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Xun T, Rong Y, Lv B, Tian J, Zhang Q, Yang X. Interaction and potential mechanisms between atorvastatin and voriconazole, agents used to treat dyslipidemia and fungal infections. Front Pharmacol 2023; 14:1165950. [PMID: 37251310 PMCID: PMC10213937 DOI: 10.3389/fphar.2023.1165950] [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: 02/14/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose: Voriconazole (VOR) is combined with atorvastatin (ATO) to treat fungal infections in patients with dyslipidemia in clinical practice. However, the pharmacokinetic interactions and potential mechanisms between them are unknown. Therefore, this study aimed to investigate the pharmacokinetic interactions and potential mechanisms between ATO and VOR. Patients and methods: We collected plasma samples from three patients using ATO and VOR. Rats were administered either VOR or normal saline for 6 days, followed by a single dose of 2 mg/kg ATO, and then plasma samples were collected at different time points. The incubation models of human liver microsomes or HepG2 cells were constructed in vitro. A high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) system was developed to determine the concentration of ATO, 2-hydroxy-ATO, 4-hydroxy-ATO, and VOR. Results: In patients, VOR significantly reduced the metabolism of ATO and slowed the formation of 2-hydroxy- and 4-hydroxy-ATO. In rats pretreated with orally administered VOR for 6 days or normal saline given a single dose of 2 mg/kg ATO administered orally on Day 6, the t1/2 of ATO was significantly prolonged from 3.61 to 6.43 h, and the area under the concentration-time curve (AUC0-24h) values of ATO increased from 53.86 to 176.84 h μg.L-1. However, the pharmacokinetic parameters of VOR (20 mg/kg) with or without pretreatment with ATO (2 mg/kg) only slightly changed. In vitro studies indicated that VOR inhibited the metabolism of ATO and testosterone, and the IC50 values were 45.94 and 49.81 μM. However, no significant change in transporter behaviors of ATO was observed when VOR or transporter inhibitors were co-administered. Conclusion: Our study demonstrated that VOR has significant interactions with ATO, probably due to VOR's inhibition of the CYP3A4-mediated metabolism of ATO. Based on the clinical cases and potential interactions, the basic data obtained in our study are expected to help adjust the dose of ATO and promote the design of rational dosage regimens for pharmacotherapy for fungal infections in patients with dyslipidemia.
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Affiliation(s)
- Tianrong Xun
- Department of Pharmacy, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Yan Rong
- Department of Pharmacy, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Bin Lv
- Department of Pharmacy, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Jinfei Tian
- Department of Pharmacy, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Qing Zhang
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xixiao Yang
- Department of Pharmacy, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
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Liu Q, Dong S, Zhou X, Zhao Y, Dong B, Shen J, Yang K, Li L, Zhu D. Effects of Long-Term Intervention with Losartan, Aspirin and Atorvastatin on Vascular Remodeling in Juvenile Spontaneously Hypertensive Rats. Molecules 2023; 28:molecules28041844. [PMID: 36838830 PMCID: PMC9965824 DOI: 10.3390/molecules28041844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Hypertension in adolescents is associated with adverse cardiac and vascular events. In addition to lowering blood pressure, it is not clear whether pharmacological therapy in early life can improve vascular remodeling. This study aimed to evaluate the effects of long-term administration of losartan, aspirin, and atorvastatin on vascular remodeling in juvenile spontaneously hypertensive rats (SHRs). Losartan, aspirin, and atorvastatin were administered via gavage at doses of 20, 10, and 10 mg/kg/day, respectively, on SHRs aged 6-22 weeks. Paraffin sections of the blood vessels were stained with hematoxylin-eosin (H&E) and Sirius Red to evaluate the changes in the vascular structure and the accumulation of different types of collagen. The plasma levels of renin, angiotensin II (Ang II), aldosterone (ALD), endothelin-1 (ET-1), interleukin-6 (IL-6), and neutrophil elastase (NE) were determined using ELISA kits. After the 16-week treatment with losartan, aspirin, and atorvastatin, the wall thickness of the thoracic aorta and carotid artery decreased. The integrity of the elastic fibers in the tunica media was maintained in an orderly manner, and collagen deposition in the adventitia was retarded. The plasma levels of renin, ALD, ET-1, IL-6, and NE in the SHRs also decreased. These findings suggest that losartan, aspirin, and atorvastatin could improve vascular remodeling beyond their antihypertensive, anti-inflammatory, and lipid-lowering effects. Many aspects of the protection provided by pharmacological therapy are important for the prevention of cardiovascular diseases in adults and older adults.
