1
|
Yan R, Song A, Zhang C. The Pathological Mechanisms and Therapeutic Molecular Targets in Arteriovenous Fistula Dysfunction. Int J Mol Sci 2024; 25:9519. [PMID: 39273465 PMCID: PMC11395150 DOI: 10.3390/ijms25179519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 08/28/2024] [Accepted: 08/30/2024] [Indexed: 09/15/2024] Open
Abstract
The number of patients with end-stage renal disease (ESRD) requiring hemodialysis is increasing worldwide. Although arteriovenous fistula (AVF) is the best and most important vascular access (VA) for hemodialysis, its primary maturation failure rate is as high as 60%, which seriously endangers the prognosis of hemodialysis patients. After AVF establishment, the venous outflow tract undergoes hemodynamic changes, which are translated into intracellular signaling pathway cascades, resulting in an outward and inward remodeling of the vessel wall. Outward remodeling refers to the thickening of the vessel wall and the dilation of the lumen to accommodate the high blood flow in the AVF, while inward remodeling is mainly characterized by intimal hyperplasia. More and more studies have shown that the two types of remodeling are closely related in the occurrence and development of, and jointly determining the final fate of, AVF. Therefore, it is essential to investigate the underlying mechanisms involved in outward and inward remodeling for identifying the key targets in alleviating AVF dysfunction. In this review, we summarize the current clinical diagnosis, monitoring, and treatment techniques for AVF dysfunction and discuss the possible pathological mechanisms related to improper outward and inward remodeling in AVF dysfunction, as well as summarize the similarities and differences between the two remodeling types in molecular mechanisms. Finally, the representative therapeutic targets of potential clinical values are summarized.
Collapse
Affiliation(s)
- Ruiwei Yan
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Anni Song
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| |
Collapse
|
2
|
Seyferth ER, Song H, Vance AZ, Clark TWI. Association between statin intensity and femoropopliteal stent primary patency in peripheral arterial disease. CVIR Endovasc 2024; 7:60. [PMID: 39096322 PMCID: PMC11297851 DOI: 10.1186/s42155-024-00472-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 07/24/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Statins are widely used in coronary and peripheral arterial disease, but their impact on patency of stents placed for peripheral arterial disease is not well-studied. The purpose of this study was to evaluate femoropopliteal stent primary patency according to statin intensity at the time of stent placement and compare this effect to other covariates that may influence stent patency. MATERIALS AND METHODS A retrospective review identified 278 discrete femoropopliteal stent constructs placed in 216 patients over a 10-year period; Rutherford categories were 2 (3.6%), 3 (12.9%), 4 (21.2%), 5 (49.6%), and 6 (12.6%). Stent locations were common femoral (1.8%), common femoral/superficial femoral (0.7%), superficial femoral (50.7%), superficial femoral/popliteal (32.7%) and popliteal (14.0%) arteries; 63.3% of stents were paclitaxel-eluting. Primary patency of each stent construct was determined with duplex ultrasound, angiography, or computed tomographic angiography. Greater than 50% restenosis or stent occlusion was considered loss of patency. Cox proportional hazard and Kaplan-Meier modeling were used to assess the effect of statin use and additional covariates on stent patency. RESULTS Patients on any statin at the time of stent placement were half as likely to undergo loss of primary unassisted patency as patients on no statin therapy (hazard ratio, 0.53; 95% confidence interval, 0.19-0.87; P = .004). Moderate/high intensity statin therapy conferred 17 additional months of median stent patency compared to the no statin group. Antiplatelet therapy, anticoagulant therapy, drug-eluting stents (versus bare metal or covered stents), and Rutherford class were not predictive of stent patency (P = 0.52, 0.85, 0.58, and 0.82, respectively). CONCLUSION Use of statin therapy at the time of femoropopliteal stent placement was the most predictive examined variable influencing primary unassisted patency.
Collapse
Affiliation(s)
- Elisabeth R Seyferth
- Section of Interventional Radiology, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Helen Song
- Section of Interventional Radiology, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ansar Z Vance
- Section of Interventional Radiology, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Timothy W I Clark
- Section of Interventional Radiology, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- University of Pennsylvania Perelman School of Medicine, Penn Presbyterian Medical Center, Philadelphia, PA, 19104, USA.
| |
Collapse
|
3
|
Chen Y, Gue Y, McDowell G, Gorog DA, Lip GYH. Impaired endogenous fibrinolysis status: a potential prognostic predictor in ischemic stroke. Minerva Med 2024; 115:364-379. [PMID: 38727704 DOI: 10.23736/s0026-4806.24.09133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Stroke confers a severe global healthcare burden, hence exploring risk factors for stroke occurrence and prognosis is important for stroke prevention and post-stroke management strategies. Endogenous fibrinolysis is a spontaneous physiological protective mechanism that dissolves thrombus to maintain vascular patency. Recently, impaired endogenous fibrinolysis has been considered as a potential novel cardiovascular risk factor, but its link with ischaemic stroke in the past has been underappreciated. In this review, we summarize the latest mechanisms of endogenous fibrinolysis, review the current evidence and data on endogenous fibrinolysis in ischemic stroke. It includes the structure of thrombus in ischemic stroke patients, the effect of fibrin structure on the endogenous fibrinolytic efficiency, and the association between intravenous thrombolytic therapy and endogenous fibrinolysis in ischemic stroke. It also includes the single factors (tissue plasminogen activator, urokinase plasminogen activator, plasminogen activator inhibitor-1, thrombin activatable fibrinolysis inhibitor, complement component 3, complement component 5, alpha-2-antiplasmin, plasmin-alpha-2-antiplasmin complex, and lipoprotein[a]), and the global assessments of endogenous fibrinolysis status (thromboelastography, rotational thromboelastometry, and global thrombosis test), and their potential as predictors to identify occurrence or unfavorable functional outcomes of ischemic stroke. All of these assessments present advantages and limitations, and we suggest that the global thrombosis test may be more appropriate for detecting impaired endogenous fibrinolysis status in ischemic stroke patients.
Collapse
Affiliation(s)
- Yang Chen
- Liverpool Center for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Ying Gue
- Liverpool Center for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool, UK -
| | - Garry McDowell
- Liverpool Center for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool, UK
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Diana A Gorog
- School of Life and Medical Sciences, Postgraduate Medical School, University of Hertfordshire, Hatfield, UK
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK
| | - Gregory Y H Lip
- Liverpool Center for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
4
|
Alana NB, Ciurylo WA, Hurlock N. HMG-CoA reductase inhibitors and the attenuation of risk for disseminated intravascular coagulation in patients with sepsis. J Thromb Thrombolysis 2024; 57:260-268. [PMID: 37945940 DOI: 10.1007/s11239-023-02910-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Disseminated Intravascular Coagulation (DIC) is a syndrome of dysregulated coagulation. Patients with sepsis are at increased risk for DIC. HMG-CoA Reductase Inhibitors (Statins) are primarily used as lipid-lowering agents; however, studies have suggested statins may possess anti-inflammatory, antithrombotic, anticoagulant, and endothelial stabilizing properties. These mechanisms may oppose those that underlie the pathogenesis of septic DIC. METHODS To evaluate whether statins may be protective against the development of DIC, we conducted a multi-center, retrospective case-control study where 86,638 critically ill patients admitted to the ICU with sepsis, severe sepsis or septic shock were identified during a 3-year period. Patients who developed DIC during their hospitalization were identified and stratified by whether they received a statin or not during their hospitalization. Odds ratios for development of DIC was calculated by composite of any statin, as well as low, moderate, and high intensity statins. RESULTS 2236 patients would develop DIC compared to 84,402 who did not. The use of any statin was associated with a reduced likelihood for developing DIC (odds ratio [OR], 0.69; 95% CI, 0.61-0.78). This was observed with use of both moderate (OR, 0.64; 95% CI, 0.53-0.77) and high (OR, 0.72; 95% CI, 0.61-0.84) but not low intensity statins (OR, 0.84; 95% CI, 0.53-1.32). CONCLUSIONS The use of moderate and high intensity statins was associated with a significantly reduced odds of developing DIC in critically ill patients with sepsis. This present study may be the first to suggest that statin medications may independently reduce the frequency of DIC in critically ill patients with severe sepsis or septic shock. More research is needed to investigate the potential for this class of medication to be protective against DIC.
Collapse
Affiliation(s)
- Nicholas B Alana
- Portsmouth Regional Hospital Internal Medicine Residency Program, HCA Healthcare/Tufts University School of Medicine, 333 Borthwick Ave. Portsmouth, New Hampshire, 03801, USA.
| | - William A Ciurylo
- Portsmouth Regional Hospital Internal Medicine Residency Program, HCA Healthcare/Tufts University School of Medicine, 333 Borthwick Ave. Portsmouth, New Hampshire, 03801, USA
| | - Natalie Hurlock
- HCA Healthcare, 2000 Health Park Drive, Brentwood, TN, 37027, UK
| |
Collapse
|
5
|
Khatiwada N, Hong Z. Potential Benefits and Risks Associated with the Use of Statins. Pharmaceutics 2024; 16:214. [PMID: 38399268 PMCID: PMC10892755 DOI: 10.3390/pharmaceutics16020214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/13/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
HMG-CoA reductase inhibitors, commonly known as statins, are the primary treatment choice for cardiovascular diseases, which stand as the leading global cause of mortality. Statins also offer various pleiotropic effects, including improved endothelial function, anti-inflammatory properties, reduced oxidative stress, anti-thrombotic effects, and the stabilization of atherosclerotic plaques. However, the usage of statins can be accompanied by a range of adverse effects, such as the development of type 2 diabetes mellitus, muscular symptoms, liver toxicity, kidney diseases, cataracts, hemorrhagic strokes, and psychiatric complications. These issues are referred to as statin-associated symptoms (SAS) and are relatively infrequent in clinical trials, making it challenging to attribute them to statin use definitively. Therefore, these symptoms can lead to significant problems, necessitating dose adjustments or discontinuation of statin therapy. This review aims to provide a comprehensive overview of the mechanism of action, potential advantages, and associated risks of statin utilization in clinical settings.
