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Cai Y, Zhao F. Fluvastatin suppresses the proliferation, invasion, and migration and promotes the apoptosis of endometrial cancer cells by upregulating Sirtuin 6 (SIRT6). Bioengineered 2021; 12:12509-12520. [PMID: 34927546 PMCID: PMC8810182 DOI: 10.1080/21655979.2021.2009415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fluvastatin, the first fully synthesized 3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase (HMGCR) inhibitor, has been reported to inhibit the development and metastasis of multiple cancers. The present study aimed to explore the effects of fluvastatin on endometrial cancer (EC) as well as reveal its potential mechanism. After exposure to fluvastatin, the cell viability, proliferation, migration, and invasion of EC cells were measured by Cell Counting Kit-8 (CCK-8), 5-ethynyl-2ʹ-deoxyuridine (EDU), wound healing, and invasion assays, respectively. The apoptosis and its related proteins of fluvastatin-treated EC cells were detected by TUNEL and Western blot, separately. In order to figure out the effects of SIRT6 silence on EC cells, a series of cellular activities were performed again. Fluvastatin suppressed the proliferation, migration, and invasion of EC cells, but induced the apoptosis. The expression of SIRT6 was elevated in EC cells upon fluvastatin exposure. After silencing SIRT6 in fluvastatin-treated EC cells, the proliferation, migration, and invasion were promoted whereas the apoptosis was decreased. To sum up, this study firstly evidenced that fluvastatin suppresses the proliferation, invasion, and migration and promotes the apoptosis of endometrial cancer cells by regulating SIRT6 expression.
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Affiliation(s)
- Yu Cai
- Gynecology Department, The Third People's Hospital of Da Lian, Da Lian, China
| | - Feng Zhao
- Obstetrics and Gynecology Department, Hankou Hospital, Wuhan, Hubei, China
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2
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Bhattarai AK, Acharya A, Karki PK. Use of Statins as Lipid Lowering Agent in Hypercholesterolemia in a Tertiary Care Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2020; 58:1031-1035. [PMID: 34506382 PMCID: PMC8028536 DOI: 10.31729/jnma.5444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Lipids contribute to atherosclerosis and obesity that can lead to different cardiovascular diseases. Statins are hydroxymethylglutaryl reductase inhibitors that effectively lower the cholesterol level. It is widely prescribed in the treatment of hypercholesterolemia. Thus it optimizes the lipoprotein profile. The selection of a particular drug by the practitioner should be primarily based on clinical outcome. This study was conducted to find the type of statins that are most preferred by the doctors for treating dyslipidemia and preferred the fixed-dose in a tertiary care hospital. METHODS This was a descriptive cross-sectional study conducted among the practicing doctors of Kathmandu Medical College from July to August 2020. Ethical approval was taken from the Institutional Review Committee of the college (Ref: 207202006). Convenient sampling was done. A semi-structured questionnaire was used with consent. The data were analyzed with Social Statistical Package for the Social Sciences version 20. RESULTS Statins, with the score 4.25 was accounted for most preferred for the treatment of dyslipidemia. Among different statins, atorvastatin with a score of 4.48 was most popular followed by rosuvastatin 2.9 score and simvastatin 2.1 scores. CONCLUSIONS Statins were the most preferred agents for the treatment of dyslipidemia. Although different types of statins ought to have similar efficacy in treating dyslipidemia, atorvastatin was found to be popular and the most commonly prescribed one. The most common side effect reported with statins was myopathy.
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Affiliation(s)
| | - Anna Acharya
- Department of Pharmacology, Kathmandu Medical College, Duwakot, Bhaktapur, Nepal
| | - Prabin Kumar Karki
- Department of Physiology, Kathmandu Medical College, Duwakot, Bhaktapur, Nepal
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3
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Mahdavi A, Bagherniya M, Fakheran O, Reiner Ž, Xu S, Sahebkar A. Medicinal plants and bioactive natural compounds as inhibitors of HMG-CoA reductase: A literature review. Biofactors 2020; 46:906-926. [PMID: 33053603 DOI: 10.1002/biof.1684] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 08/15/2020] [Accepted: 08/29/2020] [Indexed: 12/16/2022]
Abstract
Cardiovascular diseases (CVDs) are one of the most important causes for mortality worldwide. Elevated levels of total cholesterol, and particularly LDL-cholesterol (LDL-C) are the main risk factor for acute myocardial infarction (AMI) and ischemic heart disease. The risk of CVDs could be reduced by decreasing the elevated cholesterol levels. β-hydroxy β-methylglutaryl-CoA reductase (HMGCoAR) is the primary and rate-limiting enzyme in the cholesterol biosynthesis pathway. Recently, the crucial role of nutraceuticals in maintaining normal physiological function was established. Nutraceuticals play an important role in preventing several non-communicable diseases such as obesity, CVDs, cancer, diabetes, and reducing hyperlipidemia. Although the effect of nutraceuticals and herbal medicine on CVDs and dyslipidemia was previously investigated thoroughly, the effect of these natural products on HMGCoAR as one of the important enzymes involved in CVDs etiopathogenesis has not yet been investigated. Therefore, the major aim of this paper was to review the effects of nutraceuticals and medicinal plants on HMGCoAR. Results indicate that different types of natural foods, isolated nutrients, herbal products, and dietary supplements as nutraceuticals decrease the expression and activity of HMGCoAR. This review shows that medicinal plants and nutraceuticals could be used to decrease HMGCoAR activity as accessible and convenient and economical natural compounds to prevent dyslipidemia and CVDs.
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Affiliation(s)
- Atena Mahdavi
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Bagherniya
- Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Fakheran
- Dental research center, Department of Periodontics, Dental research institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Suowen Xu
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Halal Research Center of IRI, FDA, Tehran, Iran
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
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4
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Cruz R, Pesce G, Calasans-Maia J, Moraschini V, Calasans-Maia MD, Granjeiro JM. Calcium Phosphate Carrying Simvastatin Enhances Bone Regeneration: A Systematic Review. Braz Dent J 2020; 31:93-102. [PMID: 32556021 DOI: 10.1590/0103-6440202002971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/11/2019] [Indexed: 12/28/2022] Open
Abstract
Several studies have aimed to develop alternative therapeutic biomaterials for bone repair. The purpose of this systematic review was to evaluate how statins carried by calcium phosphate affect the formation and regeneration of bone tissue in animal models when compared to other biomaterials or spontaneous healing. This systematic review followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions, the PRISMA guidelines, and the Preclinical Systematic Review & Meta-analysis Facility (SyRF). The protocol of this systematic review was registered in PROSPERO (CRD42018091112) and in CAMARADES. In addition, ARRIVE checklists were followed in order to increase the quality and transparency of the search. An electronic search was performed using the MEDLINE/PubMed, Scopus, SciELO, and PROSPERO library databases. The authors used a specific search strategy for each database, and they also conducted a search in the grey literature and cross-references. The eligibility criteria were animal studies, which evaluated bone repair treated with calcium phosphate as a simvastatin carrier. The selection process yielded 8 studies from the 657 retrieved. All manuscripts concluded that locally applied simvastatin carried by calcium phosphate is biocompatible, enhanced bone repair and induced statistically greater bone formation than cloth or calcium phosphate alone. In conclusion, the pertinent pre-clinical studies evidenced the calcium phosphate biocompatibility and its effectiveness in delivering SIM to improve the repair of bone defects. So, clinical trials are encouraged to investigate the impact of SIM associated with calcium phosphate bone graft in repairing bone defect in humans.
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Affiliation(s)
- Rebecca Cruz
- Laboratory of Dental Clinical Research, Dentistry school, UFF - Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Giovanna Pesce
- Laboratory of Dental Clinical Research, Dentistry school, UFF - Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - José Calasans-Maia
- Department of Orthodontics, Dentistry School, UFF - Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Vittorio Moraschini
- Laboratory of Dental Clinical Research, Dentistry school, UFF - Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Monica Diuana Calasans-Maia
- Laboratory of Dental Clinical Research, Dentistry school, UFF - Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - José Mauro Granjeiro
- Laboratory of Dental Clinical Research, Dentistry school, UFF - Universidade Federal Fluminense, Niterói, RJ, Brazil.,Bioengineering Laboratory, INMETRO - Instituto Nacional de Metrologia, Qualidade e Tecnologia, Duque de Caxias, RJ, Brazil
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5
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Mahmoud AR, Kamel EO, Ahmed MA, Ahmed EA, Abd-Elhamid TH. Alleviation of Simvastatin-Induced Myopathy in Rats by the Standardized Extract of Ginkgo Biloba (EGb761): Insights into the Mechanisms of Action. Cells Tissues Organs 2020; 208:158-176. [PMID: 32369804 DOI: 10.1159/000507048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 03/07/2020] [Indexed: 01/24/2023] Open
Abstract
Statins are the most widely prescribed cholesterol-lowering drugs to reduce the risk of cardiovascular diseases. Statin-induced myopathy is the major side effect of this class of drugs. Here, we studied whether standardized leaf extracts of ginkgo biloba (EGb761) would improve simvastatin (SIM)-induced muscle changes. Sixty Wistar rats were allotted into six groups: control group, vehicle group receiving 0.5% carboxymethyl cellulose (CMC) for 30 days, SIM group receiving 80 mg/kg/day SIM in 0.5% CMC orally for 30 days, SIM withdrawal group treated with SIM for 16 days and sacrificed 14 days later, and EGb761-100 and EGb761-200 groups posttreated with either 100 or 200 mg/kg/day EGb761 orally. Muscle performance on the rotarod, serum creatine kinase (CK), coenzyme Q10 (CoQ10), serum and muscle nitrite, muscle malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) activities were estimated. Additionally, muscle samples were processed for histopathological evaluation. We found that SIM decreased muscle performance on the rotarod, serum CoQ10, as well as muscle SOD and CAT activities while it increased serum CK, serum and muscle nitrite, as well as muscle MDA levels. SIM also induced sarcoplasmic vacuolation, splitting of myofibers, disorganization of sarcomeres, and disintegration of myofilaments. In contrast, posttreatment with EGb761 increased muscle performance, serum CoQ10, as well as muscle SOD and CAT activities while it reduced serum CK as well as serum and muscle nitrite levels in a dose-dependent manner. Additionally, EGb761 reversed SIM-induced histopathological changes with better results obtained by its higher dose. Interestingly, SIM withdrawal increased muscle performance on the rotarod, reduce serum CK and CoQ10, and reduced serum and muscle nitrite while it reversed SIM-induced histopathological changes. However, SIM withdrawal was not effective enough to restore their normal values. Additionally, SIM withdrawal did not improve SIM-induce muscle MDA, SOD, or CAT activities during the period studied. Our results suggest that EGb761 posttreatment reversed SIM-induces muscle changes possibly through its antioxidant effects, elevation of CoQ10 levels, and antagonizing mitochondrial damage.
