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Horbal SR, Derstine BA, Brown E, Su GL, Wang SC, Holcombe SA. Reference distributions of aortic calcification and association with Framingham risk score. Sci Rep 2023; 13:9421. [PMID: 37296154 PMCID: PMC10256704 DOI: 10.1038/s41598-023-36565-8] [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: 01/16/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023] Open
Abstract
Evidence supporting aortic calcification as a leverageable cardiovascular risk factor is rapidly growing. Given aortic calcification's potential as a clinical correlate, we assessed granular vertebral-indexed calcification measurements of the abdominal aorta in a well curated reference population. We evaluated the relationship of aortic calcification measurements with Framingham risk scores. After exclusion, 4073 participants from the Reference Analytic Morphomic Population with varying vertebral levels were included. The percent of the aortic wall calcified was used to assess calcification burden at the L1-L4 levels. Descriptive statistics of participants, sex-specific vertebral indexed calcification measurements, relational plots, and relevant associations are reported. Mean aortic attenuation was higher in female than male participants. Overall, mean aortic calcium was higher with reference to inferior abdominal aortic measurements and demonstrated significant differences across all abdominal levels [L3 Area (mm[Formula: see text]): Females 6.34 (sd 16.60), Males 6.23 (sd 17.21); L3 Volume (mm[Formula: see text]): Females 178.90 (sd 474.19), Males 195.80 (sd 547.36); Wall Calcification (%): Females (L4) 6.97 (sd 16.03), Males (L3) 5.46 (13.80)]. Participants with elevated calcification had significantly higher Framingham risk scores compared to participants with normal calcification scores. Opportunistically measuring aortic calcification may inform further cardiovascular risk assessment and enhance cardiovascular event surveillance efforts.
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Affiliation(s)
- Steven R Horbal
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Brian A Derstine
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Edward Brown
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Grace L Su
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
- Gastroenterology Section, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Stewart C Wang
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Sven A Holcombe
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
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2
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Jarrah MI, Ababneh MJ, Tawalbeh LI, Hammoudeh AJ, Barukba HM, Othman A. Statin eligibility based on the ACC/AHA guidelines among Middle Eastern patients with diabetes mellitus presenting with acute myocardial infarction. Ann Med Surg (Lond) 2021; 61:148-154. [PMID: 33425348 PMCID: PMC7782195 DOI: 10.1016/j.amsu.2020.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 12/02/2022] Open
Abstract
Background Statin eligibility based on the American College of Cardiology/American Heart Association cholesterol guidelines among patients with diabetes admitted with first time acute myocardial infarction has not been evaluated in the Middle East. Purpose To assess statin eligibility for diabetic patients admitted with first time myocardial infarction in Jordan according to ACC/AHA guidelines. Methods Consecutive patients admitted with a first acute myocardial infarction who were not taking statins, and had their serum lipoproteins measured upon hospital admission were enrolled in the study. Statin eligibility among patients with diabetes admitted with first time myocardial infarction was determined based on the ACC/AHA guidelines. Results Of 774 patients enrolled, 292 (37.30%) had diabetes. Compared with non-diabetic patients, those with diabetes were females, older, more hypertension, more hypercholesterolemia, more triglycerides, more diastolic blood pressure, less smokers and less low density lipoprotein. Among patients with diabetes, 242 diabetic patients (82.9%) were statin eligible, including 20 (6.90%) for having high serum levels of low density lipoprotein cholesterol (LDL-C) >190 mg/dL, and 222 (76%) for being aged 40–75 years with LDL-C 70–189 mg/dL. No patient had a calculated atherosclerotic cardiovascular risk score ≥7.5%. On the other hand, 393 non-diabetic patients (81.3%) were statin eligible, including 41 (8.50%) for having high serum levels of low density lipoprotein cholesterol (LDL-C) >190 mg/dL, and 351 (72.80%) for being aged 40–75 years with LDL-C 70–189 mg/dL. Conclusions Based on the ACC/AHA guidelines, the majority of patients with diabetes admitted with first acute myocardial infarction would have been eligible for statin treatment if they have LDL-c >190 mg/dl or aged 40–75 years old and they have their LDL 70–189 mg/gl. More efforts should be taken for patients who are female, older than 50 years, hypertensive, elevated diastolic blood pressure have hypercholesterolemia, and elevated triglycerides because of their significant association with diabetes. 83% of patients with diabetes mellitus presenting with MI, were statin eligible. 393 non-diabetic patients (81.3%) were statin eligible in the current sample. No diabetic or non-diabetic patients has a 10 year ASCVR score between 5 and 7.4 Statin was eligible in the same proportion among diabetic and diabetic patients.