Collapse
Affiliation(s)
| | - Zhongkui Hong
- Department of Mechanical Engineering, Texas Tech University, Lubbock, TX 79409, USA;
| |
Collapse
|
6
|
Cecchini AL, Biscetti F, Manzato M, Lo Sasso L, Rando MM, Nicolazzi MA, Rossini E, Eraso LH, Dimuzio PJ, Massetti M, Gasbarrini A, Flex A. Current Medical Therapy and Revascularization in Peripheral Artery Disease of the Lower Limbs: Impacts on Subclinical Chronic Inflammation. Int J Mol Sci 2023; 24:16099. [PMID: 38003290 PMCID: PMC10671371 DOI: 10.3390/ijms242216099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Peripheral artery disease (PAD), coronary artery disease (CAD), and cerebrovascular disease (CeVD) are characterized by atherosclerosis and inflammation as their underlying mechanisms. This paper aims to conduct a literature review on pharmacotherapy for PAD, specifically focusing on how different drug classes target pro-inflammatory pathways. The goal is to enhance the choice of therapeutic plans by considering their impact on the chronic subclinical inflammation that is associated with PAD development and progression. We conducted a comprehensive review of currently published original articles, narratives, systematic reviews, and meta-analyses. The aim was to explore the relationship between PAD and inflammation and evaluate the influence of current pharmacological and nonpharmacological interventions on the underlying chronic subclinical inflammation. Our findings indicate that the existing treatments have added anti-inflammatory properties that can potentially delay or prevent PAD progression and improve outcomes, independent of their effects on traditional risk factors. Although inflammation-targeted therapy in PAD shows promising potential, its benefits have not been definitively proven yet. However, it is crucial not to overlook the pleiotropic properties of the currently available treatments, as they may provide valuable insights for therapeutic strategies. Further studies focusing on the anti-inflammatory and immunomodulatory effects of these treatments could enhance our understanding of the mechanisms contributing to the residual risk in PAD and pave the way for the development of novel therapies.
Collapse
Affiliation(s)
- Andrea Leonardo Cecchini
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Federico Biscetti
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Matteo Manzato
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lorenzo Lo Sasso
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Margherita Rando
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Anna Nicolazzi
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Enrica Rossini
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Luis H. Eraso
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Paul J. Dimuzio
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Massimo Massetti
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Flex
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| |
Collapse
|
7
|
German CA, Liao JK. Understanding the molecular mechanisms of statin pleiotropic effects. Arch Toxicol 2023; 97:1529-1545. [PMID: 37084080 PMCID: PMC10119541 DOI: 10.1007/s00204-023-03492-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/30/2023] [Indexed: 04/22/2023]
Abstract
Statins represent the cornerstone of pharmacotherapy for the prevention of atherosclerotic cardiovascular disease. These medications not only reduce low-density lipoprotein cholesterol (LDL-C) via inhibition of 3-hydroxy-3-methylglutarate attached to CoA reductase, the key rate-limiting step in the cholesterol biosynthetic pathway, but also upregulate expression of the low-density lipoprotein receptor, improving serum clearance. Given LDL-C is a causal risk factor for the development of atherosclerosis, these complementary mechanisms largely explain why statin therapy leads to reductions in major adverse cardiovascular events. However, decades of basic and clinical research have suggested that statins may exert other effects independent of LDL-C lowering, termed pleiotropic effects, which have become a topic of debate among the scientific community. While some literature suggests statins may improve plaque stability, reduce inflammation and thrombosis, decrease oxidative stress, and improve endothelial function and vascular tone, other studies have suggested potential harmful pleiotropic effects related to increased risk of muscle-related side effects, diabetes, hemorrhagic stroke, and cognitive decline. Furthermore, the introduction of newer, non-statin LDL-C lowering therapies, including ezetimibe, proprotein convertase subtilisin/Kexin Type 9, and bempedoic acid, have challenged the statin pleiotropy theory. This review aims to provide a historical background on the development of statins, explore the mechanistic underpinnings of statin pleiotropy, review the available literature, and provide up to date examples that suggest statins may exert effects outside of LDL-C lowering and the cardiovascular system.
Collapse
Affiliation(s)
- Charles A German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA.
| | - James K Liao
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
8
|
Facts and ideas on statins with respect to their lipophilicity: a focus on skeletal muscle cells and bone besides known cardioprotection. Mol Cell Biochem 2022:10.1007/s11010-022-04621-y. [PMID: 36471123 PMCID: PMC9734727 DOI: 10.1007/s11010-022-04621-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Statins are known to block cholesterol synthesis in the liver. They also exhibit non-lipid pleiotropic effects due to the inhibition of protein prenylation, thereby modulating various signaling pathways of cellular homeostasis and integrity. Both lipid control and pleiotropic action of statins are clinically used, mainly for treatment of hypercholesterolemia and primary and secondary prevention of cardiovascular diseases. Because the prescription of statins is increasing and statin therapy is often lifelong, in particular in patients with other risk factors, safety issues being associated with polymorbidity and polypragmasia as well as the persistence with and adherence to statins are specific points of attention of clinicians and clinical pharmacologists. Furthermore, because skeletal myocytes have a cholesterol inhibitory sensitivity greater than hepatocytes, a choice of an appropriate statin based on its lipophilicity and the associated likelihood of its side effects on skeletal muscle cells and bone is warranted in such polymorbid patients. These approaches can effectively modulate the risk: benefit ratio and highlight a need for personalized therapy as much as possible, thereby minimizing risk of discontinuation of therapy and poor compliance.
Collapse
|
9
|
Wasim R, Ansari TM, Ahsan F, Siddiqui MH, Singh A, Shariq M, Parveen S. Pleiotropic Benefits of Statins in Cardiovascular Diseases. Drug Res (Stuttg) 2022; 72:477-486. [PMID: 35868336 DOI: 10.1055/a-1873-1978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In 1976, Japanese microbiologist Akira Endo discovered the first statin as a product of the fungus Penicillium citrinum that inhibited the activity of 3-hydroxy-3-methylglutaryl coenzyme A reductase. Their primary mode of action is to lower the blood cholesterol by decreasing hepatic cholesterol production, which upregulates hepatic low-density lipoprotein (LDL) receptors and increases LDL-cholesterol clearance. In addition to cholesterol lowering, statins inhibit other downstream products of the mevalonate pathway, causing the so-called pleiotropic effects. As a result of their pleiotropic effects statins modulate virtually all known processes of atherosclerosis and have beneficial effects outside the cardiovascular system Statins inhibit the post-translational prenylation of small GTP-binding proteins such as Rho, Rac, as well as their downstream effectors such as Rho kinase and nicotinamide adenine dinucleotide phosphate oxidases since they suppress the synthesis of isoprenoid intermediates in the cholesterol biosynthetic pathway altering the expression of endothelial nitric oxide synthase, the stability of atherosclerotic plaques, production of proinflammatory cytokines, reactive oxygen species, platelet reactivity, development of cardiac hypertrophy and fibrosis in cell culture and animal experiments. Inhibition of Rho and Rho-associated coiled-coil containing protein kinase (ROCK), has emerged as the principle mechanisms underlying the pleiotropic effects of statins. However, the relative contributions of statin pleiotropy to clinical outcomes are debatable and difficult to measure because the amount of isoprenoid inhibition by statins corresponds to some extent with the amount of LDL-cholesterol decrease. This article examines some of the existing molecular explanations underlying statin pleiotropy and discusses if they have clinical relevance in cardiovascular diseases.
Collapse
Affiliation(s)
- Rufaida Wasim
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow, India
| | | | - Farogh Ahsan
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow, India
| | | | - Aditya Singh
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow, India
| | - Mohammad Shariq
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow, India
| | - Saba Parveen
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow, India
| |
Collapse
|
10
|
Borghi C, Levy BI. Synergistic actions between angiotensin-converting enzyme inhibitors and statins in atherosclerosis. Nutr Metab Cardiovasc Dis 2022; 32:815-826. [PMID: 35082055 DOI: 10.1016/j.numecd.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/31/2021] [Accepted: 11/25/2021] [Indexed: 01/09/2023]
Abstract
AIMS Hypertension and hypercholesterolemia are independent risk factors for atherosclerotic cardiovascular disease (ASCVD) by acting directly on the endothelium and activating the renin-angiotensin aldosterone system (RAAS) and mevalonate pathways. This review examines how the severity and duration of these risk factors may influence the cardiovascular risk through a reciprocal interplay leading to oxidative stress and pro-inflammatory response. DATA SYNTHESIS The review highlights the clinical evidence supporting the benefits of statins and angiotensin-converting enzyme (ACE) inhibitors for hypertension, lipid disorders and ASCVD management, both individually and combined, at all stages of the cardiovascular continuum. CONCLUSION Drug strategies incorporating an ACE-inhibitor and a statin, and in particular perindopril and atorvastatin, have consistently demonstrated reductions in the rate of ASCVD events in patients with hypertension and lipid disorders, cementing their position as first-line therapies for the management of atherosclerosis complications.
Collapse
Affiliation(s)
- Claudio Borghi
- Department of Medical and Surgical Sciences, IRCCS-S.Orsola, University of Bologna, Italy.
| | - Bernard I Levy
- INSERM Unit 970, PARCC, 56 rue Leblanc, 75015 Paris, France
| |
Collapse
|
11
|
Beyond Lipid-Lowering: Effects of Statins on Cardiovascular and Cerebrovascular Diseases and Cancer. Pharmaceuticals (Basel) 2022; 15:ph15020151. [PMID: 35215263 PMCID: PMC8877351 DOI: 10.3390/ph15020151] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/15/2022] Open
Abstract
The 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, also known as statins, are administered as first-line therapy for hypercholesterolemia, both as primary and secondary prevention. Besides the lipid-lowering effect, statins have been suggested to inhibit the development of cardiovascular disease through anti-inflammatory, antioxidant, vascular endothelial function-improving, plaque-stabilizing, and platelet aggregation-inhibiting effects. The preventive effect of statins on atherothrombotic stroke has been well established, but statins can influence other cerebrovascular diseases. This suggests that statins have many neuroprotective effects in addition to lowering cholesterol. Furthermore, research suggests that statins cause pro-apoptotic, growth-inhibitory, and pro-differentiation effects in various malignancies. Preclinical and clinical evidence suggests that statins inhibit tumor growth and induce apoptosis in specific cancer cell types. The pleiotropic effects of statins on cardiovascular and cerebrovascular diseases have been well established; however, the effects of statins on cancer patients have not been fully elucidated and are still controversial. This review discusses the recent evidence on the effects of statins on cardiovascular and cerebrovascular diseases and cancer. Additionally, this study describes the pharmacological action of statins, focusing on the aspect of ‘beyond lipid-lowering’.