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Affiliation(s)
- Qi Liu
- School of Pharmacy, Minzu University of China, Beijing 100081, China
| | - Shuai Dong
- School of Pharmacy, Minzu University of China, Beijing 100081, China
| | - Xue Zhou
- Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu 610041, China
| | - Yubo Zhao
- School of Pharmacy, Minzu University of China, Beijing 100081, China
| | - Bin Dong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Core Laboratory, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jing Shen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Core Laboratory, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Kang Yang
- School of Pharmacy, Minzu University of China, Beijing 100081, China
| | - Linsen Li
- School of Pharmacy, Minzu University of China, Beijing 100081, China
- Correspondence: (L.L.); (D.Z.); Tel.: +86-158-1089-2058 (D.Z.)
| | - Dan Zhu
- School of Pharmacy, Minzu University of China, Beijing 100081, China
- Correspondence: (L.L.); (D.Z.); Tel.: +86-158-1089-2058 (D.Z.)
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Zhou YF, Wang Y, Wang G, Zhou Z, Chen S, Geng T, Zhang YB, Wang Y, Chen JX, Pan A, Wu S. Association Between Statin Use and Progression of Arterial Stiffness Among Adults With High Atherosclerotic Risk. JAMA Netw Open 2022; 5:e2218323. [PMID: 35713899 PMCID: PMC9206193 DOI: 10.1001/jamanetworkopen.2022.18323] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Limited studies have investigated the association between statin use and progression of arterial stiffness, a key player in the pathophysiology of cardiovascular disease. OBJECTIVE To examine the association between statin use and progression of arterial stiffness in Chinese adults with high atherosclerotic risk measured by brachial-ankle pulse wave velocity (baPWV). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study enrolled 5105 adults with high atherosclerotic risk from the Kailuan General Hospital from 2010 to 2020. Data were analyzed from February 2021 to April 2022. EXPOSURES Statin use information was retrieved from electronic medical records from 2010 to 2020, and statin users were those who have been prescribed any statin medications at least 6 months before baPWV measurements. Statin users were 1:1 matched with non-statin users by propensity score method. MAIN OUTCOMES AND MEASURES Progression of baPWV was assessed using the absolute difference between baseline and follow-up baPWV, divided by the follow-up time in years. Multivariable linear regression models were used to estimate the association between statin use and arterial stiffness. RESULTS Among 5105 adults with assessment of baPWV (mean [SD] age: 60.8 [9.7] years; 3842 [75.3%] men and 1263 [24.7%] women), 1310 statin users were matched with 1310 non-statin users (mean [SD] age, 63.2 [9.3] years). Compared with non-statin users, statin users were associated with significantly lower baPWV at baseline (difference: -33.6 cm/s; 95% CI, -62.1 to -5.1 cm/s). Among 1502 adults with repeated assessment of baPWV, 410 statin users were matched with 410 non-statin users (mean [SD] age, 62.9 [9.2] years). Compared with non-statin users, statin users had significantly slower progression of baPWV (difference, -23.3 cm/s per year; 95% CI, -40.6 to -6.0 cm/s per year) during a mean (SD) follow-up of 4.8 (2.7) years. A significantly slower progression of baPWV was observed in continuous statin users (difference, -24.2 cm/s per year; 95% CI, -42.2 to -6.3 cm/s per year) and high adherent users (difference, -39.7 cm/s per year; 95% CI, -66.9 to -12.4 cm/s per year), but not in discontinued users (difference, -17.3 cm/s per year; 95% CI, -52.4 to 17.8 cm/s per year) and low adherent users (difference, -17.9 cm/s per year; 95% CI, -36.5 to 0.7 cm/s per year), compared with non-statin users. CONCLUSIONS AND RELEVANCE In this cohort study, statin use was associated with slower progression of arterial stiffness in Chinese adults with high atherosclerotic risk.