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Affiliation(s)
- Amany R Mahmoud
- Department of Human Anatomy and Embryology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Anatomy Unit, Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Esam Omar Kamel
- Department of Medical Histology and Cell Biology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Marwa A Ahmed
- Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa A Ahmed
- Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Centre of Excellence in Environmental Studies, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tarek Hamdy Abd-Elhamid
- Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt,
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6
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Morales-Palomo F, Ramirez-Jimenez M, Ortega JF, Moreno-Cabañas A, Mora-Rodriguez R. Exercise Training Adaptations in Metabolic Syndrome Individuals on Chronic Statin Treatment. J Clin Endocrinol Metab 2020; 105:5687002. [PMID: 31875915 DOI: 10.1210/clinem/dgz304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/20/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Statins reduce atherogenic dyslipidemia and cardiovascular disease (CVD) risk in metabolic syndrome (MetS) individuals. Exercise training could also contribute to reduce CVD by improving cardiorespiratory fitness and fat oxidation. However, statin use could interfere with training adaptations. METHODS A total of 106 MetS individuals were divided into statin users (statin group, n = 46) and statin-naïve (control group, n = 60). Groups were matched by age, weight, and MetS components. Subjects completed 16 weeks of high intensity interval training (HIIT). Before and after HIIT, muscle biopsies were collected to assess mitochondrial content (citrate synthase [CS] activity) and the activity of the rate limiting β-oxidation enzyme (3-hydroxyacyl-CoA-dehydrogenase [HAD]). Fasting plasma glucose, insulin, TG, HDL-c, and LDL-c concentrations were measured. Exercise maximal fat oxidation (FOMAX) and oxygen uptake (VO2PEAK) were determined. RESULTS Training improved MetS similarly in both groups (MetS z-score -0.26 ± 0.38 vs. -0.22 ± 0.31; P < 0.001 for time and P = 0.60 for time x group). Before training, the statin group had reduced muscle HAD activity and whole body FOMAX compared to the control group. However, 16 weeks of HIIT increased HAD and FOMAX in both groups (P < 0.03, time-effect). The statin group did not prevent the increases in CS with HIIT observed in the control group (38% vs 64%, respectively; P < 0.001, time-effect). Conversely, with training VO2PEAK improved less in the statin than in the control group (12% vs. 19%, respectively; P = 0.013, time × group effect). CONCLUSION Chronic statin use in MetS does not interfere with exercise training improvements in MetS components, FOMAX, or mitochondrial muscle enzymes (ie, CS and HAD). However, the statin group attenuated the improvements in VO2PEAK with training. CLINICAL TRIAL INFORMATION ClinicalTrials.gov identifier no. NCT03019796, January 13, 2017.
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Affiliation(s)
- Felix Morales-Palomo
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | | | - Juan F Ortega
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain
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7
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Janssen L, Allard NAE, Saris CGJ, Keijer J, Hopman MTE, Timmers S. Muscle Toxicity of Drugs: When Drugs Turn Physiology into Pathophysiology. Physiol Rev 2019; 100:633-672. [PMID: 31751166 DOI: 10.1152/physrev.00002.2019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Drugs are prescribed to manage or prevent symptoms and diseases, but may sometimes cause unexpected toxicity to muscles. The symptomatology and clinical manifestations of the myotoxic reaction can vary significantly between drugs and between patients on the same drug. This poses a challenge on how to recognize and prevent the occurrence of drug-induced muscle toxicity. The key to appropriate management of myotoxicity is prompt recognition that symptoms of patients may be drug related and to be aware that inter-individual differences in susceptibility to drug-induced toxicity exist. The most prevalent and well-documented drug class with unintended myotoxicity are the statins, but even today new classes of drugs with unintended myotoxicity are being discovered. This review will start off by explaining the principles of drug-induced myotoxicity and the different terminologies used to distinguish between grades of toxicity. The main part of the review will focus on the most important pathogenic mechanisms by which drugs can cause muscle toxicity, which will be exemplified by drugs with high risk of muscle toxicity. This will be done by providing information on key clinical and laboratory aspects, muscle electromyography patterns and biopsy results, and pathological mechanism and management for a specific drug from each pathogenic classification. In addition, rather new classes of drugs with unintended myotoxicity will be highlighted. Furthermore, we will explain why it is so difficult to diagnose drug-induced myotoxicity, and which tests can be used as a diagnostic aid. Lastly, a brief description will be given of how to manage and treat drug-induced myotoxicity.
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Affiliation(s)
- Lando Janssen
- Departments of Physiology, Hematology, and Neurology, Radboud University Medical Center, Nijmegen, The Netherlands; and Human and Animal Physiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Neeltje A E Allard
- Departments of Physiology, Hematology, and Neurology, Radboud University Medical Center, Nijmegen, The Netherlands; and Human and Animal Physiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Christiaan G J Saris
- Departments of Physiology, Hematology, and Neurology, Radboud University Medical Center, Nijmegen, The Netherlands; and Human and Animal Physiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Jaap Keijer
- Departments of Physiology, Hematology, and Neurology, Radboud University Medical Center, Nijmegen, The Netherlands; and Human and Animal Physiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Maria T E Hopman
- Departments of Physiology, Hematology, and Neurology, Radboud University Medical Center, Nijmegen, The Netherlands; and Human and Animal Physiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Silvie Timmers
- Departments of Physiology, Hematology, and Neurology, Radboud University Medical Center, Nijmegen, The Netherlands; and Human and Animal Physiology, Wageningen University & Research, Wageningen, The Netherlands
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8
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Ramesh M, Campos JC, Lee P, Song Y, Hernandez G, Sin J, Tucker KC, Saadaeijahromi H, Gurney M, Ferreira JCB, Andres AM. Mitophagy protects against statin-mediated skeletal muscle toxicity. FASEB J 2019; 33:11857-11869. [PMID: 31365836 PMCID: PMC6902735 DOI: 10.1096/fj.201900807rr] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/09/2019] [Indexed: 12/13/2022]
Abstract
The deleterious effects of statins on skeletal muscle are well known, but the mechanism associated with these effects remains unresolved. Statins are associated with mitochondrial damage, which may contribute to muscle myopathy. Here we demonstrate that simvastatin induces mitophagy in skeletal muscle cells and hypothesized that attenuating this process by silencing the mitophagy adapter p62/sequestosome-1 (SQSTM1) might mitigate myotoxicity. Surprisingly, silencing p62/SQSTM1 in differentiated C2C12 muscle cells exacerbated rather than attenuated myotoxicity. This inhibition of mitophagy in the face of statin challenge correlated with increased release of cytochrome c to the cytosol, activation of caspase-3, and lactate dehydrogenase (LDH) release. Correspondingly, targeted knockdown of Parkin, a canonical E3 ubiquitin ligase important for mitophagy, mirrored the effects of p62/SQSTM1 silencing. To corroborate these findings in vivo, we treated Parkin knockout mice with simvastatin for 2 wk. In line with our findings in vitro, these mitophagy-compromised mice displayed reduced spontaneous activity, loss of grip strength, and increased circulating levels of muscle damage marker LDH. Our findings demonstrate that mitophagy is an important mechanism to resist statin-induced skeletal muscle damage.-Ramesh, M., Campos, J. C., Lee, P., Song, Y., Hernandez, G., Sin, J., Tucker, K. C., Saadaeijahromi, H., Gurney, M., Ferreira, J. C. B., Andres, A. M. Mitophagy protects against statin-mediated skeletal muscle toxicity.