Collapse
|
12
|
Liu X, Zhao J, Qiu G, Alahmadi TA, Alharbi SA, Wainwright M, Duan W. Biological Activities of Some Natural Compounds and Their Cytotoxicity Studies against Breast and Prostate Cancer Cell Lines and Anti-COVID19 Studies. J Oleo Sci 2022; 71:587-597. [DOI: 10.5650/jos.ess21275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xin Liu
- Department of Intervention Therapy, Lanzhou University Second Hospital
| | - Jiangtao Zhao
- Department of General Surgery, Baoding Fourth Central Hospital
| | - Guoqiang Qiu
- Department of Pharmacy, Zhangzhou Hospital Affiliated to Fujian Medical University
| | - Tahani Awad Alahmadi
- Department of Pediatrics, College of Medicine and King Khalid University Hospital, King Saud University
| | | | - Milton Wainwright
- Department of Molecular Biology and Biotechnology, University of Sheffield
| | - Wei Duan
- Department of Clinical Laboratory, First Affiliated Hospital, School of Medicine, Shihezi University
| |
Collapse
|
13
|
Yang WY, Li YF, Wang ZR, Yu TX, Xu DJ, Yang N, Niu XY, Cai XL, Zhuo WY, Wu XM, Yan M, Zhou JS, Zhang HW, Liang ZG, Wu WJ, Cheng JH, Huang LA, Zhang YS, Guan Y, Tan ZF, Lu D, He N, Dong DW, Zhu HL, Yang B, Shen QY, Xu AD. Combined therapy of intensive statin plus intravenous rt-PA in acute ischemic stroke: the INSPIRE randomized clinical trial. J Neurol 2021; 268:2560-2569. [PMID: 33555418 DOI: 10.1007/s00415-020-10388-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/18/2020] [Accepted: 12/27/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of intensive statin in the acute phase of ischemic stroke after intravenous thrombolysis therapy. METHODS A total of 310 stroke patients treated with rt-PA were randomly scheduled into the intensive statin group (rosuvastatin 20 mg daily × 14 days) and the control group (rosuvastatin 5 mg daily × 14 days). The primary clinical endpoint was excellent functional outcome (mRS ≤ 1) at 3 months, and the primary safety endpoint was symptomatic intracranial hemorrhage (sICH) in 90 days. RESULTS The intensive statin users did not achieve a favorable outcome in excellent functional outcome (mRS ≤ 1) at 3 months compared with controls (70.3% vs. 66.5%, p = 0.464). Intensive statin also not significantly improved the overall distribution of scores on the modified Rankin scale, as compared with controls (p = 0.82 by the Cochran-Mantel-Haenszel test). The incidence of primary safety endpoint events (sICH) in 90 days did not significantly differ between the intensive statin group and control group (0.6% vs. 1.3%, p > 0.999). CONCLUSION The INSPIRE study indicated that intensive statin therapy may not improve clinical outcomes compared with the low dose of statin therapy in AIS patients undergoing intravenous thrombolysis, and the two groups had similar safety profile. CLINICAL TRIAL REGISTRATION URL: http://www.chictr.org . Unique identifier: ChiCTR-IPR-16008642.
Collapse
Affiliation(s)
- Wan-Yong Yang
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Yu-Feng Li
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Zi-Ran Wang
- Department of Neurology and Stroke Center, Linyi People's Hospital, Linyi, 276003, China
| | - Tian-Xia Yu
- Department of Neurology, Yan Tai Shan Hospital, Yantai, 264000, China
| | - Dong-Juan Xu
- Department of Neurology, Dongyang Affiliated Hospital of Wenzhou Medical University, Dongyang, 322100, China
| | - Nan Yang
- Department of Neurology, Traditional Chinese Medicine Hospital of Zhongshan City, Zhongshan, 528400, China
| | - Xiao-Yuan Niu
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, 030000, China
| | - Xue-Li Cai
- Department of Neurology, Lishui Hospital of Zhejiang University, The Central Hospital of Lishui, Lishui, 323000, China
| | - Wen-Yan Zhuo
- Department of Neurology, Zhuhai Hospital Affiliated With Jinan University, Zhuhai, 519000, China
| | - Xue-Mei Wu
- Department of Neurology, General Hospital of TISCO, Taiyuan, 030000, China
| | - Min Yan
- Jingdong Medical District, General Hospital of the Chinese People's Liberation Army, Beijing, 100853, China
| | - Jun-Shan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210000, China
| | - Hao-Wen Zhang
- Department of Neurology, Laixi City People's Hospital, Qingdao, 266600, China
| | - Zhi-Gang Liang
- Department of Neurology, Yuhuangding Hospital Affiliated to Qingdao University, Yantai, 264000, China
| | - Wen-Jun Wu
- Department of Neurology, Zhongshan City People's Hospital, Zhongshan, 528403, China
| | - Jian-Hua Cheng
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Li-An Huang
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Yu-Sheng Zhang
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Ying Guan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Ze-Feng Tan
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Dan Lu
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Niu He
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Da-Wei Dong
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Hui-Li Zhu
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Bing Yang
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Qing-Yu Shen
- Department of Neurology, Sun-Yet Sen Memorial Hospital of Sun-Yet Sen University, Guangzhou, 510120, China.
| | - An-Ding Xu
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China. .,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.
| |
Collapse
|
14
|
Park HK, Lee JS, Hong KS, Cho YJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Nah HW, Han MK, Kim BJ, Park TH, Park SS, Lee KB, Lee J, Lee BC, Yu KH, Oh MS, Kim JT, Choi KH, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Sohn SI, Hong JH, Lee J, Gorelick PB, Bae HJ. Statin therapy in acute cardioembolic stroke with no guidance-based indication. Neurology 2020; 94:e1984-e1995. [DOI: 10.1212/wnl.0000000000009397] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/17/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveIt is uncertain whether patients with cardioembolic stroke and without a guidance-based indication for statin therapy should be administered a statin for prevention of subsequent vascular events. This study was performed to determine whether the statin therapy is beneficial in preventing major vascular events in this population.MethodsUsing a prospective multicenter stroke registry database, we identified patients with acute cardioembolic stroke who were hospitalized between 2008 and 2015. Patients who had other established indications for statin therapy according to current guidelines were excluded. Major vascular event was defined as a composite of stroke recurrence, myocardial infarction, and vascular death. We performed frailty model analysis with the robust sandwich variance estimator using the stabilized inverse probability of treatment weighting method to estimate hazard ratios of statin therapy on outcomes.ResultsOf 6,124 patients with cardioembolic stroke, 2,888 (male 44.6%, mean age 75.3 years, 95% confidence interval [CI] 74.8–75.8) were eligible, and 1,863 (64.5%) were on statin therapy during hospitalization. After a median follow-up of 359 days, cumulative incidences of major vascular events were 9.3% in the statin users and 20.5% in the nonusers (p < 0.001 by log-rank test). The adjusted hazard ratios of statin therapy were 0.39 (95% CI 0.31–0.48) for major vascular events, 0.81 (95% CI 0.57–1.16) for stroke recurrence, 0.28 (95% CI 0.21–0.36) for vascular death, and 0.53 (95% CI 0.45–0.61) for all-cause death.ConclusionStarting statin during the acute stage of ischemic stroke may reduce the risk of major vascular events, vascular death, and all-cause death in patients with cardioembolic stroke with no guidance-based indication for statin.
Collapse
|
15
|
Cui J, Kessinger CW, Jhajj HS, Grau MS, Misra S, Libby P, McCarthy JR, Jaffer FA. Atorvastatin Reduces In Vivo Fibrin Deposition and Macrophage Accumulation, and Improves Primary Patency Duration and Maturation of Murine Arteriovenous Fistula. J Am Soc Nephrol 2020; 31:931-945. [PMID: 32152232 DOI: 10.1681/asn.2019060612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/07/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Arteriovenous fistulas placed surgically for dialysis vascular access have a high primary failure rate resulting from excessive inward remodeling, medial fibrosis, and thrombosis. No clinically established pharmacologic or perisurgical therapies currently address this unmet need. Statins' induction of multiple anti-inflammatory and antithrombotic effects suggests that these drugs might reduce arteriovenous fistula failure. Yet, the in vivo physiologic and molecular effects of statins on fistula patency and maturation remain poorly understood. METHODS We randomized 108 C57Bl/6J mice to receive daily atorvastatin 1.14 mg/kg or PBS (control) starting 7 days before end-to-side carotid artery-jugular vein fistula creation and for up to 42 days after fistula creation. We then assessed longitudinally the effects of statin therapy on primary murine fistula patency and maturation. We concomitantly analyzed the in vivo arteriovenous fistula thrombogenic and inflammatory macrophage response to statin therapy, using the fibrin-targeted, near-infrared fluorescence molecular imaging agent FTP11-CyAm7 and dextranated, macrophage-avid nanoparticles CLIO-VT680. RESULTS In vivo molecular-structural imaging demonstrated that atorvastatin significantly reduced fibrin deposition at day 7 and macrophage accumulation at days 7 and 14, findings supported by histopathologic and gene-expression analyses. Structurally, atorvastatin promoted favorable venous limb outward remodeling, preserved arteriovenous fistula blood flow, and prolonged primary arteriovenous fistula patency through day 42 (P<0.05 versus control for all measures). CONCLUSIONS These findings provide new in vivo evidence that statins improve experimental arteriovenous fistula patency and maturation, indicating that additional clinical evaluation of statin therapy in patients on dialysis undergoing arteriovenous fistula placement is warranted.
Collapse
Affiliation(s)
- Jie Cui
- Division of Cardiology, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Nephrology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chase W Kessinger
- Division of Cardiology, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Harkamal S Jhajj
- Division of Cardiology, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Madeleine S Grau
- Division of Cardiology, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sanjay Misra
- Department of Radiology, Vascular and Interventional Radiology Translational Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Peter Libby
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jason R McCarthy
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Farouc A Jaffer
- Division of Cardiology, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
16
|
Schol-Gelok S, Morelli F, Arends LR, Boersma E, Kruip MJHA, Versmissen J, van Gelder T. A revised systematic review and meta-analysis on the effect of statins on D-dimer levels. Eur J Clin Invest 2019; 49:e13130. [PMID: 31112290 DOI: 10.1111/eci.13130] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/22/2019] [Accepted: 05/18/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND D-dimers are generated during endogenous fibrinolysis of a blood clot and have a central role in diagnostic algorithms to rule out venous thromboembolism. HMG-CoA reductase inhibitors, more commonly called statins, are known to have effects independent of LDL-cholesterol lowering, including antithrombotic properties. An effect of statins on D-dimer levels has been reported in a prior systematic review and meta-analysis, but methodological shortcomings might have led to an overestimated effect. To re-evaluate the association between statins and D-dimer levels, we systematically reviewed all published articles on the influence of statins on D-dimer levels and conducted a novel meta-analysis (PROSPERO registration number CRD42017058932). MATERIALS AND METHODS We electronically searched EMBASE, Medline Epub, Cochrane, Web of Science and Google Scholar (100 top relevance) (date of last search: 5 October 2017). We included randomized controlled trials, cohort studies and cross-sectional studies. Two reviewers independently screened all articles retrieved and extracted data on study and patient characteristics, study quality and D-dimer levels. RESULTS Study-level meta-analysis involving 18,052 study participants showed lower D-dimer levels in those receiving statin treatment than controls (SMD: -0.165, 95% CI -0.234; -0.096, P = <0.001). Sensitivity analyses and additional analyses on treatment duration (<12 weeks vs ≥12 weeks) and type of statin (lipophilic or hydrophilic) did not modify this overall result. CONCLUSION This meta-analysis suggests an association between use of statins and reduction of D-dimer levels, independent of treatment duration and type of statin used. This effect is small but robust, and should be interpreted with caution.