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Affiliation(s)
- Yan-Feng Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanxiu Wang
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Guodong Wang
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Tingting Geng
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan-Bo Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun-Xiang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
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Ren S, Hansbro PM, Srikusalanukul W, Horvat JC, Hunter T, Brown AC, Peel R, Faulkner J, Evans TJ, Li SC, Newby D, Hure A, Abhayaratna WP, Tsimikas S, Gonen A, Witztum JL, Attia J, Hansbro PM, Peel R, Srikusalanukul W, Abhayaratna W, Newby D, Hure A, D'Este C, Tonkin A, Hopper I, Thrift A, Levi C, Sturm J, Durrheim D, Hung J, Briffa T, Chew D, Anderson P, Moon L, McEvoy M, Attia J. Generation of cardio-protective antibodies after pneumococcal polysaccharide vaccine: Early results from a randomised controlled trial. Atherosclerosis 2022; 346:68-74. [PMID: 35290813 DOI: 10.1016/j.atherosclerosis.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND AIMS Observational studies have demonstrated that the pneumococcal polysaccharide vaccine (PPV) is associated with reduced risk of cardiovascular events. This may be mediated through IgM antibodies to OxLDL, which have previously been associated with cardioprotective effects. The Australian Study for the Prevention through Immunisation of Cardiovascular Events (AUSPICE) is a double-blind, randomised controlled trial (RCT) of PPV in preventing ischaemic events. Participants received PPV or placebo once at baseline and are being followed-up for incident fatal and non-fatal myocardial infarction or stroke over 6 years. METHODS A subgroup of participants at one centre (Canberra; n = 1,001) were evaluated at 1 month and 2 years post immunisation for changes in surrogate markers of atherosclerosis, as pre-specified secondary outcomes: high-sensitive C-reactive protein (CRP), pulse wave velocity (PWV), and carotid intima-media thickness (CIMT). In addition, 100 participants were randomly selected in each of the intervention and control groups for measurement of anti-pneumococcal antibodies (IgG, IgG2, IgM) as well as anti-OxLDL antibodies (IgG and IgM to CuOxLDL, MDA-LDL, and PC-KLH). RESULTS Concentrations of anti-pneumococcal IgG and IgG2 increased and remained high at 2 years in the PPV group compared to the placebo group, while IgM increased and then declined, but remained detectable, at 2 years. There were statistically significant increases in all anti-OxLDL IgM antibodies at 1 month, which were no longer detectable at 2 years; there was no increase in anti-OxLDL IgG antibodies. There were no significant changes in CRP, PWV or CIMT between the treatment groups at the 2-year follow-up. CONCLUSIONS PPV engenders a long-lasting increase in anti-pneumococcal IgG, and to a lesser extent, IgM titres, as well as a transient increase in anti-OxLDL IgM antibodies. However, there were no detectable changes in surrogate markers of atherosclerosis at the 2-year follow-up. Long-term, prospective follow-up of clinical outcomes is continuing to assess if PPV reduces CVD events.
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Affiliation(s)
- Shu Ren
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Philip M Hansbro
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia; Centenary UTS Centre for Inflammation, Sydney, NSW, Australia
| | - Wichat Srikusalanukul
- Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia
| | - Jay C Horvat
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Tegan Hunter
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Alexandra C Brown
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Roseanne Peel
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia.
| | - Jack Faulkner
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | | | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - David Newby
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Alexis Hure
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Walter P Abhayaratna
- Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia
| | - Sotirios Tsimikas
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Ayelet Gonen
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Joseph L Witztum
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia; Department of Medicine, John Hunter Hospital, Newcastle, NSW, Australia.