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Affiliation(s)
- Mohamad I Jarrah
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Muhannad J Ababneh
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Loai Issa Tawalbeh
- Faculty of Nursing, Al al-Bayt University Al-Mafraq, P.O. Box: 130049, 25113, Jordan
| | - Ayman J Hammoudeh
- Department of Cardiology, and Coronary Computed Tomography Section, Istishari Hospital, Amman, Jordan
| | - Hanan M Barukba
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad Othman
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Rees-Milton KJ, Norman P, Babiolakis C, Hulbert M, Turner ME, Berger C, Anastassiades TP, Hopman WM, Adams MA, Powley WL, Holden RM. Statin Use is Associated With Insulin Resistance in Participants of the Canadian Multicentre Osteoporosis Study. J Endocr Soc 2020; 4:bvaa057. [PMID: 32715271 PMCID: PMC7371386 DOI: 10.1210/jendso/bvaa057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/08/2020] [Indexed: 12/15/2022] Open
Abstract
Context Statins have been linked to the development of diabetes and atherosclerotic plaque calcification in patients with cardiac disease. Objective To determine the association between statin use and statin characteristics and insulin resistance and abdominal aortic calcification (AAC) in participants of the Canadian Multicentre Osteoporosis Study (CaMos). Design Observational study. Setting General community. Participants Nondiabetic participants of the Kingston CaMos site. Intervention Insulin resistance and AAC in statin users and nonstatin users were compared with and without the inclusion of a propensity score (PS) to be on a statin. The covariates of hypertension, sex, body mass index, smoking, kidney stones, and age that were included in the PS were selected based on clinical judgment confirmed by the statistical analysis of a difference between statin users and nonstatin users. Main Outcome Measures Insulin resistance measured by the homeostasis model assessment (HOMA-IR) and AAC assessed on lateral spine radiographs using the Framingham methodology. Results Using a general linear model, statin use was associated with higher levels of HOMA-IR after stratified PS adjustment (β = 1.52, [1.18-1.95], P < 0.01). Hydrophilic statin users (n = 9) and lipophilic statins users (n = 30) had higher HOMA-IR compared to nonstatin users (n = 125) ([β = 2.29, (1.43-3.68), P < 0.001] and [β = 1.36, (1.04-1.78), P < 0.05]), respectively, in general linear models after stratified PS adjustment. Statin use was associated with AAC without stratifying by PS in the Wilcoxon test, but was no longer significant when stratified by PS. Conclusions Statins, widely prescribed drugs to lower cholesterol, may have unintended consequences related to glucose homeostasis that could be relevant in healthy aging.