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Affiliation(s)
- Mridula Ramesh
- Donald P. Shiley BioScience Center, San Diego State University, San Diego, California, USA
| | - Juliane C. Campos
- Cedars-Sinai Medical Center, Los Angeles, California, USA
- Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Pamela Lee
- Donald P. Shiley BioScience Center, San Diego State University, San Diego, California, USA
| | - Yang Song
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Genaro Hernandez
- Donald P. Shiley BioScience Center, San Diego State University, San Diego, California, USA
| | - Jon Sin
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kyle C. Tucker
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Michael Gurney
- Donald P. Shiley BioScience Center, San Diego State University, San Diego, California, USA
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9
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Zhang T, Bai R, Wang Q, Wang K, Li X, Liu K, Ryu J, Wang T, Chang X, Ma W, Bode AM, Xia Q, Song Y, Dong Z. Fluvastatin Inhibits HMG-CoA Reductase and Prevents Non-Small Cell Lung Carcinogenesis. Cancer Prev Res (Phila) 2019; 12:837-848. [PMID: 31554629 DOI: 10.1158/1940-6207.capr-19-0211] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/06/2019] [Accepted: 09/18/2019] [Indexed: 11/16/2022]
Abstract
Lung cancer is the leading cause of cancer-related death worldwide. However, promising agents for lung cancer prevention are still very limited. Identification of preventive targets and novel effective preventive agents is urgently needed for clinical applications. In this study, we found that fluvastatin targeted 3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase (HMGCR), which a rate-limiting enzyme in the mevalonate pathway, and inhibited non-small cell lung cancer (NSCLC) tumorigenesis. Initially, we demonstrated that HMGCR is overexpressed in human lung adenocarcinoma tissues compared with normal tissues. Knockdown of HMGCR in NSCLC cells attenuated growth and induced apoptosis in vitro and in vivo Furthermore, we found that fluvastatin, an inhibitor of HMGCR, suppressed NSCLC cell growth and induced apoptosis. Intriguingly, fluvastastin functions by inhibiting the HMGCR-driven Braf/MEK/ERK1/2 and Akt signaling pathways. Notably, fluvastatin attenuated tumor growth in 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)-induced lung tumorigenesis and in a patient-derived xenograft lung tumor model. Overall, our findings suggest that fluvastatin might be promising chemopreventive or potential therapeutic drug against NSCLC tumorigenesis, providing hope for rapid clinical translation.
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Affiliation(s)
- Tianshun Zhang
- The Hormel Institute, University of Minnesota, Austin, Minnesota
| | - Ruihua Bai
- The Hormel Institute, University of Minnesota, Austin, Minnesota.,Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qiushi Wang
- The Hormel Institute, University of Minnesota, Austin, Minnesota
| | - Keke Wang
- The Hormel Institute, University of Minnesota, Austin, Minnesota.,China-US (Henan) Hormel Cancer Institute, Zhengzhou, Henan, China
| | - Xiang Li
- China-US (Henan) Hormel Cancer Institute, Zhengzhou, Henan, China
| | - Kangdong Liu
- China-US (Henan) Hormel Cancer Institute, Zhengzhou, Henan, China
| | - Joohyun Ryu
- The Hormel Institute, University of Minnesota, Austin, Minnesota
| | - Ting Wang
- The Hormel Institute, University of Minnesota, Austin, Minnesota.,China-US (Henan) Hormel Cancer Institute, Zhengzhou, Henan, China
| | - Xiaoyu Chang
- The Hormel Institute, University of Minnesota, Austin, Minnesota
| | - Weiya Ma
- The Hormel Institute, University of Minnesota, Austin, Minnesota
| | - Ann M Bode
- The Hormel Institute, University of Minnesota, Austin, Minnesota
| | - Qingxin Xia
- Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yongping Song
- Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zigang Dong
- The Hormel Institute, University of Minnesota, Austin, Minnesota. .,China-US (Henan) Hormel Cancer Institute, Zhengzhou, Henan, China
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10
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Gu L, Saha ST, Thomas J, Kaur M. Targeting cellular cholesterol for anticancer therapy. FEBS J 2019; 286:4192-4208. [DOI: 10.1111/febs.15018] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/30/2019] [Accepted: 07/24/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Liang Gu
- School of Molecular and Cell Biology University of the Witwatersrand Johannesburg South Africa
| | - Sourav Taru Saha
- School of Molecular and Cell Biology University of the Witwatersrand Johannesburg South Africa
| | - Jodie Thomas
- School of Molecular and Cell Biology University of the Witwatersrand Johannesburg South Africa
| | - Mandeep Kaur
- School of Molecular and Cell Biology University of the Witwatersrand Johannesburg South Africa
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11
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Nogueira AA, Strunz CM, Takada JY, Mansur AP. Biochemical markers of muscle damage and high serum concentration of creatine kinase in patients on statin therapy. Biomark Med 2019; 13:619-626. [PMID: 31157560 DOI: 10.2217/bmm-2018-0379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Some patients experience statin-associated muscle symptoms (SAMS) and elevated serum concentrations of CK. The relationship between SAMS and biomarkers of muscle damage was examined. Methods: We analyzed 359 consecutive patients taking statins with high CK values. Muscle-related symptoms and biochemical variables, including CK, MB isoenzyme of creatine kinase (CK-MB), troponin and carbonic anhydrase type III were evaluated. Results: SAMS was reported by 181 (50.4%) patients and they had greater BMI (p = 0.021) and a trend toward higher CK-MB values (p = 0.064). The use of simvastatin (OR: 2.24; 95% CI: 1.47-3.42), CK-MB (OR: 1.59; 95% CI: 1.02-2.49) and BMI (OR: 1.06; 95% CI: 1.01-1.10) were independent variables for SAMS. Conclusion: Simvastatin use, BMI and CK-MB were independent markers of SAMS.
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Affiliation(s)
- Adriana Ar Nogueira
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Célia Mc Strunz
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Julio Y Takada
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Antonio P Mansur
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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12
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Oxidative stress as a possible mechanism of statin-induced myopathy. Inflammopharmacology 2018; 26:667-674. [PMID: 29574631 DOI: 10.1007/s10787-018-0469-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/15/2018] [Indexed: 01/05/2023]
Abstract
Statins, inhibitors of hydroxy methyl glutaryl coenzyme-A (HMG-CoA) reductase, are the most widely used drugs for treating hypercholesterolemia. However, statins can cause disabling myopathy as their main adverse effect. Several molecular mechanisms underlie the statin-induced myopathy including the decrease in the levels of essential mevalonate and cholesterol derivatives. This review discusses a further mechanism involving the loss of other anti-oxidant defenses besides ubiquinone (Co-Q) in skeletal muscles which produce a significant amount of reactive oxygen species (ROS). Therefore, to maintain their function, skeletal muscles need a high level of anti-oxidants.
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Bertl K, Steiner I, Pandis N, Buhlin K, Klinge B, Stavropoulos A. Statins in nonsurgical and surgical periodontal therapy. A systematic review and meta-analysis of preclinical in vivo trials. J Periodontal Res 2017; 53:267-287. [PMID: 29211309 DOI: 10.1111/jre.12514] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/13/2022]
Abstract
The cholesterol-lowering drugs, statins, possess anti-inflammatory, antimicrobial and pro-osteogenic properties, and thus have been tested as an adjunct to periodontal treatment. The present systematic review aimed to answer the following focused research question: What is the effect of local and/or systemic statin use on periodontal tissues in preclinical in vivo studies of experimentally induced periodontitis (EIP) and/or acute/chronified periodontal defect (ACP) models? A literature search (of Medline/PubMed, Embase/Ovid, CENTRAL/Ovid) using the following main eligibility criteria was performed: (i) English or German language; (ii) controlled preclinical in vivo trials; (iii) local and/or systemic statin use in EIP and/or ACP models; and (iv) quantitative evaluation of periodontal tissues (i.e., alveolar bone level/amount, attachment level, cementum formation, periodontal ligament formation). Sixteen studies in EIP models and 7 studies in ACP models evaluated simvastatin, atorvastatin or rosuvastatin. Thirteen of the EIP (81%) and 2 of the ACP (29%) studies presented significantly better results in terms of alveolar bone level/amount in favor of statins. Meta-analysis based on 14 EIP trials confirmed a significant benefit of local and systemic statin use (P < .001) in terms of alveolar bone level/amount; meta-regression revealed that statin type exhibited a significant effect (P = .014) in favor of atorvastatin. Three studies reported a significantly higher periodontal attachment level in favor of statin use (P < .001). Complete periodontal regeneration was never observed; furthermore, statins did not exert any apparent effect on cementum formation. Neither local nor systemic use of statins resulted in severe adverse effects. Statin use in periodontal indications has a positive effect on periodontal tissue parameters, supporting the positive results already observed in clinical trials. Nevertheless, not all statins available have been tested so far, and further research is needed to identify the maximum effective concentration/dose and optimal carrier.