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Saeed S, Holm H, Nilsson PM. Ventricular-arterial coupling: definition, pathophysiology and therapeutic targets in cardiovascular disease. Expert Rev Cardiovasc Ther 2021; 19:753-761. [PMID: 34252318 DOI: 10.1080/14779072.2021.1955351] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The heart and arterial system are equally affected by arteriosclerosis/atherosclerosis. There is a constant interaction between the left ventricular (LV) function and the arterial system, termed ventricular-arterial coupling (VAC), which reflects the global cardiovascular efficiency. VAC is traditionally assessed by echocardiography as the ratio of effective arterial elastance (Ea) over end-systolic elastance (Ees) (Ea/Ees). However, the concept of VAC is evolving and new methods have been proposed such as the ratio of pulse wave velocity (PWV) to global longitudinal strain (GLS) and myocardial work index. AREA COVERED This clinical review presents the hemodynamic background of VAC, its clinical implications and the impact of therapeutic interventions to normalize VAC. The review also summarizes the detrimental effects of cardio-metabolic risk factors on the aorta and LV, and provides an update on arterial load and its impact on LV function. The narrative review is based upon a systemic search of the bibliographic database PubMed for publications on VAC. EXPERT OPINION Newer methods such as PWV/GLS-ratio may be a superior marker of VAC than the traditional echocardiographic Ea/Ees in predicting target organ damage and its association with clinical outcomes. Novel anti-diabetic drugs and optimal antihypertensive treatment may normalize VAC in high-risk patients.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Hannes Holm
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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Turgutkaya A, Aşçı G. The association between Hba1c and arterial stiffness among non-diabetic patients with chronic kidney disease. J Vasc Bras 2021; 20:e20200245. [PMID: 34211541 PMCID: PMC8218830 DOI: 10.1590/1677-5449.200245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Cardiovascular events are seen more frequently after the age of 60 and they are a significant cause of morbidity and mortality. Arterial stiffness is a property that can be expressed by pulse wave velocity and this value is assumed to be a predictor of cardiovascular events. Patients with chronic kidney disease and dysregulated blood sugar have increased atherosclerosis and arterial stiffness, but the relationship between physiological levels of Hba1c and arterial stiffness is less clear in chronic kidney disease patients without diabetes mellitus. Objectives Here, we aimed to investigate the degree of arterial stiffness among non-diabetic, non-dialysis dependent chronic kidney disease patients with physiological HbA1c levels. Methods We enrolled 51 patients who were followed up at Ege University Hospital Nephrology Department between February and June 2015. Non-diabetic, non-dialysis dependent chronic kidney disease patients were included in the study. Blood pressure and pulse wave velocity were measured with an applanation tonometry device (Sphygmocor Vx Software Atcor Medical, Australia). Correlations between pulse wave velocity and the aforementioned parameters were investigated (see below). Results We detected a significant correlation between pulse wave velocity and systolic blood pressure (p=0.0001) and Hba1c (p=0.044) separately. There was an inverse correlation with creatinine clearance (p=0.04). We also detected a significant correlation with serum phosphorus level (p=0.0077) and furosemide use (p=0.014). No correlations were found among the other parameters. Conclusions Arterial stiffness is an important predictor of cardiovascular events and measuring it is an inexpensive method for estimating morbidity and mortality. Our study supports the importance of measuring arterial stiffness and of controlling blood glucose levels, even at physiological Hba1c values, especially for chronic kidney disease patients.