Collapse
Affiliation(s)
- Suzanne Schol-Gelok
- Department of Hospital Pharmacy and Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Francesca Morelli
- Department of Hospital Pharmacy and Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lidia R Arends
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marieke J H A Kruip
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jorie Versmissen
- Department of Hospital Pharmacy and Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Teun van Gelder
- Department of Hospital Pharmacy and Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
17
|
Nam YH, Bilker WB, Leonard CE, Bell ML, Alexander LM, Hennessy S. Effect of statins on the association between high temperature and all-cause mortality in a socioeconomically disadvantaged population: a cohort study. Sci Rep 2019; 9:4685. [PMID: 30886182 PMCID: PMC6423125 DOI: 10.1038/s41598-019-41109-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/28/2019] [Indexed: 12/28/2022] Open
Abstract
High temperature increases all-cause mortality. Thermoregulatory ability is impaired in persons with elevated serum cholesterol, but can be improved by the administration of statins, even in the short-term. We investigated whether the impact of high temperature (≥24 °C) on all-cause mortality among socioeconomically disadvantaged adults with a current or past indication for a statin is attenuated by current use of a statin with temperature dependence, by using claims data from five US Medicaid programs supplemented with Medicare claims for dual-enrollees and meteorological data from 1999-2010. We identified 3,508,948 persons (3,181,752 person-years) in a 1:1 propensity score-matched cohort. The incidence rate of all-cause mortality (deaths per 1,000 person-years) was 21.9 (95% confidence interval [CI]: 21.6 to 22.3) in current statin users and 30.1 (95% CI: 30.2 to 30.6) in former users. The adjusted odds ratios of mortality for current vs. former statin use were statistically significantly lower than 1.0, suggesting a protective effect of current statin use, on days with high temperature, with either daily average temperature or daily maximum temperature, and declined as daily average temperature increased from 29 °C and daily maximum temperature increased from 34 °C. These results were robust to the adjustment for daily relative humidity.
Collapse
Affiliation(s)
- Young Hee Nam
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104-4865, USA
| | - Warren B Bilker
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104-4865, USA
| | - Charles E Leonard
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104-4865, USA
| | - Michelle L Bell
- School of Forestry & Environmental Studies, Yale University, New Haven, CT, 06511, USA
| | - Lacy M Alexander
- Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Sean Hennessy
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104-4865, USA.
| |
Collapse
|
18
|
Pertzov B, Eliakim-Raz N, Atamna H, Trestioreanu AZ, Yahav D, Leibovici L. Hydroxymethylglutaryl-CoA reductase inhibitors (statins) for the treatment of sepsis in adults - A systematic review and meta-analysis. Clin Microbiol Infect 2018; 25:280-289. [PMID: 30472427 DOI: 10.1016/j.cmi.2018.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/14/2018] [Accepted: 11/03/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The pleiotropic effect of hydroxymethylglutaryl-CoA reductase inhibitors (statins) might have a beneficial effect in sepsis through several mechanisms. The aim was to assess the efficacy and safety of statins, compared with placebo, for the treatment of sepsis in adults. METHODS We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2017, Issue 12), OVID MEDLINE (from 1966 to January 2018), Embase (Ovid SP, from 1974 to January 2018), and LILACS (from 1986 to January 2018). We also searched the trial registries ISRCTN and ClinicalTrials.gov to January 2018. The eligibility criteria were randomized controlled trials comparing the treatment of statins versus placebo in adult patients who were hospitalized due to sepsis. Participants were adults (16 years and older) hospitalized because of sepsis or who developed sepsis during admission. Interventions were treatment with hydroxymethylglutaryl-CoA reductase inhibitors (statins) versus no treatment or placebo. We performed a systematic review of all randomized controlled trials published until January 2018, assessing the efficacy and safety of statins in sepsis treatment. Two primary outcomes were assessed: 30-day overall mortality and deterioration to severe sepsis during management. Secondary outcomes were hospital mortality, need for mechanical ventilation and drug related adverse events. RESULTS Fourteen trials evaluating 2628 patients were included. Statins did not reduce 30-day all-cause mortality neither in all patients (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.83-1.10), nor in a subgroup of patients with severe sepsis (RR 0.97, 95% CI 0.84-1.12). The certainty of evidence for both outcomes was high. There was no change in the rate of adverse events between study arms (RR 1.24, 95% CI 0.94 to 1.63). The certainty of evidence for this outcome was high. CONCLUSIONS The use of statin therapy in adults for the indication of sepsis is not recommended.
Collapse
Affiliation(s)
- B Pertzov
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - N Eliakim-Raz
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - H Atamna
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A Z Trestioreanu
- Department of Family Medicine, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel
| | - D Yahav
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah-Tikva, Israel
| | - L Leibovici
- Department of Medicine E, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
19
|
Rebalka IA, Cao AW, Raleigh MJ, Henriksbo BD, Coleman SK, Schertzer JD, Hawke TJ. Statin Therapy Negatively Impacts Skeletal Muscle Regeneration and Cutaneous Wound Repair in Type 1 Diabetic Mice. Front Physiol 2017; 8:1088. [PMID: 29311999 PMCID: PMC5742241 DOI: 10.3389/fphys.2017.01088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/11/2017] [Indexed: 12/26/2022] Open
Abstract
Those with diabetes invariably develop complications including cardiovascular disease (CVD). To reduce their CVD risk, diabetics are generally prescribed cholesterol-lowering 3-hydroxy-methylglutaryl coenzyme A reductase inhibitors (i.e., statins). Statins inhibit cholesterol biosynthesis, but also reduce the synthesis of a number of mevalonate pathway intermediates, leading to several cholesterol-independent effects. One of the pleiotropic effects of statins is the reduction of the anti-fibrinolytic hormone plasminogen activator inhibitor-1 (PAI-1). We have previously demonstrated that a PAI-1 specific inhibitor alleviated diabetes-induced delays in skin and muscle repair. Here we tested if statin administration, through its pleiotropic effects on PAI-1, could improve skin and muscle repair in a diabetic rodent model. Six weeks after diabetes onset, adult male streptozotocin-induced diabetic (STZ), and WT mice were assigned to receive control chow or a diet enriched with 600 mg/kg Fluvastatin. Tibialis anterior muscles were injured via Cardiotoxin injection to induce skeletal muscle injury. Punch biopsies were administered on the dorsal scapular region to induce injury of skin. Twenty-four days after the onset of statin therapy (10 days post-injury), tissues were harvested and analyzed. PAI-1 levels were attenuated in statin-treated diabetic tissue when compared to control-treated tissue, however no differences were observed in non-diabetic tissue as a result of treatment. Muscle and skin repair were significantly attenuated in Fluvastatin-treated STZ-diabetic mice as demonstrated by larger wound areas, less mature granulation tissue, and an increased presence of smaller regenerating muscle fibers. Despite attenuating PAI-1 levels in diabetic tissue, Fluvastatin treatment impaired cutaneous healing and skeletal muscle repair in STZ-diabetic mice.
Collapse
Affiliation(s)
- Irena A Rebalka
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Andrew W Cao
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthew J Raleigh
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Brandyn D Henriksbo
- Department of Biochemistry and Biomedical Sciences and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Samantha K Coleman
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Jonathan D Schertzer
- Department of Biochemistry and Biomedical Sciences and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Thomas J Hawke
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
20
|
Abstract
OBJECTIVES To examine the association between statin use and the risk of delirium in hospitalized patients with an admission to the medical ICU. DESIGN Retrospective propensity-matched cohort analysis with accrual from September 1, 2012, to September 30, 2015. SETTING Hartford Hospital, Hartford, CT. PATIENTS An initial population of patients with an admission to a medical ICU totaling 10,216 visits were screened for delirium by means of the Confusion Assessment Method. After exclusions, a population of 6,664 was used to match statin users and nonstatin users. The propensity-matched cohort resulted in a sample of 1,475 patients receiving statin matched 1:1 with control patients not using statin. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Delirium defined as a positive Confusion Assessment Method assessment was the primary end point. The prevalence of delirium was 22.3% in the unmatched cohort and 22.8% in the propensity-matched cohort. Statin use was associated with a significant decrease in the risk of delirium (odds ratio, 0.47; 95% CI, 0.38-0.56). Considering the type of statin used, atorvastatin (0.51; 0.41-0.64), pravastatin (0.40; 0.28-0.58), and simvastatin (0.33; 0.21-0.52) were all significantly associated with a reduced frequency of delirium. CONCLUSIONS The use of statins was independently associated with a reduction in the risk of delirium in hospitalized patients. When considering types of statins used, this reduction was significant in patients using atorvastatin, pravastatin, and simvastatin. Randomized trials of various statin types in hospitalized patients prone to delirium should validate their use in protection from delirium.
Collapse
|
21
|
Oesterle A, Laufs U, Liao JK. Pleiotropic Effects of Statins on the Cardiovascular System. Circ Res 2017; 120:229-243. [PMID: 28057795 DOI: 10.1161/circresaha.116.308537] [Citation(s) in RCA: 761] [Impact Index Per Article: 108.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/13/2016] [Accepted: 10/25/2016] [Indexed: 12/13/2022]
Abstract
The statins have been used for 30 years to prevent coronary artery disease and stroke. Their primary mechanism of action is the lowering of serum cholesterol through inhibiting hepatic cholesterol biosynthesis thereby upregulating the hepatic low-density lipoprotein (LDL) receptors and increasing the clearance of LDL-cholesterol. Statins may exert cardiovascular protective effects that are independent of LDL-cholesterol lowering called pleiotropic effects. Because statins inhibit the production of isoprenoid intermediates in the cholesterol biosynthetic pathway, the post-translational prenylation of small GTP-binding proteins such as Rho and Rac, and their downstream effectors such as Rho kinase and nicotinamide adenine dinucleotide phosphate oxidases are also inhibited. In cell culture and animal studies, these effects alter the expression of endothelial nitric oxide synthase, the stability of atherosclerotic plaques, the production of proinflammatory cytokines and reactive oxygen species, the reactivity of platelets, and the development of cardiac hypertrophy and fibrosis. The relative contributions of statin pleiotropy to clinical outcomes, however, remain a matter of debate and are hard to quantify because the degree of isoprenoid inhibition by statins correlates to some extent with the amount of LDL-cholesterol reduction. This review examines some of the currently proposed molecular mechanisms for statin pleiotropy and discusses whether they could have any clinical relevance in cardiovascular disease.