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Affiliation(s)
| | - Patrick Norman
- Kingston General Health Research Institute, Kingston, ON
| | | | - Maggie Hulbert
- Department of Medicine, Queen's University, Kingston, ON
| | - Mandy E Turner
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON
| | - Claudie Berger
- Research Institute of the McGill University Health Centre, Montreal, QC
| | - Tassos P Anastassiades
- Department of Medicine, Queen's University, Kingston, ON.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON
| | - Wilma M Hopman
- Kingston General Health Research Institute, Kingston, ON.,Department of Public Health Sciences, Queen's University, Kingston, ON
| | - Michael A Adams
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON
| | | | - Rachel M Holden
- Department of Medicine, Queen's University, Kingston, ON.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON
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4
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Wang H, Wang S, Tao Y, Sun Y. Further insight into 10-year CVD risk evaluation and recommended eligibility for statin therapy in Chinese population: Comparison of cardiovascular risk prediction models and their guidelines. Int J Cardiol 2018; 271:343. [DOI: 10.1016/j.ijcard.2018.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/05/2018] [Indexed: 11/29/2022]
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Brown F, Singer A, Katz A, Konrad G. Statin-prescribing trends for primary and secondary prevention of cardiovascular disease. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:e495-e503. [PMID: 29138175 PMCID: PMC5685466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the proportion of patients receiving statins for primary or secondary prevention of cardiovascular disease (CVD), as well as to describe lipid-screening trends. DESIGN Retrospective chart review using the Manitoba Primary Care Research Network repository. SETTING Manitoba. PARTICIPANTS A total of 149 262 patients. MAIN OUTCOME MEASURES Proportion of patients who were taking statins for primary or secondary prevention of cardiovascular disease (CVD), who did not have evidence of CVD recorded in their charts, and who underwent lipid screening; distribution of statins among age groups; and the proportion of patients eligible for lipid screening when the age cutoffs of the 2012 and 2016 Canadian Cardiovascular Society guidelines were applied. RESULTS Of the 149 262 patients, 139 025 (93%) did not have CVD recorded in their electronic medical records and made up the primary prevention group; of these 139 025 patients, 5955 (4%) were taking statins. Also in the primary prevention group, 14 814 (11%) patients were 75 years of age and older; of these patients, 1374 (9%) were taking statins. A total of 10 237 of the 149 262 (7%) patients had CVD recorded in their charts (secondary prevention group); 3013 (29%) of these patients were taking statins. When the 2016 Canadian Cardiovascular Society guidelines age cutoffs were applied, 56% of patients (83 119 of 149 262) were eligible for lipid screening, and 31% (26 024 of 83 119) of them had evidence of screening in the past 5 years. Of the total population of those aged 75 and older, 28% (5597 of 20 188) had undergone lipid screening. Of the total population taking statins, 28% (2481 of 8968) had undergone lipid testing while taking statins. CONCLUSION In Manitoba, less than 5% of the primary prevention population and less than 30% of the secondary prevention population had received repeat statin prescriptions from their primary care providers. This represents a possible practice gap that warrants future research, as statins offer considerable morbidity and mortality benefits in these patients.
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Affiliation(s)
- Felicity Brown
- Practising physician at Seven Oaks Emergency Department in Winnipeg, Man.
| | - Alexander Singer
- Director of the Manitoba Primary Care Research Network and Assistant Professor in the Department of Family Medicine at the University of Manitoba
| | - Alan Katz
- Director of the Manitoba Centre for Health Policy and Professor in the Department of Community Health Sciences and the Department of Family Medicine at the University of Manitoba
| | - Gerald Konrad
- Unit Director at the Family Medical Centre Teaching Unit and Associate Professor in the Department of Family Medicine at the University of Manitoba
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Cesena FHY, Laurinavicius AG, Valente VA, Conceição RD, Santos RD, Bittencourt MS. Cardiovascular Risk Stratification and Statin Eligibility Based on the Brazilian vs. North American Guidelines on Blood Cholesterol Management. Arq Bras Cardiol 2017; 108:508-517. [PMID: 28699974 PMCID: PMC5489320 DOI: 10.5935/abc.20170088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/01/2017] [Indexed: 01/14/2023] Open
Abstract