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Affiliation(s)
- K Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - I Steiner
- Private Practice, Taiskirchen, Austria.,Postgraduate Course Periodontology, Medical University of Vienna, Vienna, Austria
| | - N Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School/Medical Faculty, University of Bern, Bern, Switzerland
| | - K Buhlin
- Division of Periodontology, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - B Klinge
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - A Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
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Risk of Late-Onset Alzheimer's Disease by Plasma Cholesterol: Rational In Silico Drug Investigation of Pyrrole-Based HMG-CoA Reductase Inhibitors. Assay Drug Dev Technol 2017; 15:342-351. [DOI: 10.1089/adt.2017.804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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15
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Dolezelova E, Stein E, Derosa G, Maffioli P, Nachtigal P, Sahebkar A. Effect of ezetimibe on plasma adipokines: a systematic review and meta-analysis. Br J Clin Pharmacol 2017; 83:1380-1396. [PMID: 28166606 DOI: 10.1111/bcp.13250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 01/22/2017] [Accepted: 01/27/2017] [Indexed: 12/11/2022] Open
Abstract
AIMS Statins are known to influence the status of adipokines, which play a key role in the pathophysiology of cardiometabolic diseases. As the effect of ezetimibe as an add-on to statin therapy on the impact of statins on plasma adipokines levels is currently unclear, the aim of the present study was to investigate this through a meta-analysis of controlled trials. METHODS A systematic review was performed, followed by a bibliographic search in PubMed, Medline, SCOPUS, Web of Science and Google Scholar databases. Quantitative data synthesis was performed using a fixed- or random-effects model (based on the level of interstudy heterogeneity) and the generic inverse variance weighting method. Effect sizes were expressed as standardized mean difference (SMD) and 95% confidence interval (CI). RESULTS Meta-analysis of 23 controlled trials did not suggest any significant effect of adding ezetimibe on top of statin therapy on plasma concentrations of adiponectin (SMD 0.34, 95% CI -0.28, 0.96; P = 0.288), leptin (SMD -0.75, 95% CI: -2.35, 0.85; P = 0.360), plasminogen activator inhibitor 1 (SMD -1.06, 95% CI: -2.81, 0.69; P = 0.236) and interleukin 6 (SMD 0.30, 95% CI: -0.08, 0.67; P = 0.124). However, significantly greater reductions in plasma concentrations of tumour necrosis factor α (TNF-α) (SMD -0.48, 95% CI -0.87, -0.08; P = 0.018) were achieved with ezetimibe/statin combination therapy. CONCLUSIONS The results suggested that ezetimibe add-on to statin therapy is associated with an enhanced TNF-α-lowering effect compared with statin monotherapy. Owing to the emerging role of TNF-α in the pathogenesis of metabolic disorders, further investigations are required to unveil the translational relevance of this TNF-α-lowering effect.
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Affiliation(s)
- Eva Dolezelova
- Faculty of Pharmacy in Hradec Kralove, Department of Biological and Medical Sciences, Charles University, Hradec Kralove, Czech Republic
| | - Evan Stein
- Metabolic and Atherosclerosis Research Center, Cincinnati, OH, USA
| | - Giuseppe Derosa
- Centre of Diabetes and Metabolic Diseases, Department of Internal Medicine and Therapeutics, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Center for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research, University of Pavia, Pavia, Italy.,Molecular Medicine Laboratory, University of Pavia, Pavia, Italy
| | - Pamela Maffioli
- Centre of Diabetes and Metabolic Diseases, Department of Internal Medicine and Therapeutics, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,PhD School in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Petr Nachtigal
- Faculty of Pharmacy in Hradec Kralove, Department of Biological and Medical Sciences, Charles University, Hradec Kralove, Czech Republic
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Medicine, University of Western Australia, Perth, WA, Australia
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Wang D, Wu Y, Liu C, Wang Y, Li Y, Luo L, Zhao Y, Ke Z, Huang C, Fan S. Ethyl acetate extract of crabapple fruit is the cholesterol-lowering fraction. RSC Adv 2017. [DOI: 10.1039/c7ra06585j] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hypercholesterolemia is highly associated with cardiovascular diseases (CVDs) such as atherosclerosis.
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Affiliation(s)
- Dongshan Wang
- School of Pharmacy
- Shanghai University of Traditional Chinese Medicine
- Shanghai 201203
- China
| | - Yingchun Wu
- School of Pharmacy
- Shanghai University of Traditional Chinese Medicine
- Shanghai 201203
- China
| | - Chuhe Liu
- School of Pharmacy
- Shanghai University of Traditional Chinese Medicine
- Shanghai 201203
- China
| | - Yahui Wang
- School of Pharmacy
- Shanghai University of Traditional Chinese Medicine
- Shanghai 201203
- China
| | - Yin Li
- School of Pharmacy
- Shanghai University of Traditional Chinese Medicine
- Shanghai 201203
- China
| | - Lingling Luo
- School of Pharmacy
- Shanghai University of Traditional Chinese Medicine
- Shanghai 201203
- China
| | - Yuanyuan Zhao
- School of Pharmacy
- Shanghai University of Traditional Chinese Medicine
- Shanghai 201203
- China
| | - Zunli Ke
- School of Pharmacy
- Shanghai University of Traditional Chinese Medicine
- Shanghai 201203
- China
| | - Cheng Huang
- School of Pharmacy
- Shanghai University of Traditional Chinese Medicine
- Shanghai 201203
- China
| | - Shengjie Fan
- School of Pharmacy
- Shanghai University of Traditional Chinese Medicine
- Shanghai 201203
- China
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Chung HR, Vakil M, Munroe M, Parikh A, Meador BM, Wu PT, Jeong JH, Woods JA, Wilund KR, Boppart MD. The Impact of Exercise on Statin-Associated Skeletal Muscle Myopathy. PLoS One 2016; 11:e0168065. [PMID: 27936249 PMCID: PMC5148116 DOI: 10.1371/journal.pone.0168065] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/23/2016] [Indexed: 01/07/2023] Open
Abstract
HMG-CoA reductase inhibitors (statins) are the most effective pharmacological means of reducing cardiovascular disease risk. The most common side effect of statin use is skeletal muscle myopathy, which may be exacerbated by exercise. Hypercholesterolemia and training status are factors that are rarely considered in the progression of myopathy. The purpose of this study was to determine the extent to which acute and chronic exercise can influence statin-induced myopathy in hypercholesterolemic (ApoE-/-) mice. Mice either received daily injections of saline or simvastatin (20 mg/kg) while: 1) remaining sedentary (Sed), 2) engaging in daily exercise for two weeks (novel, Nov), or 3) engaging in daily exercise for two weeks after a brief period of training (accustomed, Acct) (2x3 design, n = 60). Cholesterol, activity, strength, and indices of myofiber damage and atrophy were assessed. Running wheel activity declined in both exercise groups receiving statins (statin x time interaction, p<0.05). Cholesterol, grip strength, and maximal isometric force were significantly lower in all groups following statin treatment (statin main effect, p<0.05). Mitochondrial content and myofiber size were increased and 4-HNE was decreased by exercise (statin x exercise interaction, p<0.05), and these beneficial effects were abrogated by statin treatment. Exercise (Acct and Nov) increased atrogin-1 mRNA in combination with statin treatment, yet enhanced fiber damage or atrophy was not observed. The results from this study suggest that exercise (Nov, Acct) does not exacerbate statin-induced myopathy in ApoE-/- mice, yet statin treatment reduces activity in a manner that prevents muscle from mounting a beneficial adaptive response to training.
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Affiliation(s)
- Hae R. Chung
- Renal and Cardiovascular Disease Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Mayand Vakil
- Renal and Cardiovascular Disease Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Michael Munroe
- Molecular Muscle Physiology Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Alay Parikh
- Molecular Muscle Physiology Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Benjamin M. Meador
- Renal and Cardiovascular Disease Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Pei T. Wu
- Renal and Cardiovascular Disease Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Jin H. Jeong
- Renal and Cardiovascular Disease Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Jeffrey A. Woods
- Exercise Immunology Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Kenneth R. Wilund
- Renal and Cardiovascular Disease Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Marni D. Boppart
- Molecular Muscle Physiology Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- * E-mail:
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18
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Duh MS, Cremieux P, Audenrode MV, Vekeman F, Karner P, Zhang H, Greenberg P. Can social media data lead to earlier detection of drug-related adverse events? Pharmacoepidemiol Drug Saf 2016; 25:1425-1433. [PMID: 27601271 PMCID: PMC5157765 DOI: 10.1002/pds.4090] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 11/06/2022]
Abstract
Purpose To compare the patient characteristics and the inter‐temporal reporting patterns of adverse events (AEs) for atorvastatin (Lipitor®) and sibutramine (Meridia®) in social media (AskaPatient.com) versus the FDA Adverse Event Reporting System (FAERS). Methods We identified clinically important AEs associated with atorvastatin (muscle pain) and sibutramine (cardiovascular AEs), compared their patterns in social media postings versus FAERS and used Granger causality tests to assess whether social media postings were useful in forecasting FAERS reports. Results We analyzed 998 and 270 social media postings between 2001 and 2014, 69 003 and 7383 FAERS reports between 1997 and 2014 for atorvastatin and sibutramine, respectively. Social media reporters were younger (atorvastatin: 53.9 vs. 64.0 years, p < 0.001; sibutramine: 36.8 vs. 43.8 years, p < 0.001). Social media reviews contained fewer serious AEs (atorvastatin, pain: 2.5% vs. 38.2%; sibutramine, cardiovascular issues: 7.9% vs. 63.0%; p < 0.001 for both) and concentrated on fewer types of AEs (proportion comprising the top 20 AEs: atorvastatin, 88.7% vs. 55.4%; sibutramine, 86.3% vs. 65.4%) compared with FAERS. While social media sibutramine reviews mentioning cardiac issues helped predict those in FAERS 11 months later (p < 0.001), social media atorvastatin reviews did not help predict FAERS reports. Conclusions Social media AE reporters were younger and focused on less‐serious and fewer types of AEs than FAERS reporters. The potential for social media to provide earlier indications of AEs compared with FAERS is uncertain. Our findings highlight some of the promises and limitations of online social media versus conventional pharmacovigilance sources and the need for careful interpretation of the results. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.
