis calculated an absolute risk reduction of 0.6%/year per 38.7mg/dl reduction in LDL-C levels in patients aged >75years, that would translate into a number needed to treat of 167. However, the absolute effect of a 38.7mg/dl cholesterol lowering on the rate of annual ischemic heart disease mortality is 10-fold larger in older vs younger patients. In order to advise physician prescription, three major Guidelines have been published over the last few years, i.e. the AHA/ACC and the NLA in the US, and the ESC/EAS in Europe. Moreover, statin prescription in the elderly should also consider the cardiovascular outcomes of elderly patients reported in classical statin preventive trials which give important clues on adherence and persistence of use, as well as on drug safety. The present review discusses benefits of intensive vs moderate statin therapy, justifications for the use of aggressive lipid management in the very old and the use of statins in frail elderlies. The final decision on the therapeutic strategy with statins in elderlies at higher risk to develop cardiovascular events should be always based on a careful analysis of the patient's general health and on the presence of metabolic abnormalities or drug interactions potentially leading to risk.
Collapse
Affiliation(s)
- M Ruscica
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy.
| | - C Macchi
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
| | - C Pavanello
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
| | - A Corsini
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy; Multimedica IRCCS, Milan, Italy
| | - A Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - C R Sirtori
- Dyslipidemia Center, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| |
Collapse
|
6
|
Indumathi C, Anusha N, Vinod KV, Santhosh S, Dkhar SA. Atorvastatin Induced Adverse Drug Reactions among South Indian Tamils. J Clin Diagn Res 2017; 11:FC01-FC05. [PMID: 28892923 DOI: 10.7860/jcdr/2017/27223.10175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/27/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Atorvastatin is the most widely used statin world-over. Although atorvastatin is beneficial in reducing cardiovascular morbidity and mortality, they are associated with Adverse Drug Reactions (ADRs) which are under-recognized as well as under-reported. There is no data on safety of atorvastatin in ethnic populations like South Indian Tamils and hence the need for this study. AIM To report the Adverse Events (AEs) associated with atorvastatin use, their causality and severity in dyslipidemic south Indian Tamils. MATERIALS AND METHODS This cross-sectional study was carried out on 304 dyslipidemic Tamils. Those on any lipid lowering therapy within one month before study enrolment, those with contraindications to statin therapy, hypothyroid patients, those with LDL cholesterol >250 mg/dL or serum triglycerides >400 mg/dL and patients who were on drugs which modulate Cytochrome P 450 3A4/5 (CYP3A4/5) activity were excluded from the study. Causality assessment for atorvastatin induced AEs were done using Naranjo adverse drug reaction probability scale criteria and severity assessment was done using Hartwig scale. AEs which were causally related to atorvastatin use were reported as ADRs. RESULTS One hundred and eighty three AEs were noted among 145 (47.7%) patients, during the course of first 45 days of atorvastatin therapy. AEs were probably due to atorvastatin in 11% of the patients and possibly due to atorvastatin in 89%. Most common ADRs were myalgia (41%), followed by nervous system ADRs (35.5%) and gastrointestinal ADRs (14%). CONCLUSION Myalgia was the most common cause for atorvastatin discontinuation which might place these individuals at an increased risk of cardiovascular morbidity and mortality. Measures to identify and address atorvastatin induced myalgia should be given priority.