Background: The best way to select individuals for lipid-lowering treatment in the population is controversial. Objective: In healthy individuals in primary prevention: to assess the relationship between cardiovascular risk categorized according to the V Brazilian Guideline on Dyslipidemia and the risk calculated by the pooled cohort equations (PCE); to compare the proportion of individuals eligible for statins, according to different criteria. Methods: In individuals aged 40-75 years consecutively submitted to routine health assessment at one single center, four criteria of eligibility for statin were defined: BR-1, BR-2 (LDL-c above or at least 30 mg/dL above the goal recommended by the Brazilian Guideline, respectively), USA-1 and USA-2 (10-year risk estimated by the PCE ≥ 5.0% or ≥ 7.5%, respectively). Results: The final sample consisted of 13,947 individuals (48 ± 6 years, 71% men). Most individuals at intermediate or high risk based on the V Brazilian Guideline had a low risk calculated by the PCE, and more than 70% of those who were considered at high risk had this categorization because of the presence of aggravating factors. Among women, 24%, 17%, 4% and 2% were eligible for statin use according to the BR-1, BR-2, USA-1 and USA-2 criteria, respectively (p < 0.01). The respective figures for men were 75%, 58%, 31% and 17% (p < 0.01). Eighty-five percent of women and 60% of men who were eligible for statin based on the BR-1 criterion would not be candidates for statin based on the USA-1 criterion. Conclusions: As compared to the North American Guideline, the V Brazilian Guideline considers a substantially higher proportion of the population as eligible for statin use in primary prevention. This results from discrepancies between the risk stratified by the Brazilian Guideline and that calculated by the PCE, particularly because of the risk reclassification based on aggravating factors. Fundamento: Existe controvérsia sobre a melhor forma de selecionar indivíduos para tratamento hipolipemiante na população. Objetivos: Em indivíduos saudáveis em prevenção primária: avaliar a relação entre o risco cardiovascular segundo a V Diretriz Brasileira de Dislipidemias e o risco calculado pelas pooled cohort equations (PCE); comparar a proporção de indivíduos elegíveis para estatinas, de acordo com diferentes critérios. Métodos: Em indivíduos de 40 a 75 anos submetidos consecutivamente a avaliação rotineira de saúde em um único centro, quatro critérios de elegibilidade para estatina foram definidos: BR-1, BR-2 (LDL-c acima ou pelo menos 30 mg/dL acima da meta preconizada pela diretriz brasileira, respectivamente), EUA-1 e EUA-2 (risco estimado pelas PCE em 10 anos ≥ 5,0% ou ≥ 7,5%, respectivamente). Resultados: Foram estudados 13.947 indivíduos (48 ± 6 anos, 71% homens). A maioria dos indivíduos de risco intermediário ou alto pela V Diretriz apresentou risco calculado pelas PCE baixo e mais de 70% daqueles considerados de alto risco o foram devido à presença de fator agravante. Foram elegíveis para estatina 24%, 17%, 4% e 2% das mulheres pelos critérios BR-1, BR-2, EUA-1 e EUA-2, respectivamente (p < 0,01). Os respectivos valores para os homens foram 75%, 58%, 31% e 17% (p < 0,01). Oitenta e cinco por cento das mulheres e 60% dos homens elegíveis para estatina pelo critério BR-1 não seriam candidatos pelo critério EUA-1. Conclusões: Comparada à diretriz norte-americana, a V Diretriz Brasileira considera uma proporção substancialmente maior da população como elegível para estatina em prevenção primária. Isso se relaciona com discrepâncias entre o risco estratificado pela diretriz brasileira e o calculado pelas PCE, particularmente devido à reclassificação de risco baseada em fatores agravantes.
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Affiliation(s)
| | | | | | | | - Raul D Santos
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil.,Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Marcio S Bittencourt
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil.,Hospital Universitário da Universidade de São Paulo; São Paulo, SP - Brazil
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Campitelli MA, Maxwell CJ, Giannakeas V, Bell CM, Daneman N, Jeffs L, Morris AM, Austin PC, Hogan DB, Ko DT, Lapane KL, Maclagan LC, Seitz DP, Bronskill SE. The Variation of Statin Use Among Nursing Home Residents and Physicians: A Cross-Sectional Analysis. J Am Geriatr Soc 2017; 65:2044-2051. [PMID: 28791683 DOI: 10.1111/jgs.15013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the variability of statin use among nursing home residents and prescribing physicians, and to assess statin use by resident frailty. DESIGN Population-based, cross-sectional analysis. SETTING All nursing home facilities (N = 631) in Ontario, Canada between April 1, 2013 and March 31, 2014. PARTICIPANTS All adults aged 66 years and older who received a full clinical assessment while residing in a nursing home facility and their assigned, most responsible, physician. MEASUREMENTS Statin use on date of clinical assessment. Resident- and physician-level characteristics ascertained through clinical assessment and health administrative data. Resident frailty was derived using a previously validated index. RESULTS Among 76,226 nursing home residents assigned to 1,919 physicians, 25,648 (33.6%) were statin users. There were 13,331 (30.1%) statin users among the 44,290 residents categorized as frail. In an adjusted mixed-effects logistic regression model, frail residents (adjusted odds ratio = 0.62, 95% confidence interval 0.58-0.65) were significantly less likely to be statin users compared with non-frail residents. After adjustment for resident characteristics, the intraclass correlation coefficient indicated that between-physician variability accounted for 9.1% of the residual unexplained variation in statin use (P < .001). Among the 894 physicians assigned 20 or more residents, funnel plots confirmed there were more low-outlying (17.4%) and high-outlying (12.0%) prescribers of statins than expected by chance. Physicians who were high-outlying prescribers had higher historical rates of statin prescribing. CONCLUSIONS AND RELEVANCE Statin prescribing was substantial within nursing homes, even among frail residents. After controlling for resident characteristics, the likelihood of statin prescribing varied significantly across physicians. Further studies are required to evaluate the risks and benefits of statin use, and discontinuation, among nursing home residents to better inform clinical practice in this setting.