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Kheirallah M, Almeshaly H. Simvastatin, dosage and delivery system for supporting bone regeneration, an update review. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2016. [DOI: 10.1016/j.ajoms.2015.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Diamond DM, Ravnskov U. How statistical deception created the appearance that statins are safe and effective in primary and secondary prevention of cardiovascular disease. Expert Rev Clin Pharmacol 2015; 8:201-10. [DOI: 10.1586/17512433.2015.1012494] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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21
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Auer J, Sinzinger H, Franklin B, Berent R. Muscle- and skeletal-related side-effects of statins: tip of the iceberg? Eur J Prev Cardiol 2014; 23:88-110. [DOI: 10.1177/2047487314550804] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/18/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Johann Auer
- Department of Cardiology and Intensive Care, General Hospital Braunau, Braunau, Austria
| | - Helmut Sinzinger
- Department of Nuclear Medicine, Medical University, Vienna, Austria
| | - Barry Franklin
- Cardiac Rehabilitation and Exercise Laboratories, William Beaumont Hospital Royal Oak, MI, USA
| | - Robert Berent
- Center of Cardiac Rehabilitation, Bad Ischl, Austria
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22
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Moßhammer D, Schaeffeler E, Schwab M, Mörike K. Mechanisms and assessment of statin-related muscular adverse effects. Br J Clin Pharmacol 2014; 78:454-66. [PMID: 25069381 PMCID: PMC4243897 DOI: 10.1111/bcp.12360] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/14/2014] [Indexed: 12/11/2022] Open
Abstract
Statin-associated muscular adverse effects cover a wide range of symptoms, including asymptomatic increase of creatine kinase serum activity and life-threatening rhabdomyolysis. Different underlying pathomechanisms have been proposed. However, a unifying concept of the pathogenesis of statin-related muscular adverse effects has not emerged so far. In this review, we attempt to categorize these mechanisms along three levels. Firstly, among pharmacokinetic factors, it has been shown for some statins that inhibition of cytochrome P450-mediated hepatic biotransformation and hepatic uptake by transporter proteins contribute to an increase of systemic statin concentrations. Secondly, at the myocyte membrane level, cell membrane uptake transporters affect intracellular statin concentrations. Thirdly, at the intracellular level, inhibition of the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase results in decreased intracellular concentrations of downstream metabolites (e.g. selenoproteins, ubiquinone, cholesterol) and alteration of gene expression (e.g. ryanodine receptor 3, glycine amidinotransferase). We also review current recommendations for prescribers.
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Affiliation(s)
- Dirk Moßhammer
- Division of General Practice, University Hospital TübingenTübingen, D-72074, Germany
| | - Elke Schaeffeler
- Dr. Margarete Fischer-Bosch Institute of Clinical PharmacologyStuttgart, D-70376, Germany
- University TübingenTübingen, Germany
| | - Matthias Schwab
- Department of Clinical Pharmacology, University Hospital TübingenTübingen, D-72076, Germany
- Dr. Margarete Fischer-Bosch Institute of Clinical PharmacologyStuttgart, D-70376, Germany
- University TübingenTübingen, Germany
| | - Klaus Mörike
- Department of Clinical Pharmacology, University Hospital TübingenTübingen, D-72076, Germany
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Shah SR, Werlang CA, Kasper FK, Mikos AG. Novel applications of statins for bone regeneration. Natl Sci Rev 2014; 2:85-99. [PMID: 26543666 DOI: 10.1093/nsr/nwu028] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The use of statins for bone regeneration is a promising and growing area of research. Statins, originally developed to treat high cholesterol, are inhibitors of the enzyme 3-hydroxy-3-methylglutaryl, the rate-limiting enzyme of the mevalonate pathway. Because the mevalonate pathway is responsible for the synthesis of a wide variety of important biochemical molecules, including cholesterol and other isoprenoids, the effects of statins are pleiotropic. In particular, statins can greatly affect the process of bone turnover and regeneration via effects on important cell types, including mesenchymal stem cells, osteoblasts, endothelial cells, and osteoclasts. Statins have also been shown to have anti-inflammatory and antimicrobial properties that may be useful since infection can derail normal bone healing. This review will explore the pleiotropic effects of statins, discuss the current use of statins for bone regeneration, particularly with regard to biomaterials-based controlled delivery, and offer perspectives on the challenges and future directions of this emerging area of bone tissue engineering.
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Affiliation(s)
- Sarita R Shah
- Department of Bioengineering, Rice University, Houston, TX 77005-1892, USA
| | - Caroline A Werlang
- Department of Bioengineering, Rice University, Houston, TX 77005-1892, USA
| | - F Kurtis Kasper
- Department of Bioengineering, Rice University, Houston, TX 77005-1892, USA
| | - Antonios G Mikos
- Department of Bioengineering, Rice University, Houston, TX 77005-1892, USA ; Department of Chemical and Biomolecular Engineering, Rice University, Houston, TX 77251-1892, USA
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Hsieh KC, Kao CL, Feng CW, Wen ZH, Chang HF, Chuang SC, Wang GJ, Ho ML, Wu SM, Chang JK, Chen HT. A novel anabolic agent: a simvastatin analogue without HMG-CoA reductase inhibitory activity. Org Lett 2014; 16:4376-9. [PMID: 25115530 DOI: 10.1021/ol501486b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
For the first time, structural information regarding the role of simvastatin in bone anabolism is described, and a bone-specific statin is introduced. Polyaspartate-conjugated simvastatin was synthesized by solid-phase synthesis with the assistance of microwave irradiation. It displays significant bone targeting and bone formation with less toxicity than simvastatin.
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Affiliation(s)
- Kuang-Chan Hsieh
- School of Pharmacy, ‡Department of Medicinal and Applied Chemistry, §Department of Fragrance and Cosmetic Science, ∥Orthopedic Research Center, ⊥Department of Physiology, and #Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan
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Stuart B, Loh FE, Roberto P, Miller L. Incident user cohorts for assessing medication cost-offsets. Health Serv Res 2014; 49:1364-86. [PMID: 24628528 PMCID: PMC4239854 DOI: 10.1111/1475-6773.12170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To develop and test incident drug user designs for assessing cost savings from statin use in diabetics. DATA SOURCE Random 5 percent sample of Medicare beneficiaries, 2006-2008. STUDY DESIGN Seven-step incident user design to assess impact of statin initiation on subsequent Medicare spending: (1) unadjusted pre/post initiation test; (2) unadjusted difference-in-difference (DID) with comparison series; (3) adjusted DID; (4) propensity score (PS)-matched DID with static and dynamic baseline covariates; (5) PS-matched DID by drug adherence strata; (6) PS-matched DID for high adherers controlling for healthy adherer bias; and (7) replication for ACE-inhibitor/ARB initiators. DATA COLLECTION/EXTRACTION METHODS Subjects with prevalent diabetes and no statin use (January-June 2006) and statin initiation (July 2006-January 2008) compared to nonusers with a random "potential-initiation" month. Monthly Medicare spending tracked 24 months pre- and post-initiation. PRINCIPAL FINDINGS Statistically significant savings in Medicare spending were observed beginning 7 months post-initiation for statins and 13 months post-initiation for ACEIs/ARBs. However, these savings were only observed for adherent patients in steps 5 and 6. CONCLUSIONS Drug initiator designs are more robust to confounding than prevalent user designs in assessing cost-offsets from drug use but still require other adjustments and sensitivity analysis to ensure proper inference.
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Affiliation(s)
- Bruce Stuart
- The Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy220 Arch Street, Room 12-212, Baltimore, MD 21201
| | - F Ellen Loh
- Department of Pharmaceutical Health Services Research, University of Maryland School of PharmacyBaltimore, MD
| | - Pamela Roberto
- Pharmaceutical Research and Manufacturers of AmericaWashington, DC
| | - Laura Miller
- National Association of Chain Drug StoresArlington, VA
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Murlasits Z, Radák Z. The Effects of Statin Medications on Aerobic Exercise Capacity and Training Adaptations. Sports Med 2014; 44:1519-30. [DOI: 10.1007/s40279-014-0224-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abdelbaset M, Safar MM, Mahmoud SS, Negm SA, Agha AM. Red yeast rice and coenzyme Q10 as safe alternatives to surmount atorvastatin-induced myopathy in hyperlipidemic rats. Can J Physiol Pharmacol 2014; 92:481-9. [PMID: 24896301 DOI: 10.1139/cjpp-2013-0430] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Statins are the first line treatment for the management of hyperlipidemia. However, the primary adverse effect limiting their use is myopathy. This study examines the efficacy and safety of red yeast rice (RYR), a source of natural statins, as compared with atorvastatin, which is the most widely used synthetic statin. Statin interference with the endogenous synthesis of coenzyme Q10 (CoQ10) prompted the hypothesis that its deficiency may be implicated in the pathogenesis of statin-associated myopathy. Hence, the effects of combination of CoQ10 with either statin have been evaluated. Rats were rendered hyperlipidemic through feeding them a high-fat diet for 90 days, during the last 30 days of the diet they were treated daily with either atorvastatin, RYR, CoQ10, or combined regimens. Lipid profile, liver function tests, and creatine kinase were monitored after 15 and 30 days of drug treatments. Heart contents of CoQ9 and CoQ10 were assessed and histopathological examination of the liver and aortic wall was performed. RYR and CoQ10 had the advantage over atorvastatin in that they lower cholesterol without elevating creatine kinase, a hallmark of myopathy. RYR maintained normal levels of heart ubiquinones, which are essential components for energy production in muscles. In conclusion, RYR and CoQ10 may offer alternatives to overcome atorvastatin-associated myopathy.
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Affiliation(s)
- Marwan Abdelbaset
- a Department of Pharmacology, Medical Research Division, National Research Centre, El Tahrir Street, 12622 Giza, Egypt
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Affiliation(s)
- Leon Chaitow
- Corfu, Greece; 21 Siddons Lane, London NW15NF, United Kingdom.