Collapse
Affiliation(s)
- Adam Oesterle
- From the Section of Cardiology, Department of Medicine, The University of Chicago, IL (A.O., J.K.L.); and Division of Cardiology, Department of Medicine, The University of Saarland, Homburg, Germany (U.L.)
| | - Ulrich Laufs
- From the Section of Cardiology, Department of Medicine, The University of Chicago, IL (A.O., J.K.L.); and Division of Cardiology, Department of Medicine, The University of Saarland, Homburg, Germany (U.L.)
| | - James K Liao
- From the Section of Cardiology, Department of Medicine, The University of Chicago, IL (A.O., J.K.L.); and Division of Cardiology, Department of Medicine, The University of Saarland, Homburg, Germany (U.L.).
| |
Collapse
|
22
|
George R, Sivadasanpillai H, Jayakumari N, Bhatt A, Thulaseedharan JV, Tharakan JA. Circulating Thrombotic Risk Factors in Young Patients with Coronary Artery Disease Who Are on Statins and Anti-platelet Drugs. Indian J Clin Biochem 2016; 31:302-9. [PMID: 27382201 PMCID: PMC4910856 DOI: 10.1007/s12291-015-0540-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/08/2015] [Indexed: 12/12/2022]
Abstract
Thrombotic risk factors may contribute to premature coronary artery disease (CAD), in addition to the conventional risk factors. There is paucity of data on studies evaluating the role of thrombotic factors in premature CAD in Indian patients. Thus a case-control study was performed to evaluate the role of thrombotic and atherogenic factors in young patients with angiographically proven CAD who are on treatment with statins and anti-platelet drugs. 152 patients (≤55 years) with angiographically proven CAD and 102 asymptomatic controls were recruited. Clinical and biochemical data were obtained in both groups. Blood levels of thrombotic factors-fibrinogen, antithrombin-III, tissue-plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), von-Willebrand factor (v-WF), lipoprotein(a) [Lp(a)] and homocysteine were analyzed. Patients had high levels of conventional CAD risk factors (diabetes mellitus, smoking, hypertension, dyslipidemia and positive family history) compared to controls. Logistic regression analysis revealed that low antithrombin-III (odds ratio/OR 11.2; 95 % confidence interval/CI 2.29-54.01), high fibrinogen (OR 6.04; 95 % CI 1.09-33.21) and high Lp(a) (OR 4.54; 95 % CI 0.92-22.56), as important, independent risk factors in patients. PAI-1(OR 0.15; 95 % CI 0.03-0.69) levels were significantly lower in patients. But other thrombotic risk factors studied (t-PA, v-WF and homocysteine) were comparable among patients and controls. The treatment using statins and anti-platelet drugs might be contributing to the control of some of the thrombotic risk factors. The strategies aiming at lowering the levels of thrombotic risk factors along with conventional risk factors may be useful in primary and secondary prevention of CAD.
Collapse
Affiliation(s)
- Reema George
- />Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011 Kerala India
| | - Harikrishnan Sivadasanpillai
- />Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011 Kerala India
| | - Narayani Jayakumari
- />Department of Biochemistry, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011 Kerala India
| | - Anugya Bhatt
- />Thrombosis Research Unit, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Poojapura, 695012 Kerala India
| | - Jissa V. Thulaseedharan
- />Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011 Kerala India
| | - Jaganmohan A. Tharakan
- />Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011 Kerala India
| |
Collapse
|
23
|
Simvastatin ameliorates deep vein thrombosis in rabbits by regulating the fibrinolytic system. Blood Coagul Fibrinolysis 2016; 27:531-41. [DOI: 10.1097/mbc.0000000000000567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
Abstract
OBJECTIVE Since statins have pleiotropic effects on inflammation and coagulation that may interrupt delirium pathogenesis, we tested the hypotheses that statin exposure is associated with reduced delirium during critical illness, whereas discontinuation of statin therapy is associated with increased delirium. DESIGN Multicenter, prospective cohort study. SETTING Medical and surgical ICUs in two large tertiary care hospitals in the United States. PATIENTS Patients with acute respiratory failure or shock. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We measured statin exposure prior to hospitalization and daily during the ICU stay, and we assessed patients for delirium twice daily using the Confusion Assessment Method for the ICU. Of 763 patients included, whose median (interquartile range) age was 61 years (51-70 yr) and Acute Physiology and Chronic Health Evaluation II was 25 (19-31), 257 (34%) were prehospital statin users and 197 (26%) were ICU statin users. Overall, delirium developed in 588 patients (77%). After adjusting for covariates, ICU statin use was associated with reduced delirium (p < 0.01). This association was modified by sepsis and study day; for example, statin use was associated with reduced delirium among patients with sepsis on study day 1 (odds ratio, 0.22; 95% CI, 0.10-0.49) but not among patients without sepsis on day 1 (odds ratio, 0.92; 95% CI, 0.46-1.84) or among those with sepsis later, for example, on day 13 (odds ratio, 0.70; 95% CI, 0.35-1.41). Prehospital statin use was not associated with delirium (odds ratio, 0.86; 95% CI, 0.44-1.66; p = 0.18), yet the longer a prehospital statin user's statin was held in the ICU, the higher the odds of delirium (overall p < 0.001 with the odds ratio depending on sepsis status and study day due to significant interactions). CONCLUSIONS In critically ill patients, ICU statin use was associated with reduced delirium, especially early during sepsis; discontinuation of a previously used statin was associated with increased delirium.
Collapse
|
25
|
Tsivgoulis G, Katsanos AH, Sharma VK, Krogias C, Mikulik R, Vadikolias K, Mijajlovic M, Safouris A, Zompola C, Faissner S, Weiss V, Giannopoulos S, Vasdekis S, Boviatsis E, Alexandrov AW, Voumvourakis K, Alexandrov AV. Statin pretreatment is associated with better outcomes in large artery atherosclerotic stroke. Neurology 2016; 86:1103-11. [PMID: 26911636 DOI: 10.1212/wnl.0000000000002493] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/16/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Even though statin pretreatment is associated with better functional outcomes and lower risk of mortality in acute ischemic stroke, there are limited data evaluating this association in acute ischemic stroke due to large artery atherosclerosis (LAA), which carries the highest risk of early stroke recurrence. METHODS Consecutive patients with acute LAA were prospectively evaluated from 7 tertiary-care stroke centers during a 3-year period. Statin pretreatment, demographics, vascular risk factors, and admission and discharge stroke severity were recorded. The outcome events of interest were neurologic improvement during hospitalization (quantified as the relative decrease in NIH Stroke Scale score at discharge in comparison to hospital admission), favorable functional outcome (FFO) (defined as modified Rankin Scale score of 0-1), recurrent stroke, and death at 1 month. Statistical analyses were performed using univariable and multivariable Cox regression models adjusting for potential confounders. All analyses were repeated following propensity score matching. RESULTS Statin pretreatment was documented in 192 (37.2%) of 516 consecutive patients with LAA (mean age: 65 ± 13 years; 60.8% men; median NIH Stroke Scale score: 9 points, interquartile range: 5-18). Statin pretreatment was associated with greater neurologic improvement during hospitalization and higher rates of 30-day FFO in unmatched and matched (odds ratio for FFO: 2.44; 95% confidence interval [CI]: 1.07-5.53) analyses. It was also related to lower risk of 1-month mortality and stroke recurrence in unmatched and matched analyses (hazard ratio for recurrent stroke: 0.11, 95% CI: 0.02-0.46; hazard ratio for death: 0.24, 95% CI: 0.08-0.75). CONCLUSION Statin pretreatment in patients with acute LAA appears to be associated with better early outcomes regarding neurologic improvement, disability, survival, and stroke recurrence.
Collapse
Affiliation(s)
- Georgios Tsivgoulis
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia.
| | - Aristeidis H Katsanos
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Vijay K Sharma
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Christos Krogias
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Robert Mikulik
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Konstantinos Vadikolias
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Milija Mijajlovic
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Apostolos Safouris
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Christina Zompola
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Simon Faissner
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Viktor Weiss
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Sotirios Giannopoulos
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Spyros Vasdekis
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Efstathios Boviatsis
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Anne W Alexandrov
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Konstantinos Voumvourakis
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| | - Andrei V Alexandrov
- From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia
| |
Collapse
|
26
|
Heo JH, Song D, Nam HS, Kim EY, Kim YD, Lee KY, Lee KJ, Yoo J, Kim YN, Lee BC, Yoon BW, Kim JS. Effect and Safety of Rosuvastatin in Acute Ischemic Stroke. J Stroke 2016; 18:87-95. [PMID: 26846760 PMCID: PMC4747071 DOI: 10.5853/jos.2015.01578] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/06/2016] [Accepted: 01/06/2016] [Indexed: 01/09/2023] Open
Abstract
Background and Purpose The benefit of statins in acute stroke remains uncertain. Statins may prevent stroke recurrence during the acute stage of stroke via pleiotropic effects. However, statins may increase the risk of intracerebral hemorrhage. We investigated the effect and safety of rosuvastatin in acute stroke patients. Methods This randomized, double-blind, multi-center trial compared rosuvastatin 20 mg and placebo in statin-naïve stroke patients who underwent diffusion-weighted imaging (DWI) within 48 hours after symptom onset. The primary outcome was occurrence of new ischemic lesions on DWI at 5 or 14 days. Results This trial was stopped early after randomization of 316 patients due to slow enrollment. Among 289 patients with at least one follow-up imaging, the frequency of new ischemic lesions on DWI was not different between groups (rosuvastatin: 27/137, 19.7% vs. placebo: 36/152, 23.6%) (relative risk 0.83, 95% confidence interval 0.53–1.30). Infarct volume growth at 5 days (log-transformed volume change, rosuvastatin: 0.2±1.0 mm3 vs. placebo: 0.3±1.3 mm3; P=0.784) was not different, either. However, hemorrhagic infarction or parenchymal/subarachnoid hemorrhage on gradient-recalled echo magnetic resonance imaging occurred less frequently in the rosuvastatin group (6/137, 4.4%) than the placebo group (22/152, 14.5%, P=0.007). Among 314 patients with at least one dose of study medication, progression or clinical recurrence of stroke tended to occur less frequently in the rosuvastatin group (1/155, 0.6% vs. 7/159, 4.4%, P=0.067). Adverse events did not differ between groups. Conclusions The efficacy of rosuvastatin in reducing recurrence in acute stroke was inconclusive. However, statin use was safe and reduced hemorrhagic transformation.
Collapse
Affiliation(s)
- Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Dongbeom Song
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Yeop Kim
- Department of Radiology, Gachon University, Gil Medical Center, Incheon, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ki-Jeong Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Youn Nam Kim
- Clinical Trials Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Byung Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Pyeongchon, Korea
| | - Byung-Woo Yoon
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | | |
Collapse
|
27
|
Abstract
The aim of this review article is to summarize the current knowledge about mechanisms that connect blood pressure regulation and hypercholesterolemia, the mutual interaction between hypertension and hypercholesterolemia, and their influence on atherosclerosis development. Our research shows that at least one-third of the population of Western Europe has hypertension and hypercholesterolemia. Several biohumoral mechanisms could explain the relationship between hypertension and hypercholesterolemia and the association between these risk factors and accelerated atherosclerosis. The most investigated mechanisms are the renin-angiotensin-aldosterone system, oxidative stress, endothelial dysfunction, and increased production of endothelin-1. Arterial hypertension is frequently observed in combination with hypercholesterolemia, and this is related to accelerated atherosclerosis. Understanding the mechanisms behind this relationship could help explain the benefits of therapy that simultaneously reduce blood pressure and cholesterol levels.