Collapse
Affiliation(s)
| | - Natarajan Anusha
- Senior Resident, Department of Pharmacology, JIPMER, Puducherry, India
| | | | - Satheesh Santhosh
- Additional Professor, Department of Cardiology, JIPMER, Puducherry, India
| | - Steven Aibor Dkhar
- Senior Professor and Head, Deprtment of Clinical Pharmacology, JIPMER, Puducherry, India
| |
Collapse
|
7
|
Jacobson TA, Edelman SV, Galipeau N, Shields AL, Mallya UG, Koren A, Davidson MH. Development and Content Validity of the Statin Experience Assessment Questionnaire (SEAQ)©. THE PATIENT 2017; 10:321-334. [PMID: 27981439 PMCID: PMC5422451 DOI: 10.1007/s40271-016-0211-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The National Lipid Association Statin Intolerance (SI) Panel recognized the need for better understanding of the patient SI experience. OBJECTIVE The objective of this research was to develop a patient-reported outcome (PRO) questionnaire to assess a patient's experience with SI. METHODS Questionnaire development was informed via a series of research activities: literature review, concept elicitation, item generation, and content evaluation. Following the literature review and concept elicitation, a draft questionnaire was constructed and subsequently modified based on feedback from therapeutic area experts and patients via cognitive debriefing interviews. RESULTS Muscle-related symptoms were the most commonly reported symptoms associated with SI in the literature review (35 of 41 articles reviewed [85%]) and in semi-structured interviews with experts (n = 5 [100%]) and patients (n = 17 of 20 [85.0%]). Physical and other impacts of SI symptoms on daily activities were also frequently reported. A 17-item draft questionnaire was created, and cognitive debriefing with experts (n = 5) and patients (n = 15) was conducted. Overall, the items, response options, and instructions were comprehensible and positively reviewed; minor changes resulted in the 15-item Statin Experience Assessment Questionnaire (SEAQ)©. Using a 30-day recall period, the SEAQ© assesses the severity and impact of six SI symptoms (muscle ache, muscle pain, muscle cramps, muscle weakness, tiredness, and joint pain) on an 11-point numeric scale. Statin discontinuation and likelihood of discontinuation due to symptoms are assessed and scored on a yes/no and five-point verbal response scale, respectively. CONCLUSION The SEAQ
Collapse
Affiliation(s)
- Terry A Jacobson
- Emory University School of Medicine, Lipid Clinic and Cardiovascular Risk Reduction Program, Department of Medicine, 49 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA.
| | - Steven V Edelman
- University of California San Diego School of Medicine, Veterans Affairs Medical Center, 3350 La Jolla Village Drive (111G), San Diego, CA, 92161, USA
| | - Nina Galipeau
- Adelphi Values, 290 Congress Street, 7th Floor, Boston, MA, 02210, USA
| | - Alan L Shields
- Adelphi Values, 290 Congress Street, 7th Floor, Boston, MA, 02210, USA
| | - Usha G Mallya
- Sanofi US, 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Andrew Koren
- Sanofi US, 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Michael H Davidson
- University of Chicago Pritzker School of Medicine, 150 E. Huron, Suite 900, Chicago, IL, 60611, USA
| |
Collapse
|
8
|
Sai K, Kajinami K, Akao H, Iwadare M, Sato-Ishida R, Kawai Y, Takeda K, Tanimoto T, Yamano T, Akasaka T, Ishida T, Hirata KI, Saku K, Yagi S, Soeki T, Sata M, Ueno M, Miyazaki S, Shiraki A, Oyama JI, Node K, Sugamura K, Ogawa H, Kurose K, Maekawa K, Matsuzawa Y, Imatoh T, Hasegawa R, Saito Y. A possible role for HLA-DRB1*04:06 in statin-related myopathy in Japanese patients. Drug Metab Pharmacokinet 2016; 31:467-470. [PMID: 27839692 DOI: 10.1016/j.dmpk.2016.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/17/2016] [Accepted: 09/11/2016] [Indexed: 10/21/2022]
Abstract
Statin-related myopathy (SRM) is a clinically important adverse reaction. Recent pharmacogenetic research, mainly in non-Asian populations, have indicated clinical relevance of some of genetic biomarkers to SRM, but predictive markers for SRM in Asian populations including Japanese has not yet been established. This study was aimed to identify clinically important genetic markers associated with SRM in Japanese patients. Allele frequencies of the three reported candidate markers - SLCO1B1 rs4149056, RYR2 rs2819742, and GATM rs9806699 - and carrier frequencies of HLA types were compared between patients with SRM patients (n = 52) and healthy Japanese subjects (n = 2878 or 86 (for rs9806699) as controls). No significant association of RYR2, SLCO1B1, and GATM variants with SRM were observed in our Japanese patients, but a significant association was detected for HLA-DRB1*04:06 with SRM (odds ratio: 3.19; 95% confidence interval: 1.53-6.66). This study suggested that HLA-DRB1*04:06 might be associated with SRM onset in a Japanese population. Further studies are required to validate these results.