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Smith R, Solberg R, Jacobsen LL, Voreland AL, Rustan AC, Thoresen GH, Johansen HT. Simvastatin inhibits glucose metabolism and legumain activity in human myotubes. PLoS One 2014; 9:e85721. [PMID: 24416446 PMCID: PMC3885717 DOI: 10.1371/journal.pone.0085721] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/30/2013] [Indexed: 01/05/2023] Open
Abstract
Simvastatin, a HMG-CoA reductase inhibitor, is prescribed worldwide to patients with hypercholesterolemia. Although simvastatin is well tolerated, side effects like myotoxicity are reported. The mechanism for statin-induced myotoxicity is still poorly understood. Reports have suggested impaired mitochondrial dysfunction as a contributor to the observed myotoxicity. In this regard, we wanted to study the effects of simvastatin on glucose metabolism and the activity of legumain, a cysteine protease. Legumain, being the only known asparaginyl endopeptidase, has caspase-like properties and is described to be involved in apoptosis. Recent evidences indicate a regulatory role of both glucose and statins on cysteine proteases in monocytes. Satellite cells were isolated from the Musculus obliquus internus abdominis of healthy human donors, proliferated and differentiated into polynuclear myotubes. Simvastatin with or without mevalonolactone, farnesyl pyrophosphate or geranylgeranyl pyrophosphate were introduced on day 5 of differentiation. After 48 h, cells were either harvested for immunoblotting, ELISA, cell viability assay, confocal imaging or enzyme activity analysis, or placed in a fuel handling system with [14C]glucose or [3H]deoxyglucose for uptake and oxidation studies. A dose-dependent decrease in both glucose uptake and oxidation were observed in mature myotubes after exposure to simvastatin in concentrations not influencing cell viability. In addition, simvastatin caused a decrease in maturation and activity of legumain. Dysregulation of glucose metabolism and decreased legumain activity by simvastatin points out new knowledge about the effects of statins on skeletal muscle, and may contribute to the understanding of the myotoxicity observed by statins.
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Affiliation(s)
- Robert Smith
- Department of Pharmaceutical Biosciences, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- * E-mail:
| | - Rigmor Solberg
- Department of Pharmaceutical Biosciences, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Linn Løkken Jacobsen
- Department of Pharmaceutical Biosciences, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Anette Larsen Voreland
- Department of Pharmaceutical Biosciences, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Arild Christian Rustan
- Department of Pharmaceutical Biosciences, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - G. Hege Thoresen
- Department of Pharmaceutical Biosciences, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Department of Pharmacology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Harald Thidemann Johansen
- Department of Pharmacology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
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Kurisu S, Shimonaga T, Iwasaki T, Ishibashi K, Mitsuba N, Dohi Y, Kihara Y. Effects of ezetimibe on serum polyunsaturated fatty acids in patients with coronary artery disease. Int Heart J 2013; 54:254-7. [PMID: 24097212 DOI: 10.1536/ihj.54.254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Residual risk of cardiovascular disease might stem, at least partially, from low serum concentrations of n-3 polyunsaturated fatty acid (PUFA). The purpose of this study was to evaluate the effects of ezetimibe on serum lipids and PU-FAs in patients with coronary artery disease who were intolerant of new or high-dose statin therapy. The study population consisted of 13 patients who were intolerant of new statin therapy and 10 patients who were intolerant of high-dose statin therapy for the treatment of low-density lipoprotein (LDL) cholesterol. Patients who were intolerant of high-dose statin therapy continued taking a statin, but at a lower dose during the study period. Blood samples were collected before and 12 weeks after ezetimibe (10 mg). We measured serum lipids and PUFAs including dihomo-γ-linolenic acid, arachidonic acid (AA), eicosapentaenoic acid (EPA), and docosahexaenoic acid. Ezetimibe significantly decreased LDL cholesterol (138 ± 19 mg/dL to 97 ± 34 mg/dL, P < 0.01), but did not significantly affect high-density lipoprotein cholesterol, triglyceride, or any of the PUFAs measured during the follow-up period. Consequently, it did not affect the ratio of EPA to AA (0.40 ± 0.17 to 0.43 ± 0.18, P = ns) or the ratio of n-3 PUFA to n-6 PUFA (1.10 ± 0.39 to 1.09 ± 0.36, P = ns) during the follow-up period. Ezetimibe in combination with a low-dose statin, or as monotherapy in statin-intolerant patients, decreased LDL cholesterol, but did not significantly affect serum PUFA concentrations in patients with coronary artery disease.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
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Rosenbaum D, Dallongeville J, Sabouret P, Bruckert E. Discontinuation of statin therapy due to muscular side effects: a survey in real life. Nutr Metab Cardiovasc Dis 2013; 23:871-875. [PMID: 22748604 DOI: 10.1016/j.numecd.2012.04.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 04/20/2012] [Accepted: 04/25/2012] [Indexed: 01/14/2023]
Abstract
BACKGROUNDS AND AIMS To assess the burden of statin related muscular symptom in real life. METHODS AND RESULTS We conducted a wide survey on 10,409 French subjects. Among these, 2850 (27%) had hypercholesterolemia and 1074 were treated with statins. Muscular symptoms were reported by 104 (10%) statin treated patients and led to discontinuation in 30% of the symptomatic patients. The main prescribed statins were low doses rosuvastatin, atorvastatin and simvastatin. Pains were the most commonly described symptoms (87%) but many patients also reported stiffness (62%), cramps (67%), weakness or a loss of strength during exertion (55%). Pain was localized in 70% but mostly described as affecting several muscular groups. Approximately 38% of patients reported that their symptoms prevented even moderate exertion during everyday activities, while 42% of patients suffered major disruption to their everyday life. CONCLUSION Muscular symptoms associated with average dosage statin therapy are more frequent than in clinical trials and have a greater impact on patients' life than usually thought.
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Affiliation(s)
- D Rosenbaum
- Unité de Prévention Cardiovasculaire, Service d'Endocrinologie Métabolisme, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France; UPMC Université Paris 06, UMR S 939, F-75013, France.
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Mikus CR, Boyle LJ, Borengasser SJ, Oberlin DJ, Naples SP, Fletcher J, Meers GM, Ruebel M, Laughlin MH, Dellsperger KC, Fadel PJ, Thyfault JP. Simvastatin impairs exercise training adaptations. J Am Coll Cardiol 2013; 62:709-14. [PMID: 23583255 DOI: 10.1016/j.jacc.2013.02.074] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/06/2013] [Accepted: 02/14/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study sought to determine if simvastatin impairs exercise training adaptations. BACKGROUND Statins are commonly prescribed in combination with therapeutic lifestyle changes, including exercise, to reduce cardiovascular disease risk in patients with metabolic syndrome. Statin use has been linked to skeletal muscle myopathy and impaired mitochondrial function, but it is unclear whether statin use alters adaptations to exercise training. METHODS This study examined the effects of simvastatin on changes in cardiorespiratory fitness and skeletal muscle mitochondrial content in response to aerobic exercise training. Sedentary overweight or obese adults with at least 2 metabolic syndrome risk factors (defined according to National Cholesterol Education Panel Adult Treatment Panel III criteria) were randomized to 12 weeks of aerobic exercise training or to exercise in combination with simvastatin (40 mg/day). The primary outcomes were cardiorespiratory fitness and skeletal muscle (vastus lateralis) mitochondrial content (citrate synthase enzyme activity). RESULTS Thirty-seven participants (exercise plus statins: n = 18; exercise only: n = 19) completed the study. Cardiorespiratory fitness increased by 10% (p < 0.05) in response to exercise training alone, but was blunted by the addition of simvastatin resulting in only a 1.5% increase (p < 0.005 for group by time interaction). Similarly, skeletal muscle citrate synthase activity increased by 13% in the exercise-only group (p < 0.05), but decreased by 4.5% in the simvastatin-plus-exercise group (p < 0.05 for group-by-time interaction). CONCLUSIONS Simvastatin attenuates increases in cardiorespiratory fitness and skeletal muscle mitochondrial content when combined with exercise training in overweight or obese patients at risk of the metabolic syndrome. (Exercise, Statins, and the Metabolic Syndrome; NCT01700530).
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Affiliation(s)
- Catherine R Mikus
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
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Ried K, Toben C, Fakler P. Effect of garlic on serum lipids: an updated meta-analysis. Nutr Rev 2013; 71:282-99. [DOI: 10.1111/nure.12012] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Catherine Toben
- Discipline of General Practice; The University of Adelaide; Adelaide; South Australia; Australia
| | - Peter Fakler
- Discipline of General Practice; The University of Adelaide; Adelaide; South Australia; Australia
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El-Salem K, Ababneh B, Rudnicki S, Malkawi A, Alrefai A, Khader Y, Saadeh R, Saydam M. Prevalence and risk factors of muscle complications secondary to statins. Muscle Nerve 2012; 44:877-81. [PMID: 22102457 DOI: 10.1002/mus.22205] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The aim of the study was to investigate the prevalence and risk factors of muscle complications among patients using statins. METHODS We conducted a prospective comparative study on 345 patients receiving statins and compared the findings with an age- and gender-matched control group of 85 subjects. Univariate and multivariate analyses with logistic regression models were used to study the association of different patient and disease characteristics with muscle complications. RESULTS Adverse reactions were reported by 21% of patients and 5.9% of controls (P = 0.0013). Objective weakness was found in 15% of the patients who reported muscle symptoms (3.2% of the total cohort), but not in controls. Older age, longer duration of statin use, diabetes, stroke, and lower body mass index were associated with increased risk of developing these symptoms. CONCLUSIONS Adverse reactions to statins may be more common than previously reported, and they may be affected by specific patient and disease characteristics.