Collapse
|
28
|
ERK5 regulates basic fibroblast growth factor-induced type 1 plasminogen activator inhibitor expression and cell proliferation in lung fibroblasts. Life Sci 2015; 135:1-8. [DOI: 10.1016/j.lfs.2015.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 05/06/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
|
29
|
Akyüz A, Akkoyun DÇ, Değirmenci H, Oran M. Rosuvastatin Decreases Mean Platelet Volume in Patients With Diabetes Mellitus. Angiology 2015; 67:116-20. [PMID: 25943745 DOI: 10.1177/0003319715584725] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Statins have multiple effects (also known as pleiotropic effects) on inflammation, plaque stabilization, endothelial function, and hemostasis. We evaluated the effects of rosuvastatin on mean platelet volume (MPV)--a marker for platelet activity--in patients with diabetes mellitus (DM) on rosuvastatin medication. Patients (n = 178) who were to be prescribed high-intensity rosuvastatin were retrospectively enrolled according to their medical records. Baseline and 6-month biochemical tests, automated blood count, cell-volume analysis, and their cardiovascular risk factors were recorded. Rosuvastatin significantly reduced the MPV and the lipid parameters including total cholesterol, triglyceride, and low-density lipoprotein cholesterol (LDL-C). However, there was no correlation between MPV and LDL-C before (r = -.66; P = .383) and after (r = -.112; P = .135) rosuvastatin treatment or between ΔMPV and ΔLDL-C after 40 mg rosuvastatin daily therapy (r = -.155; P = .073). Rosuvastatin significantly decreases the MPV as well as cholesterol levels. The antiplatelet activation properties of high-dose rosuvastatin treatment in patients with DM are not lipid dependent.
Collapse
Affiliation(s)
- Aydın Akyüz
- Department of Cardiology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Dursun Çayan Akkoyun
- Department of Cardiology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Hasan Değirmenci
- Department of Cardiology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Mustafa Oran
- Department of Internal Medicine, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey
| |
Collapse
|
30
|
Tong LS, Hu HT, Zhang S, Yan SQ, Lou M. Statin withdrawal beyond acute phase affected outcome of thrombolytic stroke patients: an observational retrospective study. Medicine (Baltimore) 2015; 94:e779. [PMID: 25929921 PMCID: PMC4603028 DOI: 10.1097/md.0000000000000779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Statin withdrawal is associated with deleterious outcome on stroke patients. Whether risk changes over time, depends on concomitant treatment of intravenous thrombolysis, or both remains to be clarified. We assessed the influence of statin withdrawal within 3 weeks while initiated in acute phase (72 hours) among patients receiving intravenous thrombolysis.This was a monocentered retrospective observational study enrolling intravenous thrombolytic stroke patients from June 2009 to May 2014. Consecutive patients were distinguished into 3 groups according to the initiation and withdrawal of statin: the reference group (not received statin in 72 hours after stroke onset); the continued group (initiated statin therapy in 72 hours and continued for at least 3 weeks); the withdrawal group (initiated statin in 72 hours and discontinued within 3 weeks). All reasons for cessation were recorded. The effects of statin withdrawal on short-, mid-, and long-term outcomes were evaluated as neurologic improvement (NIH Stroke Scale [NIHSS] score improvement ≥4 from baseline or later NIHSS = 0), death or poor outcome (modified Rankin Scale [mRS] ≥4), and favorable outcome (mRS ≤2). We further evaluate statin withdrawal effects in cardioembolic stroke patients for these outcomes.Among 443 IVT patients enrolled, 367 were included in the final study population. There were 88, 188, and 91 patients in the reference, continued, and withdrawal groups, respectively. Multivariable logistic regression showed that statin withdrawal compared with the reference was related to a lower possibility of long-term favorable outcome (OR = 0.45, 95% CI [0.22, 0.90], P = 0.024). Compared with the continued group, the adjusted OR of statin withdrawal was 0.40 (95% CI [0.22, 0.72], P = 0.002) and 2.52 (95% CI [1.34, 4.75], P = 0.004) for long-term favorable and poor/death outcomes, respectively. Also, results were similar for cardioembolic stroke patients (OR = 0.35, 95% CI [0.14, 0.89], P = 0.027 of favorable outcome and OR = 3.62, 95% CI [1.37, 9.62], P = 0.010 of poor/death outcome).In a real-world setting, for stroke patients receiving intravenous thrombolysis, statin withdrawal within 3 weeks initiating in 72 hours may have a harmful effect on the long-term neurologic outcome, even in cardioembolic stroke patients.
Collapse
Affiliation(s)
- Lu-Sha Tong
- From the Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | | | | | | | | |
Collapse
|
31
|
Platelet-derived MIF: A novel platelet chemokine with distinct recruitment properties. Atherosclerosis 2015; 239:1-10. [DOI: 10.1016/j.atherosclerosis.2014.12.039] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 11/06/2014] [Accepted: 12/18/2014] [Indexed: 11/21/2022]
|
32
|
Kessinger CW, Kim JW, Henke PK, Thompson B, McCarthy JR, Hara T, Sillesen M, Margey RJP, Libby P, Weissleder R, Lin CP, Jaffer FA. Statins improve the resolution of established murine venous thrombosis: reductions in thrombus burden and vein wall scarring. PLoS One 2015; 10:e0116621. [PMID: 25680183 PMCID: PMC4334538 DOI: 10.1371/journal.pone.0116621] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 12/11/2014] [Indexed: 11/18/2022] Open
Abstract
Despite anticoagulation therapy, up to one-half of patients with deep vein thrombosis (DVT) will develop the post-thrombotic syndrome (PTS). Improving the long-term outcome of DVT patients at risk for PTS will therefore require new approaches. Here we investigate the effects of statins—lipid-lowering agents with anti-thrombotic and anti-inflammatory properties—in decreasing thrombus burden and decreasing vein wall injury, mediators of PTS, in established murine stasis and non-stasis chemical-induced venous thrombosis (N = 282 mice). Treatment of mice with daily atorvastatin or rosuvastatin significantly reduced stasis venous thrombus burden by 25% without affecting lipid levels, blood coagulation parameters, or blood cell counts. Statin-driven reductions in VT burden (thrombus mass for stasis thrombi, intravital microscopy thrombus area for non-stasis thrombi) compared similarly to the therapeutic anticoagulant effects of low molecular weight heparin. Blood from statin-treated mice showed significant reductions in platelet aggregation and clot stability. Statins additionally reduced thrombus plasminogen activator inhibitor-1 (PAI-1), tissue factor, neutrophils, myeloperoxidase, neutrophil extracellular traps (NETs), and macrophages, and these effects were most notable in the earlier timepoints after DVT formation. In addition, statins reduced DVT-induced vein wall scarring by 50% durably up to day 21 in stasis VT, as shown by polarized light microscopy of picrosirius red-stained vein wall collagen. The overall results demonstrate that statins improve VT resolution via profibrinolytic, anticoagulant, antiplatelet, and anti-vein wall scarring effects. Statins may therefore offer a new pharmacotherapeutic approach to improve DVT resolution and to reduce the post-thrombotic syndrome, particularly in subjects who are ineligible for anticoagulation therapy.
Collapse
Affiliation(s)
- Chase W. Kessinger
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jin Won Kim
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Multimodal Imaging and Theranostic Lab, Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Peter K. Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Brian Thompson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jason R. McCarthy
- Center for Molecular Imaging Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Tetsuya Hara
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Martin Sillesen
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ronan J. P. Margey
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Peter Libby
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Ralph Weissleder
- Center for Molecular Imaging Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Charles P. Lin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Farouc A. Jaffer
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Molecular Imaging Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
33
|
Abstract
Hypercholesterolemia is considered the primary risk factor for cardiovascular disease. An estimated 200 million prescriptions are issued per year for statins to treat hypercholesterolemia. Importantly, statins have additional beneficial effects independent of their effects on lipids. Recent studies have shown that statins reduce thrombosis via multiple pathways, including inhibiting platelet activation and reducing the pathologic expression of the procoagulant protein tissue factor. Many of the antithrombotic effects of statins are attributed to inhibiting prenylation of RhoA and effects on other intracellular signaling molecules such as NF-κB and KLF2. These antithrombotic activities of statins likely contribute to the ability of statins to reduce the incidence of cardiovascular death.
Collapse
Affiliation(s)
- A Phillip Owens
- Department of Medicine, Division of Hematology and Oncology, McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599;
| | | |
Collapse
|
34
|
Paraskevas KI, Veith FJ. Thrombolysis May Reduce the Incidence/Extent of Postprocedural Ischemic Strokes Associated With Carotid Artery Stenting: A Hypothesis. Angiology 2014; 66:604-6. [PMID: 25168957 DOI: 10.1177/0003319714549370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Sheffield Vascular Institute, Northern General Hospital, Sheffield, United Kingdom
| | - Frank J Veith
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA Division of Vascular Surgery, The Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
35
|
Kenaan M, Seth M, Aronow HD, Naoum J, Wunderly D, Mitchiner J, Moscucci M, Gurm HS. Preprocedural statin use in patients undergoing percutaneous coronary intervention. Am Heart J 2014; 168:110-6.e3. [PMID: 24952867 DOI: 10.1016/j.ahj.2014.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/29/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Earlier studies suggest that administering statins prior to percutaneous coronary interventions (PCIs) is associated with lower risk of periprocedural myocardial infarction and contrast-induced nephropathy. Current American College of Cardiology/American Heart Association guidelines recommend routine use of statins prior to PCI. It is unclear how commonly this recommendation is followed in clinical practice and what its effect on outcomes is. METHODS We evaluated the incidence and in-hospital outcomes associated with statin pretreatment among patients undergoing PCI and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry at 44 hospitals in Michigan between January 2010 and December 2012. Propensity and exact matching were used to adjust for the nonrandom use of statins prior to PCI. Long-term mortality was assessed in a subset of patients who were linked to Medicare data. RESULTS Our study population was comprised of 80,493 patients of whom 26,547 (33 %) did not receive statins prior to undergoing PCI. When compared to statin receivers, nonreceivers had lower rates of prior cardiovascular disease. In the matched analysis, absence of statin use prior to PCI was associated with a similar rate of in-hospital mortality (0.43% vs 0.42%, odds ratio 1.00, 95% CI 0.70-1.42, P = .98) and periprocedural myocardial infarction (2.34% vs 2.10%, odds ratio 1.13, 95% CI 0.97-1.32, P = .11) compared to statin receivers. Likewise, no difference in the rate of coronary artery bypass grafting, cerebrovascular accident (CVA), or contrast-induced nephropathy was observed. There was no association between pre-PCI use of statins and long-term survival among the subset of included Medicare patients (hazard ratio = 1.0, P = .96). CONCLUSIONS A significant number of patients undergo PCI without statin pretreatment, but this is not associated with in-hospital major complications or long-term mortality.