Collapse
Affiliation(s)
- Kimie Sai
- Division of Medicinal Safety Science, National Institute of Health Sciences, 1-18-1 Kamiyoga, Setagaya-ku, Tokyo 158-8501, Japan.
| | - Kouji Kajinami
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa 920-0293, Japan
| | - Hironobu Akao
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa 920-0293, Japan
| | - Mizuho Iwadare
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa 920-0293, Japan
| | - Ryoko Sato-Ishida
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa 920-0293, Japan
| | - Yasuyuki Kawai
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa 920-0293, Japan
| | - Kenji Takeda
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa 920-0293, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Tatsuro Ishida
- Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-24, Shinkura-cho, Tokushima 770-8501, Japan
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-24, Shinkura-cho, Tokushima 770-8501, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-24, Shinkura-cho, Tokushima 770-8501, Japan
| | - Masafumi Ueno
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, 377-2, Ono-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, 377-2, Ono-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Aya Shiraki
- Department of Cardiovascular Medicine, Saga University, 1 Honjo-machi, Saga 840-8502, Japan
| | - Jun-Ichi Oyama
- Department of Cardiovascular Medicine, Saga University, 1 Honjo-machi, Saga 840-8502, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 1 Honjo-machi, Saga 840-8502, Japan
| | - Koichi Sugamura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kouichi Kurose
- Division of Medicinal Safety Science, National Institute of Health Sciences, 1-18-1 Kamiyoga, Setagaya-ku, Tokyo 158-8501, Japan
| | - Keiko Maekawa
- Division of Medicinal Safety Science, National Institute of Health Sciences, 1-18-1 Kamiyoga, Setagaya-ku, Tokyo 158-8501, Japan
| | - Yumiko Matsuzawa
- Division of Medicinal Safety Science, National Institute of Health Sciences, 1-18-1 Kamiyoga, Setagaya-ku, Tokyo 158-8501, Japan
| | - Takuya Imatoh
- Division of Medicinal Safety Science, National Institute of Health Sciences, 1-18-1 Kamiyoga, Setagaya-ku, Tokyo 158-8501, Japan
| | - Ryuichi Hasegawa
- Division of Medicinal Safety Science, National Institute of Health Sciences, 1-18-1 Kamiyoga, Setagaya-ku, Tokyo 158-8501, Japan
| | -
- Japanese Pharmacogenomics Data Science Consortium, 4-11-6 Kuramae, Taito-ku, Tokyo 111-0051, Japan
| | - Yoshiro Saito
- Division of Medicinal Safety Science, National Institute of Health Sciences, 1-18-1 Kamiyoga, Setagaya-ku, Tokyo 158-8501, Japan
| |
Collapse
|
9
|
Wang LW, Jabbour A, Hayward CS, Furlong TJ, Girgis L, Macdonald PS, Keogh AM. Potential role of coenzyme Q10 in facilitating recovery from statin-induced rhabdomyolysis. Intern Med J 2016; 45:451-3. [PMID: 25827512 DOI: 10.1111/imj.12712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/01/2015] [Indexed: 11/30/2022]
Abstract
Rhabdomyolysis is a rare, but serious complication of statin therapy, and represents the most severe end of the spectrum of statin-induced myotoxicity. We report a case where coenzyme Q10 facilitated recovery from statin-induced rhabdomyolysis and acute renal failure, which had initially persisted despite statin cessation and haemodialysis. This observation is biologically plausible due to the recognised importance of coenzyme Q10 in mitochondrial bioenergetics within myocytes, and the fact that statins inhibit farnesyl pyrophosphate production, a biochemical step crucial for coenzyme Q10 synthesis. Coenzyme Q10 is generally well tolerated, and may potentially benefit patients with statin-induced rhabdomyolysis.