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Affiliation(s)
- Khalid El-Salem
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan.
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Meador BM, Huey KA. Statin-associated changes in skeletal muscle function and stress response after novel or accustomed exercise. Muscle Nerve 2011; 44:882-9. [DOI: 10.1002/mus.22236] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Berent R, Sinzinger H. Regarding “Optimal statin type and dosage for vascular patients”. J Vasc Surg 2011; 54:928; author reply 928-9. [DOI: 10.1016/j.jvs.2011.03.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Revised: 03/07/2011] [Accepted: 03/13/2011] [Indexed: 10/17/2022]
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Taunk NK, Haffty BG, Goyal S. Radiation Recall 5 Years After Whole-Breast Irradiation for Early-Stage Breast Cancer Secondary to Initiation of Rosuvastatin and Amlodipine. J Clin Oncol 2011; 29:e661-3. [PMID: 21646611 DOI: 10.1200/jco.2011.35.7202] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Neil K. Taunk
- The Cancer Institute of New Jersey and Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
| | - Bruce G. Haffty
- The Cancer Institute of New Jersey and Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
| | - Sharad Goyal
- The Cancer Institute of New Jersey and Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
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Thompson PD, Parker BA, Clarkson PM, Pescatello LS, White CM, Grimaldi AS, Levine BD, Haller RG, Hoffman EP. A randomized clinical trial to assess the effect of statins on skeletal muscle function and performance: rationale and study design. ACTA ACUST UNITED AC 2011; 13:104-11. [PMID: 20626664 DOI: 10.1111/j.1751-7141.2009.00063.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hydroxymethylglutaryl-coenzyme A reductase inhibitors or statins are the most effective medications for reducing elevated concentrations of low-density lipoprotein cholesterol (LDL-C). Statins reduce cardiac events in patients with coronary artery disease and previously healthy persons. Current recommendations for LDL-C treatment goals indicate that more patients will be treated with higher doses of these medications. Statins have been extremely well-tolerated in controlled clinical trials but are increasingly recognized to produce skeletal muscle myalgia, cramps, and weakness. The reported frequency of such mild symptoms is not clear, and muscle performance has not been examined with these medications. Accordingly, the present investigation, the Effect of Statins on Skeletal Muscle Function and Performance (STOMP) study, will recruit approximately 440 healthy persons. Participants will be randomly assigned to treatment with atorvastatin 80 mg/d or placebo. Handgrip, elbow and knee isometric and isokinetic strength, knee extensor endurance, and maximal aerobic exercise performance will be determined at baseline. Participants will undergo repeat testing after 6 months of treatment or after meeting the study definition of statin myalgia. This study will determine the effect of statins on skeletal muscle strength, endurance, and aerobic exercise performance and may ultimately help clinicians better evaluate statin-related muscle and exercise complaints.
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Affiliation(s)
- Paul D Thompson
- Division of Cardiology, Henry Low Heart Center, Hartford Hospital, Hartford, CT 06102, USA.
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Mor A, Wortmann RL, Mitnick HJ, Pillinger MH. Drugs Causing Muscle Disease. Rheum Dis Clin North Am 2011; 37:219-31, vi. [DOI: 10.1016/j.rdc.2011.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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40
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Ruchala M, Szczepanek E, Puszczewicz M, Sosnowski P, Sowinski J. Not a graves' situation. Am J Med 2011; 124:210-4. [PMID: 21396501 DOI: 10.1016/j.amjmed.2010.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 11/04/2010] [Accepted: 11/04/2010] [Indexed: 11/24/2022]
Affiliation(s)
- Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, University of Medical Sciences, Poznan, Poland.
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Ried K, Fakler P. Protective effect of lycopene on serum cholesterol and blood pressure: Meta-analyses of intervention trials. Maturitas 2010; 68:299-310. [PMID: 21163596 DOI: 10.1016/j.maturitas.2010.11.018] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 11/23/2010] [Accepted: 11/23/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cardiovascular disease is associated with oxidative stress, inflammatory processes, and vascular dysfunction. Lycopene, a carotenoid found in tomatoes, is an antioxidant with a protective effect on lipid peroxidation and anti-atherosclerotic capacity. This review summarises current evidence on the effect of lycopene on serum lipid concentrations and blood pressure. METHODS We searched the PubMed and Cochrane databases for intervention studies between 1955 and September 2010 investigating the effect of lycopene on blood lipids or blood pressure for a minimum duration of 2 weeks. We conducted meta-analyses using a random effect model of all studies fitting the inclusion criteria. Additionally, we conducted subgroup meta-analysis of serum lipid concentrations by lycopene dosage and subgroup meta-analysis by baseline blood pressure. RESULTS Twelve studies (13 trial arms) meeting the inclusion criteria investigated the effect of lycopene on serum lipids, and four studies examined its effect on blood pressure. Meta-analysis on serum lipids revealed a significant cholesterol-lowering effect of lycopene for total serum cholesterol (mean change±SE: -7.55±6.15mg/dl; p=0.02) and low-density-lipoprotein (LDL) cholesterol (mean change±SE: -10.35±5.64mg/dl, p=0.0003) in the subgroup of trials using lycopene dosages of ≥25mg daily, whereas subgroup meta-analysis of trials using lower lycopene dosages was not significant. Meta-analysis of the effect of lycopene on systolic blood pressure of all trials suggested a significant blood pressure reducing effect (mean systolic blood pressure change±SE: -5.60±5.26mm Hg, p=0.04). CONCLUSIONS Our meta-analysis suggests that lycopene taken in doses ≥25mg daily is effective in reducing LDL cholesterol by about 10% which is comparable to the effect of low doses of statins in patient with slightly elevated cholesterol levels. More research is needed to confirm suggested beneficial effects on total serum cholesterol and systolic blood pressure.
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Affiliation(s)
- Karin Ried
- Discipline of General Practice, School of Population Health and Clinical Practice, The University of Adelaide, Adelaide, South Australia 5005, Australia.
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Meador BM, Huey KA. Statin-associated myopathy and its exacerbation with exercise. Muscle Nerve 2010; 42:469-79. [DOI: 10.1002/mus.21817] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Teichmann LL, Fleck M. [Current views on lipid metabolism: statin-induced myopathy]. Z Rheumatol 2010; 69:696-8, 700-1. [PMID: 20862481 DOI: 10.1007/s00393-009-0584-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cardiovascular diseases are the most common causes of death in Germany and the prevalence is increased in patients with inflammatory rheumatic diseases. Statins are often employed for primary and secondary prophylaxis of cardiovascular events but can potentially induce myopathy as a side-effect. In addition to an asymptomatic elevation of muscle enzymes, myalgia and myositis as well as rhabdomyolysis, the most severe side-effect, have been observed, which are mostly manifested within 6 months after initiation of therapy. Statin-induced myopathy is rare but if risk factors are present, the individual risk can be much higher. Such factors are in particular interaction with other medications, statin dosage, the characteristics of the statin preparation used, comorbidities, age and sex of the patient. Regular testing of muscle enzymes after induction of statin therapy is not generally recommended for asymptomatic patients, but is indispensable when muscle symptoms appear. Statin therapy must be immediately terminated and a diagnostic evaluation must be carried out at the latest when creatine kinase values show a more than 10-fold increase.
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Affiliation(s)
- L L Teichmann
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
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Cham S, Evans MA, Denenberg JO, Golomb BA. Statin-associated muscle-related adverse effects: a case series of 354 patients. Pharmacotherapy 2010; 30:541-53. [PMID: 20500044 DOI: 10.1592/phco.30.6.541] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVE To characterize the properties and natural history of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin)-associated muscle-related adverse effects (MAEs). DESIGN Patient-targeted postmarketing adverse-effect surveillance approach coupling survey design with an open-ended narrative. SETTING University-affiliated health care system. SUBJECTS Three hundred fifty-four patients (age range 34-86 yrs) who self-reported muscle-related problems associated with statin therapy. MEASUREMENTS AND MAIN RESULTS Patients with perceived statin-associated MAEs completed a survey assessing statin drugs and dosages; characteristics of the MAEs; time course of onset, resolution, or recurrence; and impact on quality of life (QOL). Cases were assessed for putative drug adverse-effect causality by using the Naranjo adverse drug reaction probability scale criteria and were evaluated for inclusion in groups for which mortality benefit with statins has been shown. Patients reported muscle pain (93%), fatigue (88%), and weakness (85%). Three hundred patients (85%) met literature criteria for probable or definite drug adverse-effect causality. Ninety-four percent of atorvastatin usages (240/255) generated MAEs versus 61% of lovastatin usages (38/62, p<0.0001). Higher potency statins reproduced MAEs in 100% of 39 rechallenges versus 73% (29/40) with lower potency rechallenges (p<0.01). Time course of onset after statin initiation varied (median 14 wks); some MAEs occurred after long-term symptom-free use. Recurrence with rechallenge had a significantly shorter latency to onset (median 2 wks). The MAEs adversely affected all assessed functional and QOL domains. Most patients with probable or definite MAEs were in categories for which available randomized controlled trial evidence shows no trend to all-cause mortality benefit with statin therapy. CONCLUSION This study complements available information on the properties and natural history of statin-associated MAEs, affirming dose dependence and strong QOL impact. The data indicating a dose-dependent relationship between MAE risk and recurrence suggest lower potency statins or discontinuation may bear consideration for ameliorating symptoms.