Collapse
|
36
|
The effect of statin therapy on the incidence of infections: a retrospective cohort analysis. Am J Med Sci 2014; 347:211-6. [PMID: 23426088 DOI: 10.1097/maj.0b013e31828318e2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Statins have been postulated to prevent infection through immunomodulatory effects. OBJECTIVES To compare the incidence of infections in statin users to that in nonusers within the same health care system. METHODS This was a retrospective cohort study of patients enrolled as Tricare Prime or Plus in the San Antonio military multimarket. Statin users were patients who received a statin for at least 3 months between October 1, 2004 and September 30, 2005. Nonusers were patients who did not receive a statin within the study period (October 1, 2003-September 30, 2009). Inpatient and outpatient International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes were used to determine the incidence of infections during the follow-up period (October 1, 2005-September 30, 2009) via multivariable regression analysis and time to infection via Cox regression analysis. RESULTS Of 45,247 patients who met the study criteria, 12,981 (29%) were statin users and 32,266 were nonusers. After adjustments for age, gender, Charlson Comorbidity Score, tobacco use, alcohol abuse/dependence, health care utilization and use of specific medication classes, statin use was associated with an increased incidence of common infections (odds ratio [OR]: 1.13; 95% confidence interval [CI]: 1.06-1.19) but not influenza or fungal infections (OR: 1.06, 95% CI: 0.80-1.39; OR: 0.97; 95% CI: 0.91-1.04, respectively). Time-to-first infection was similar in statin users and nonusers in all infection categories examined. CONCLUSIONS Statin use was associated with an increased incidence of common infections but not influenza or fungal infections. This study does not support a protective role of statins in infection prevention; however, the influence of potential confounders cannot be excluded.
Collapse
|
37
|
Effects of rosuvastatin on fibrinolytic system of human umbilical vein endothelial cells in vitro. Am J Med Sci 2014; 348:319-23. [PMID: 24694789 DOI: 10.1097/maj.0000000000000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Besides its lipid-lowering effect, rosuvastatin has an antithrombotic effect, the exact underlying mechanism of which is still unclear. The aim of this study was to investigate the effects of rosuvastatin on the fibrinolytic system, including tissue-type plasminogen activator (t-PA), urokinase-type plasminogen activator (u-PA) with its receptor (u-PAR) and plasminogen activator inhibitor-1 (PAI-1), in vascular endothelial cells exposed to oxidized low-density lipoprotein (oxLDL). METHODS Human umbilical vein endothelial cells (HUVEC) were cultured and divided into 7 groups: control, rosuvastatin alone (10 nM), oxLDL alone (100 mg/L), oxLDL plus rosuvastatin (0.1, 1.0 and 10 nM, respectively) and oxLDL plus rosuvastatin (10 nM) with mevalonate (100 μM). The lactate dehydrogenase activity and concentrations of t-PA, u-PA, u-PAR and PAI-1 protein in culture medium were measured, whereas the expressions of t-PA, u-PA, u-PAR and PAI-1 mRNA in endothelial cells were detected by real-time polymerase chain reaction at 24 hours after treatment. RESULTS Compared with the control group, oxLDL caused a significant increase in lactate dehydrogenase activity. It could reduce the expression of t-PA mRNA and protein (P < 0.05) and increase the expression of PAI-1 mRNA and protein (P < 0.05). Rosuvastatin could protect the endothelial cells, improve t-PA production and reduce PAI-1 production (P < 0.05), whether in unstimulated HUVEC or in HUVEC exposed to oxLDL. The effects of rosuvastatin on the fibrinolytic system could be reversed by mevalonate. No significant differences in u-PA and u-PAR production were seen among different groups. CONCLUSIONS Rosuvastatin has protective effects on oxLDL-induced damaged human vascular endothelial cells; its antithrombotic effects may be mediated by the regulation of the fibrinolytic system.
Collapse
|
38
|
Nafasi L, Rahmani R, Shafiee A, Salari A, Abdollahi A, Meysamie A. Can a high reloading dose of atorvastatin prior to percutaneous coronary intervention reduce periprocedural myocardial infarction? Curr Med Res Opin 2014; 30:381-6. [PMID: 23952289 DOI: 10.1185/03007995.2013.834249] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Periprocedural myocardial infarction (MI) is a common complication following percutaneous coronary intervention (PCI) and statins have been shown to reduce MI in statin-naïve patients. We aimed to identify whether a high reloading dose of atorvastatin can prevent MI following PCI in patients who were already being treated with statins. MATERIAL AND METHODS In this triple-blind controlled randomized clinical trial, 190 candidates for elective PCI, who were already using statins and/or other lipid lowering agents such as fibrates, were randomly assigned to two equal groups to receive either atorvastatin (80 mg) or placebo within 24 hours before the procedure. Serum levels of creatinine kinase myocardial isoenzyme (CK-MB), cardiac troponin I (cTNI) and high-sensitive C-reactive protein (hs-CRP) were measured at baseline and then 6 and 12 hours following PCI. Post-procedural MI was defined as troponin elevation>5-fold in patients with normal baseline or >20% in those with elevated baseline measurements with or without chest pain or ST segment or T wave abnormalities. RESULTS Frequency of MI in the atorvastatin group was 3 (3.1%) vs. 10 (10.5%) in the placebo group (p=0.04). The CK-MB rise within 6 hours following PCI was 0.6±0.3 mg/dl in the intervention group versus 3.0±1.6 mg/dl in the placebo group. Also, the levels of cTNI within 6 and 12 hours in the intervention group was significantly lower than the placebo group (p=0.01 and 0.008, respectively). hs-CRP was significantly lower in the intervention group after 12 hours (p=0.004). CONCLUSION Administration of a high reloading dose of atorvastatin within 24 hours before PCI could significantly reduce the frequency of periprocedural MI. CLINICAL TRIAL REGISTRATION CODE: IRCT201205209768N1.
Collapse
Affiliation(s)
- Latifeh Nafasi
- Imam Khomeini Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | | | | | | | | | | |
Collapse
|
39
|
Undas A, Brummel-Ziedins KE, Mann KG. Anticoagulant effects of statins and their clinical implications. Thromb Haemost 2013; 111:392-400. [PMID: 24285296 DOI: 10.1160/th13-08-0720] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/15/2013] [Indexed: 12/31/2022]
Abstract
There is evidence indicating that statins (3-hydroxy-methylglutaryl coenzyme A reductase inhibitors) may produce several cholesterol-independent antithrombotic effects. In this review, we provide an update on the current understanding of the interactions between statins and blood coagulation and their potential relevance to the prevention of venous thromboembolism (VTE). Anticoagulant properties of statins reported in experimental and clinical studies involve decreased tissue factor expression resulting in reduced thrombin generation and attenuation of pro-coagulant reactions catalysed by thrombin, such as fibrinogen cleavage, factor V and factor XIII activation, as well as enhanced endothelial thrombomodulin expression, resulting in increased protein C activation and factor Va inactivation. Observational studies and one randomized trial have shown reduced VTE risk in subjects receiving statins, although their findings still generate much controversy and suggest that the most potent statin rosuvastatin exerts the largest effect.
Collapse
Affiliation(s)
- A Undas
- Anetta Undas, MD, PhD, Institute of Cardiology, Jagiellonian University School of Medicine, 80 Pradnicka St., 31-202 Krakow, Poland, Tel.: +48 12 6143004, Fax: +48 12 4233900, E-mail:
| | | | | |
Collapse
|
40
|
Lin YT, Verma A, Hodgkinson CP. Toll-like receptors and human disease: lessons from single nucleotide polymorphisms. Curr Genomics 2013; 13:633-45. [PMID: 23730203 PMCID: PMC3492803 DOI: 10.2174/138920212803759712] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 10/08/2012] [Accepted: 10/08/2012] [Indexed: 12/13/2022] Open
Abstract
Toll-like receptors (TLRs), a large group of proteins which recognize various pathogen-associated molecular patterns, are critical for the normal function of the innate immune system. Following their discovery many single nucleotide polymorphisms within TLRs and components of their signaling machinery have been discovered and subsequently implicated in a wide range of human diseases including atherosclerosis, sepsis, asthma, and immunodeficiency. This review discusses the effect of genetic variation on TLR function and how they may precipitate disease.
Collapse
Affiliation(s)
- Yi-Tzu Lin
- Department of Medicine, Duke University Medical Center & Mandel Center for Hypertension and Atherosclerosis Research, Durham, NC 27710, USA
| | | | | |
Collapse
|
41
|
Jansen JO, Lord JM, Thickett DR, Midwinter MJ, McAuley DF, Gao F. Clinical review: Statins and trauma--a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:227. [PMID: 23751018 PMCID: PMC3706835 DOI: 10.1186/cc12499] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Statins, in addition to their lipid-lowering properties, have anti-inflammatory actions. The aim of this review is to evaluate the effect of pre-injury statin use, and statin treatment following injury. MEDLINE, EMBASE, and CENTRAL databases were searched to January 2012 for randomised and observational studies of statins in trauma patients in general, and in patients who have suffered traumatic brain injury, burns, and fractures. Of 985 identified citations, 7 (4 observational studies and 3 randomised controlled trials (RCTs)) met the inclusion criteria. Two studies (both observational) were concerned with trauma patients in general, two with patients who had suffered traumatic brain injury (one observational, one RCT), two with burns patients (one observational, one RCT), and one with fracture healing (RCT). Two of the RCTs relied on surrogate outcome measures. The observational studies were deemed to be at high risk of confounding, and the RCTs at high risk of bias. Three of the observational studies suggested improvements in a number of clinical outcomes in patients taking statins prior to injury (mortality, infection, and septic shock in burns patients; mortality in trauma patients in general; mortality in brain injured patients) whereas one, also of trauma patients in general, showed no difference in mortality or infection, and an increased risk of multi-organ failure. Two of three RCTs on statin treatment in burns patients and brain injured patients showed improvements in E-selectin levels and cognitive function. The third, of patients with radial fractures, showed no acceleration in fracture union. In conclusion, there is some evidence that pre-injury statin use and post-injury statin treatment may have a beneficial effect in patients who have suffered general trauma, traumatic brain injury, and burns. However, these studies are at high risk of confounding and bias, and should be regarded as 'hypothesisgenerating'. A well-designed RCT is required to determine the therapeutic efficacy in improving outcomes in this patient population.