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Affiliation(s)
| | - Colleen J Maxwell
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Vasily Giannakeas
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Chaim M Bell
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Nick Daneman
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lianne Jeffs
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Andrew M Morris
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David B Hogan
- Divison of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dennis T Ko
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worchester, Massachusetts
| | - Laura C Maclagan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Dallas P Seitz
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Geriatric Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Susan E Bronskill
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Hsu CP, Zhao JF, Lin SJ, Shyue SK, Guo BC, Lu TM, Lee TS. Asymmetric Dimethylarginine Limits the Efficacy of Simvastatin Activating Endothelial Nitric Oxide Synthase. J Am Heart Assoc 2016; 5:e003327. [PMID: 27091343 PMCID: PMC4843600 DOI: 10.1161/jaha.116.003327] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of endothelial nitric oxide synthase (eNOS), is considered a risk factor for the pathogenesis of cardiovascular diseases. Simvastatin, a lipid‐lowering drug with other pleiotropic effects, has been widely used for treatment of cardiovascular diseases. However, little is known about the effect and underlying molecular mechanisms of ADMA on the effectiveness of simvastatin in the vascular system. Methods and Results We conducted a prospective cohort study to enroll 648 consecutive patients with coronary artery disease for a follow‐up period of 8 years. In patients with plasma ADMA level ≥0.49 μmol/L (a cut‐off value from receiver operating characteristic curve), statin treatment had no significant effect on cardiovascular events. We also conducted randomized, controlled studies using in vitro and in vivo models. In endothelial cells, treatment with ADMA (≥0.5 μmol/L) impaired simvastatin‐induced nitric oxide (NO) production, endothelial NO synthase (eNOS) phosphorylation, and angiogenesis. In parallel, ADMA markedly increased the activity of NADPH oxidase (NOX) and production of reactive oxygen species (ROS). The detrimental effects of ADMA on simvastatin‐induced NO production and angiogenesis were abolished by the antioxidant, N‐acetylcysteine, NOX inhibitor, or apocynin or overexpression of dimethylarginine dimethylaminohydrolase 2 (DDAH‐2). Moreover, in vivo, ADMA administration reduced Matrigel plug angiogenesis in wild‐type mice and decreased simvastatin‐induced eNOS phosphorylation in aortas of apolipoprotein E–deficient mice, but not endothelial DDAH‐2‐overexpressed aortas. Conclusions We conclude that ADMA may trigger NOX‐ROS signaling, which leads to restricting the simvastatin‐conferred protection of eNOS activation, NO production, and angiogenesis as well as the clinical outcome of cardiovascular events.
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Affiliation(s)
- Chiao-Po Hsu
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jin-Feng Zhao
- Department of Physiology, Genome Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Song-Kun Shyue
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Bei-Chia Guo
- Department of Physiology, Genome Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tse-Min Lu
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzong-Shyuan Lee
- Department of Physiology, Genome Research Center, National Yang-Ming University, Taipei, Taiwan
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