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Affiliation(s)
- Atakan Turgutkaya
- Adnan Menderes University - ADÜ, Hematology Department, Aydın, Turkey
| | - Gülay Aşçı
- Ege University - EÜTF, Ege University Hospital, Bornova, İzmir, Turkey
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Beneficial Effect of Statin Therapy on Arterial Stiffness. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5548310. [PMID: 33860033 PMCID: PMC8026295 DOI: 10.1155/2021/5548310] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/01/2021] [Accepted: 03/17/2021] [Indexed: 12/13/2022]
Abstract
Arterial stiffness describes the increased rigidity of the arterial wall that occurs as a consequence of biological aging and several diseases. Numerous studies have demonstrated that parameters to assess arterial stiffness, especially pulse-wave velocity, are predictive of those individuals that will suffer cardiovascular morbidity and mortality. Statin therapy may be a pharmacological strategy to improve arterial elasticity. It has been shown that the positive benefits of statin therapy on cardiovascular disease is attributable not only to their lipid-lowering capacity but also to various pleiotropic effects, such as their anti-inflammatory, antiproliferative, antioxidant, and antithrombotic properties. Additionally, statins reduce endothelial dysfunction, improve vascular and myocardial remodeling, and stabilize atherosclerotic plaque. The aim of the present review was to summarize the evidence from human studies showing the effects of statins on arterial stiffness.
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Cavero-Redondo I, Deeks JJ, Alvarez-Bueno C, Jolly K, Saz-Lara A, Price M, Pascual-Morena C, Martínez-Vizcaíno V. Comparative effect of physical exercise versus statins on improving arterial stiffness in patients with high cardiometabolic risk: A network meta-analysis. PLoS Med 2021; 18:e1003543. [PMID: 33591983 PMCID: PMC7924736 DOI: 10.1371/journal.pmed.1003543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/02/2021] [Accepted: 01/22/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The comparative analysis of the effect of several doses of statins against different intensities of physical exercise on arterial stiffness (a measure of cardiovascular risk) could shed light for clinicians on which method is most effective in preventing cardiovascular disease (CVD) and be used to inform shared decision-making between doctors and patients. This study was aimed at analyzing the effect, in high cardiometabolic risk patients, of different statins doses and exercise intensities on arterial stiffness (a measure of cardiovascular risk) by integrating all available direct and indirect evidence in network meta-analyses. METHODS AND FINDINGS We systematically searched MEDLINE, Embase, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases from their inception to February 28, 2020; for unpublished trials, we also searched ClinicalTrials.gov. We searched for studies concerning the effect of statins or physical exercise on arterial stiffness, measured by pulse wave velocity (PWV). For methodological quality assessment, Cochrane Collaboration's tool for assessing risk of bias (RoB2) was used. A network geometry graph was used to assess the strength of the evidence. Comparative evaluation of the interventions effect was performed by conducting a standard pairwise meta-analysis and a network meta-analysis (NMA) for direct and indirect comparisons between interventions and control/nonintervention. A total of 22 studies were included in the analyses (18 randomized controlled trials (RCTs) and 4 nonrandomized experimental studies), including 1,307 patients with high cardiometabolic risk from Asia (3 studies), Oceania (2 studies), Europe (10 studies), North America (5 studies), and South America (2 studies). The overall risk of bias assessed with RoB2 was high in all included studies. For standard pairwise meta-analysis and NMA, high-intensity exercise versus control (mean difference (MD) -0.56; 95% CI: -1.01, -0.11; p = 0.015 and -0.62; 95% CI: -1.20, -0.04; p = 0.038, respectively) and moderate statin dose versus control (MD -0.80, 95% CI: -1.59, -0.01; p = 0.048 and -0.73, 95% CI: -1.30, -0.15; p = 0.014, respectively) showed significant MDs. When nonrandomized experimental studies were excluded, the effect on high-intensity exercise versus control and moderate statin dose versus was slightly modified. The main limitation of this study was that the magnitude of the effect of the exercise interventions could be underestimated due to regression toward the mean bias because the baseline cardiometabolic risk profile of patients in the physical exercise intervention trials was healthier than those in the statins ones; consequently, more modest improvements in physical exercise interventions compared to statins interventions can be expected. Additionally, we might consider as limitations the small study sizes, the heterogeneous patient groups, the focus on a proxy endpoint (PWV), and the high risk of bias. CONCLUSIONS In this NMA, we found that although many patients could benefit from statins for reducing CVD risk, our results support that, considering the beneficial effects of high-intensity exercise on arterial stiffness, it would be worthwhile to refocus our attention on this type of exercise as an effective tool for the prevention of CVD. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019123120.