Collapse
|
42
|
Wang ZH, Liu XL, Zhong M, Zhang LP, Shang YY, Hu XY, Li L, Zhang Y, Deng JT, Zhang W. Pleiotropic Effects of Atorvastatin on Monocytes in Atherosclerotic Patients. J Clin Pharmacol 2013; 50:311-9. [DOI: 10.1177/0091270009340889] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
43
|
Abstract
Acute lung injury (ALI) is a devastating clinical condition associated with pulmonary and systemic inflammation and characterized by incompetence of the pulmonary microvascular barrier culminating in noncardiogenic pulmonary edema. An understanding of the mechanisms underlying endothelial barrier dysfunction in ALI has been facilitated by study of the effects of statins in relevant cellular and animals models. Many of the pleotropic properties of these drugs, including direct effects on endothelial cell (EC) cytoskeletal rearrangement, NADPH oxidase, and nitric oxide activity, as well as effects on differential EC gene expression, are relevant to the pathobiology of ALI and suggest a potential therapeutic role for statins in this context. Moreover, results from preclinical studies and observations in relevant patient populations support the protective potential of statins in ALI, paving the way now for definitive clinical trials.
Collapse
Affiliation(s)
- Sunit Singla
- Institute for Personalized Respiratory Medicine, Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, Illinois, USA
| | | |
Collapse
|
44
|
Sardella G, Conti G, Donahue M, Mancone M, Canali E, De Carlo C, Di Roma A, Calcagno S, Lucisano L, Fedele F. Rosuvastatin pretreatment in patients undergoing elective PCI to reduce the incidence of myocardial periprocedural necrosis: the ROMA trial. Catheter Cardiovasc Interv 2012; 81:E36-43. [PMID: 22517610 DOI: 10.1002/ccd.24403] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 01/22/2012] [Accepted: 03/02/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study is to assess the efficacy of the high-dose rosuvastatin preadministration in reducing periprocedural myocardial necrosis and major adverse cardiovascular and cerebrovascular events (MACCE) in patients undergoing elective percutaneous coronary intervention (PCI). BACKGROUND Elective PCI may be complicated with an elevation of cardiac biomarkers. Several studies suggested that pretreatment with statins may be associated with a reduction in periprocedural myocardial necrosis. METHODS One hundred and sixty patients with stable angina who underwent elective PCI were randomly assigned to receive either a preprocedural loading dose (40 mg) of rosuvastatin group (RG, n = 80) or a standard treatment [control group (CG), n = 80].The primary endpoint was the incidence of periprocedural myocardial necrosis. The secondary endpoint was the assessment of MACCE [cardiac death, all-myocardial infarction (MI), stroke, and target vessel revascularization (TVR)] at a 30-day and 12-month follow-up, as well as the rate of periprocedural rise of Troponin T-serum levels >3× upper limit of normal. RESULTS Twelve and 24-hr post-PCI creatinine kinase MB isoform elevation >3× occurred more frequently in the CG than in the RG (22.7 vs. 7.1; P = 0.034 and 26.4 vs. 8.7; P = 0.003). At the 30-day and 12-month follow-up, the incidence of cumulative MACCE was higher in CG than in the RG (30.0% vs. 8.7%; P = 0.001 and 35.0% vs. 12.5%; P = 0.001).The difference between the groups was mainly due to the periprocedural MI incidence (26.4% vs. 8.7%; P = 0.003).The rate of cardiac death, spontaneous MI, TVR, and stroke were similar in the two groups. CONCLUSIONS High loading dose of rosuvastatin within 24 hr before elective PCI seems to decrease the incidence of periprocedural myocardial necrosis during a period of 12-months compared to the standard treatment.
Collapse
Affiliation(s)
- Gennaro Sardella
- Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences Department, Umberto I Hospital, Sapienza University of Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
The association of prior statin use in septic shock treated with early goal directed therapy. Eur J Emerg Med 2012; 19:226-30. [PMID: 21915053 DOI: 10.1097/mej.0b013e32834b3467] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Previous literature suggests statins may have a therapeutic role in sepsis. No data have examined if statin use may have a positive impact beyond that afforded by early goal directed therapy (EGDT). OBJECTIVE To test the hypothesis that previous statin use is associated with improved clinically relevant outcomes in patients with severe sepsis and septic shock receiving EGDT. METHODS Retrospective cohort study of 91 patients who presented in an academic center in severe sepsis or septic shock and received EGDT. Primary outcome was mortality and secondary outcomes included mechanical ventilation days, ICU length of stay, and hospital length of stay. RESULTS Patients (87 of 91) presented to the Emergency Department before ICU admission. Patients (18 of 91) were receiving statin therapy before presentation. The statin group had a mortality rate of 22.2 vs. 39.7% in the nonstatin group (P=0.273). The statin group had fewer mechanical ventilation days (8.49 vs. 7.29 days, P=0.026), and a trend in improved hospital length of stay (17.9 vs. 14.4 days, P=0.065), and ICU length of stay (7.15 vs. 4.89 days, P=0.077). CONCLUSION Prior statin use is associated with fewer mechanical ventilation days and a trend toward improvement in other clinically relevant outcomes. This trial is limited by its retrospective nature and small sample size. These results should serve as hypothesis generating for future prospective trials, as the lack of novel drug therapy and the mortality rate of septic shock both remain unacceptable.
Collapse
|
46
|
Abstract
HMG-CoA reductase inhibitors, or statins, are among the most commonly prescribed pharmaceuticals in the world, especially among the elderly. The remarkable conjuncture of this fact with the rising incidence of severe sepsis among people over age 65 could prove to be of serendipitous benefit, because numerous actions of the statins make them of potential use in the prevention and treatment of severe sepsis. Severe sepsis continues to be a highly lethal condition, for which there are, as yet, no effective pharmacological treatments, save antibiotics. We explore the biological plausibility of statins as prophylaxis agents and as treatment for severe sepsis and thoroughly review the preclinical and clinical studies that have explored the effects of statins in infected and septic patients. Statins remain only promising treatments for severe sepsis, without convincing evidence that they reduce patient mortality. Ongoing randomized trials may provide conclusive evidence, whether positive or negative.
Collapse
|
47
|
Abstract
Sepsis is a common intensive care unit event occurring in approximately 750 000 patients annually, with a case mortality rate approaching 50%. Sepsis is characterized by a chaotic and excessive release of inflammatory cytokines and procoagulants including tumor necrosis factor, interleukin (IL)-1, IL-6, IL-8, platelet-activating factor, and tissue factor. Efforts to inhibit individual cytokines in order to modify poor outcomes have been generally disappointing, suggesting the need to target multiple inflammatory mediators to obtain clinical benefit. Statins lower lipids by inhibiting 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, which in turn inhibits the rate-limiting step in cholesterol biosynthesis. In addition to lowering total cholesterol, statins have pleiotropic effects on inflammation and immunity. Instead of impacting a single entity in the sepsis syndrome, statins may have positive effects on multiple inflammatory, immunomodulating, and coagulation targets involved in the development of infection and sepsis. There have been a number of institutional- and population-based studies that have evaluated the impact of statins in patients with infection and sepsis. Most of these studies, but not all, have demonstrated a number of positive outcomes in patients with statins, including reduction in mortality. Based on these data, statins are a promising therapy in the management of patients with sepsis and warrant larger and more rigorous clinical trials.
Collapse
Affiliation(s)
- Paul P Dobesh
- College of Pharmacy, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE 68198, USA.
| | | | | | | |
Collapse
|
48
|
Gazzerro P, Proto MC, Gangemi G, Malfitano AM, Ciaglia E, Pisanti S, Santoro A, Laezza C, Bifulco M. Pharmacological actions of statins: a critical appraisal in the management of cancer. Pharmacol Rev 2011; 64:102-46. [PMID: 22106090 DOI: 10.1124/pr.111.004994] [Citation(s) in RCA: 316] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Statins, among the most commonly prescribed drugs worldwide, are cholesterol-lowering agents used to manage and prevent cardiovascular and coronary heart diseases. Recently, a multifaceted action in different physiological and pathological conditions has been also proposed for statins, beyond anti-inflammation and neuroprotection. Statins have been shown to act through cholesterol-dependent and -independent mechanisms and are able to affect several tissue functions and modulate specific signal transduction pathways that could account for statin pleiotropic effects. Typically, statins are prescribed in middle-aged or elderly patients in a therapeutic regimen covering a long life span during which metabolic processes, aging, and concomitant novel diseases, including cancer, could occur. In this context, safety, toxicity, interaction with other drugs, and the state of health have to be taken into account in subjects treated with statins. Some evidence has shown a dichotomous effect of statins with either cancer-inhibiting or -promoting effects. To date, clinical trials failed to demonstrate a reduced cancer occurrence in statin users and no sufficient data are available to define the long-term effects of statin use over a period of 10 years. Moreover, results from clinical trials performed to evaluate the therapeutic efficacy of statins in cancer did not suggest statin use as chemotherapeutic or adjuvant agents. Here, we reviewed the pharmacology of the statins, providing a comprehensive update of the current knowledge of their effects on tissues, biological processes, and pathological conditions, and we dissected the disappointing evidence on the possible future use of statin-based drugs in cancer therapy.
Collapse
Affiliation(s)
- Patrizia Gazzerro
- Department of Pharmaceutical and Biomedical Sciences, University of Salerno, Via Ponte Don Melillo, 84084 Fisciano (Salerno), Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Mizuno Y, Jacob RF, Mason RP. Inflammation and the development of atherosclerosis. J Atheroscler Thromb 2011; 18:351-8. [PMID: 21427505 DOI: 10.5551/jat.7591] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Atherosclerosis is a progressive disease causally associated with multiple cardiovascular risk factors, including dyslipidemia. Without effective intervention, atherosclerosis becomes evidenced clinically as coronary artery and cerebrovascular disease, both of which remain the leading causes of death worldwide. Multiple lines of investigation indicate a central role for inflammation in atherosclerotic plaque progression, vulnerability and thrombogenicity. Randomized clinical trials have documented the benefit of lipid-lowering therapy for both primary and secondary prevention of cardiovascular events. Statins, a class of drugs that lower cholesterol levels by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, have been shown to slow the progression of the atheroma and the frequency of associated clinical events to an extent that cannot be attributed solely to LDL reduction. The non-LDL or pleiotropic effects of statins are attributed to anti-inflammatory activity, enhanced endothelial function, and inhibition of oxidative stress. In this review, we discuss the role of inflammation in atherogenesis along with the effects of statins in slowing this process through LDL-dependent and -independent mechanisms.
Collapse
Affiliation(s)
- Yoshiko Mizuno
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | | | | |
Collapse
|
50
|
Does statin in the acute phase of ischemic stroke improve outcome after intravenous thrombolysis? A retrospective study. J Neurol Sci 2011; 308:128-34. [DOI: 10.1016/j.jns.2011.05.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 05/12/2011] [Accepted: 05/17/2011] [Indexed: 11/23/2022]
|