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Affiliation(s)
- Stephanie Cham
- Department of Medicine, University of California-San Diego School of Medicine, La Jolla, California 92093-0995, USA
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Draeger A, Sanchez-Freire V, Monastyrskaya K, Hoppeler H, Mueller M, Breil F, Mohaupt MG, Babiychuk EB. Statin therapy and the expression of genes that regulate calcium homeostasis and membrane repair in skeletal muscle. THE AMERICAN JOURNAL OF PATHOLOGY 2010; 177:291-9. [PMID: 20489141 DOI: 10.2353/ajpath.2010.091140] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In skeletal muscle of patients with clinically diagnosed statin-associated myopathy, discrete signs of structural damage predominantly localize to the T-tubular region and are suggestive of a calcium leak. The impact of statins on skeletal muscle of non-myopathic patients is not known. We analyzed the expression of selected genes implicated in the molecular regulation of calcium and membrane repair, in lipid homeostasis, myocyte remodeling and mitochondrial function. Microscopic and gene expression analyses were performed using validated TaqMan custom arrays on skeletal muscle biopsies of 72 age-matched subjects who were receiving statin therapy (n = 38), who had discontinued therapy due to statin-associated myopathy (n = 14), and who had never undergone statin treatment (n = 20). In skeletal muscle, obtained from statin-treated, non-myopathic patients, statins caused extensive changes in the expression of genes of the calcium regulatory and the membrane repair machinery, whereas the expression of genes responsible for mitochondrial function or myocyte remodeling was unaffected. Discontinuation of treatment due to myopathic symptoms led to a normalization of gene expression levels, the genes encoding the ryanodine receptor 3, calpain 3, and dystrophin being the most notable exceptions. Hence, even in clinically asymptomatic (non-myopathic) patients, statin therapy leads to an upregulation in the expression of genes that are concerned with skeletal muscle regulation and membrane repair.
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Affiliation(s)
- Annette Draeger
- Institute of Anatomy, University of Bern, Baltzerstr. 2, 3012 Bern, Switzerland.
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Abstract
Myopathy occurs in approximately 10% of statin-treated patients and is most commonly manifested by myalgias with or without plasma creatine kinase (CK) elevations. Predisposition exists in patients treated with high doses of potent statins and those who are older, female, have a genetic predisposition, and when statins are coadministered with drugs that compete with or inhibit drug metabolism. In symptomatic patients, CK levels may assist in guiding management. If less than five times the upper limit of normal, the existing statin should be titrated to achieve cholesterol goals and the CK repeated when symptoms appear or worsen. In patients with moderate to severe symptoms and any patient with CK elevated to more than 5-fold the upper limit of normal, the statin should be stopped. Once asymptomatic and CK is reduced (if elevated previously), cholesterol goals can be approached by: 1) a different statin (e.g. fluvastatin or pravastatin), starting with a low dose and titrating up; 2) an alternate daily or weekly more potent statin (e.g. rosuvastatin or atorvastatin); or 3) the combination of the lowest tolerated statin with a cholesterol absorption inhibitor (ezetimibe) and/or bile acid sequestrant. Over-the-counter preparations, e.g. red yeast rice, containing natural statin-like agents, or plant sterols can also lower cholesterol. These, however, have limited efficacy to achieve targeted cholesterol levels for most patients. In patients without CK elevations and symptoms, progress can be followed clinically, but in patients who show CK elevations, CK should be monitored. At present, the superiority of one approach has not been demonstrated, and the need for clinical trials in well-characterized patients with statin intolerance cannot be dismissed.
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Affiliation(s)
- Robert H Eckel
- University of Colorado Denver, Anschutz Medical Campus, Mail Stop 8106, 12801 East 17th Avenue, Aurora, Colorado 80045, USA.
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Mohaupt MG, Karas RH, Babiychuk EB, Sanchez-Freire V, Monastyrskaya K, Iyer L, Hoppeler H, Breil F, Draeger A. Association between statin-associated myopathy and skeletal muscle damage. CMAJ 2009; 181:E11-8. [PMID: 19581603 DOI: 10.1503/cmaj.081785] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Many patients taking statins often complain of muscle pain and weakness. The extent to which muscle pain reflects muscle injury is unknown. METHODS We obtained biopsy samples from the vastus lateralis muscle of 83 patients. Of the 44 patients with clinically diagnosed statin-associated myopathy, 29 were currently taking a statin, and 15 had discontinued statin therapy before the biopsy (minimal duration of discontinuation 3 weeks). We also included 19 patients who were taking statins and had no myopathy, and 20 patients who had never taken statins and had no myopathy. We classified the muscles as injured if 2% or more of the muscle fibres in a biopsy sample showed damage. Using reverse transcriptase polymerase chain reaction, we evaluated the expression levels of candidate genes potentially related to myocyte injury. RESULTS Muscle injury was observed in 25 (of 44) patients with myopathy and in 1 patient without myopathy. Only 1 patient with structural injury had a circulating level of creatine phosphokinase that was elevated more than 1950 U/L (10x the upper limit of normal). Expression of ryanodine receptor 3 was significantly upregulated in patients with biopsy evidence of structural damage (1.7, standard error of the mean 0.3). INTERPRETATION Persistent myopathy in patients taking statins reflects structural muscle damage. A lack of elevated levels of circulating creatine phosphokinase does not rule out structural muscle injury. Upregulation of the expression of ryanodine receptor 3 is suggestive of an intracellular calcium leak.
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Affiliation(s)
- Markus G Mohaupt
- Department of Nephrology and Hypertension, Inselspital, University of Bern, Bern, Switzerland
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Mascitelli L, Pezzetta F. Physical activity in statin-treated patients. Int J Cardiol 2009; 134:136-7. [DOI: 10.1016/j.ijcard.2007.12.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 12/16/2007] [Indexed: 11/30/2022]
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Mosshammer D, Lorenz G, Meznaric S, Schwarz J, Muche R, Mörike K. Statin use and its association with musculoskeletal symptoms--a cross-sectional study in primary care settings. Fam Pract 2009; 26:88-95. [PMID: 19233960 DOI: 10.1093/fampra/cmp006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Musculoskeletal complaints are very common in primary care settings. Lipid-lowering drugs are one of several causes of musculoskeletal symptoms. However, data showing an association of lipid-lowering drug therapy and increased odds of musculoskeletal complaints in primary care patients are lacking. OBJECTIVE To investigate the association between statin use and the reporting of muscular complaints by patients and simultaneously control for several known factors of musculoskeletal complaints. METHODS In a cross-sectional study with 1031 consecutive patients (>50 years of age) in 26 offices of GPs, two investigators collected the data from the office files and by interviewing the patients. A logistic regression model was used to identify variables affecting the odds of muscular symptoms. RESULTS The prevalence of lipid-lowering drug prescription was 23% (n = 239) and that of muscular complaints was 40% (n = 411). In all, 44% (n = 106) of the patients with lipid-lowering drug prescription had muscular complaints compared to 39% (n = 305) of the patients without lipid-lowering drug therapy. Statin prescription and 10 variables remained in the final model. Statin prescription is associated with a 1.5-fold odds of musculoskeletal complaints compared to non-prescription {odds ratio [OR] = 1.5 [95% confidence interval (CI), 1.1-2.0], P = 0.02}. CONCLUSION Having a statin prescription appears to be an independent factor associated with musculoskeletal symptoms in primary care settings. Statin use may be more often associated with musculoskeletal complaints than previously assumed.
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Affiliation(s)
- Dirk Mosshammer
- Division of General Medicine, University of Tübingen, Tübingen, Germany.
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Patil S, Holt G, Raby N, McLellan AR, Smith K, O'Kane S, Beastall G, Crossan JF. Prospective, double blind, randomized, controlled trial of simvastatin in human fracture healing. J Orthop Res 2009; 27:281-5. [PMID: 18853428 DOI: 10.1002/jor.20572] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although statins are widely prescribed as cholesterol-lowering drugs, a number of studies suggest that these compounds may have anabolic effects on bone. Our aim was to assess whether simvastatin affects the rate of fracture healing in humans. A prospective, double-blind, randomized controlled trial was performed. Individuals who had sustained an undisplaced, extra-articular fracture of the distal radial metaphysis were recruited from a trauma clinic. Patients were randomized to receive simvastatin 20 mg once daily or a placebo. Regular clinical and radiological follow-up was undertaken for a 12 week period. Dual-energy X-ray absorptiometry assessment of bone mineral density was conducted at 2 and 12 weeks postinjury. Biochemical markers of bone turnover were assayed during the study period. Time to fracture union was defined as the time to cortical bridging in four cortices on plain radiographs. In addition, the rate of trabecular union was assessed. Eighty patients were recruited, of which 62 completed the study (31 in each group). Study cohorts were matched for age and gender. For patients receiving simvastatin therapy, the mean time to fracture union was 71.6 days (SD 22.2 days, SEM 3.8 days). This compared to 71.3 days (SD 21.3, SEM 4.1 days) for the control cohort (p = 0.6481). There was no significant difference between bone mineral density or bone biochemical markers between groups (p > 0.05). Despite promising results from in vivo and in vitro animal studies, simvastatin at a treatment dose of 20 mg once daily does not affect the rate of fracture healing in humans.
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Affiliation(s)
- Sanjeev Patil
- Department of Orthopaedic and Trauma Surgery, Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF, United Kingdom
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