Collapse
Affiliation(s)
- L W Wang
- Department of Cardiology, St Vincent's Hospital, Darlinghurst, New South Wales, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| | | | | | | | | | | | | |
Collapse
|
10
|
Pedro-Botet J, Pintó X. [An updated overview of the high intensity lipid lowering therapy in high cardiovascular risk patients]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28:19-30. [PMID: 26657098 DOI: 10.1016/j.arteri.2015.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/27/2015] [Indexed: 06/05/2023]
Abstract
Statins are highly effective drugs to decrease the plasma concentrations of atherogenic lipoproteins and prevent cardiovascular disease. The clinical practice guidelines recommend the use of high-intensity statins to lower LDL-cholesterol by at least 50% in patients with CVD and those at high cardiovascular risk. The recommendations for the treatment of hypercholesterolaemia by the ACC/AHA have led to a paradigm shift in cardiovascular prevention. These recommendations have abandoned the therapeutic goals of LDL-cholesterol, and recommend the treatment with statins of high or moderate intensity in four high cardiovascular risk groups. These recommendations are different from the European guidelines on cardiovascular disease prevention, in which their objectives are still towards LDL-cholesterol. This paper reviews this controversy from different angles and from the perspective of the Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention. Intervention studies with high intensity statins in primary prevention, in patients with acute coronary syndrome, and with stable ischaemic heart disease are also described. Likewise, treatment with statins of high intensity is addressed in terms of their effectiveness in cardiovascular prevention and in terms of their safety, with particular attention to muscle effects, as well as taking into account the pharmacological characteristics of the different statins and the increased safety of those with less potential for interactions. Finally, new agents are described for the treatment of hypercholesterolaemia, with special emphasis on anti-PCSK9 monoclonal antibodies, a new therapeutic group for the treatment of hypercholesterolaemia that will offer a huge progress in the prevention of cardiovascular diseases.
Collapse
Affiliation(s)
- Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, Universitat de Barcelona, Fipec. CIBERobn, Barcelona, España.
| |
Collapse
|
11
|
The effect of statin therapy on thyroid autoimmunity in patients with Hashimoto's thyroiditis: A pilot study. Pharmacol Rep 2015; 68:429-33. [PMID: 26922549 DOI: 10.1016/j.pharep.2015.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/04/2015] [Accepted: 11/13/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Statins have been found to exert antiinflammatory and immunomodulatory properties. The aim of this study was to compare the effects of intensive and less aggressive statin treatment on thyroid autoimmunity and hypothalamic-pituitary-thyroid axis activity in patients with Hashimoto's thyroiditis. METHODS The study included 38 adult women with Hashimoto's thyroiditis, who required statin therapy and were allocated into one of two groups. Patients at very high cardiovascular risk (n=16) received intensive statin treatment (rosuvastatin 20-40mg daily), while patients at moderate or moderately high cardiovascular risk (n=22) were treated with simvastatin (20-40mg daily) for the following 6 months. Serum levels of thyrotropin, total and free thyroid hormones, and high-sensitivity C-reactive protein (hsCRP), as well as titers of thyroid peroxidase and thyroglobulin antibodies were measured at the beginning and at the end of the study. RESULTS Thirty-six individuals completed the study and were included in the final analyses. Apart from improving plasma lipids and reducing circulating levels of hsCRP, intensive, but not less aggressive, statin therapy reduced thyroid peroxidase and thyroglobulin antibody titers, as well as tended to reduce circulating levels of thyrotropin. The effect of intensive statin therapy on thyroid antibody titers was lipid-independent but correlated with treatment-induced changes in thyrotropin and hsCRP. CONCLUSIONS Although 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors are able to reduce thyroid autoimmunity in women with Hashimoto's thyroiditis, intensive statin therapy is required to produce this effect.
Collapse
|
12
|
|
13
|
Vincent J. Reducing elevated plasma LDL cholesterol: the central role of the LDL receptor. Clin Pharmacol Ther 2014; 96:3-7. [PMID: 24942393 DOI: 10.1038/clpt.2014.95] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Elevated low-density lipoprotein cholesterol (LDL-C) is an established risk factor for cardiovascular disease (CVD), and reduction of elevated LDL-C reduces mortality in patients at risk. This benefit has evolved from the use of statins and knowledge of the LDL receptor (LDLR). The most potent drugs used for dyslipidemias act by mechanisms that involve this receptor. Advances in molecular genetics and understanding of the regulation of this receptor have revealed several pharmacological targets that are being explored to develop more targeted therapies for dyslipidemias.
Collapse
Affiliation(s)
- J Vincent
- Pfizer Global Pharmaceuticals, New York, New York, USA
| |
Collapse
|