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Affiliation(s)
- Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Celia Alvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Alicia Saz-Lara
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Malcolm Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | | | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
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Tentolouris A, Eleftheriadou I, Tzeravini E, Tsilingiris D, Paschou SA, Siasos G, Tentolouris N. Endothelium as a Therapeutic Target in Diabetes Mellitus: From Basic Mechanisms to Clinical Practice. Curr Med Chem 2020; 27:1089-1131. [PMID: 30663560 DOI: 10.2174/0929867326666190119154152] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/28/2018] [Accepted: 01/09/2019] [Indexed: 12/12/2022]
Abstract
Endothelium plays an essential role in human homeostasis by regulating arterial blood pressure, distributing nutrients and hormones as well as providing a smooth surface that modulates coagulation, fibrinolysis and inflammation. Endothelial dysfunction is present in Diabetes Mellitus (DM) and contributes to the development and progression of macrovascular disease, while it is also associated with most of the microvascular complications such as diabetic retinopathy, nephropathy and neuropathy. Hyperglycemia, insulin resistance, hyperinsulinemia and dyslipidemia are the main factors involved in the pathogenesis of endothelial dysfunction. Regarding antidiabetic medication, metformin, gliclazide, pioglitazone, exenatide and dapagliflozin exert a beneficial effect on Endothelial Function (EF); glimepiride and glibenclamide, dipeptidyl peptidase-4 inhibitors and liraglutide have a neutral effect, while studies examining the effect of insulin analogues, empagliflozin and canagliflozin on EF are limited. In terms of lipid-lowering medication, statins improve EF in subjects with DM, while data from short-term trials suggest that fenofibrate improves EF; ezetimibe also improves EF but further studies are required in people with DM. The effect of acetylsalicylic acid on EF is dose-dependent and lower doses improve EF while higher ones do not. Clopidogrel improves EF, but more studies in subjects with DM are required. Furthermore, angiotensin- converting-enzyme inhibitors /angiotensin II receptor blockers improve EF. Phosphodiesterase type 5 inhibitors improve EF locally in the corpus cavernosum. Finally, cilostazol exerts favorable effect on EF, nevertheless, more data in people with DM are required.
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Affiliation(s)
- Anastasios Tentolouris
- Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Eleftheriadou
- Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Evangelia Tzeravini
- Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Dimitrios Tsilingiris
- Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Stavroula A Paschou
- Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Gerasimos Siasos
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nikolaos Tentolouris
- Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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Pulse wave velocity can be accurately measured during transcatheter aortic valve implantation and used for post-procedure risk stratification. J Hypertens 2019; 37:1845-1852. [DOI: 10.1097/hjh.0000000000002141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Birdsall JW, Schmitz SL, Abosi OJ, DuBose LE, Pierce GL, Fiedorowicz JG. Inflammatory and vascular correlates of mood change over 8 weeks. HEART AND MIND 2019; 3:47-54. [PMID: 32529166 DOI: 10.4103/hm.hm_24_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Mood disorders have been associated with a variety of cardiovascular disease risk factors, including inflammation and large artery stiffness, particularly while depressed although longitudinal studies have been limited. Methods With measurements at baseline and 8 weeks, the researchers prospectively assessed mood, levels of inflammatory markers (hsCRP and TNF-α), serum lipids, and large artery stiffness in a cohort of 26 participants with a diagnosis of a mood disorder, enriched for current depression. Depressive symptoms were measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) at baseline and 8 weeks. Associations between depressive symptoms and other measures were assessed using linear mixed models, unadjusted and adjusted for age and BMI. Results The mean age of the participants (n=26) was 41.6 (standard deviation [SD] 12.8) years, and 81% were female. During the study, there was a mean (SD) MADRS score improvement of 9.5 (9.4) from baseline to eight weeks. Reductions in the primary outcome TNF-α with improvement in depression fell short of significance (P=0.076). In secondary analyses, there was a statistically significant association between improved cholesterol ratio (P=0.038) and triglycerides (P=0.042) with depression improvement. There was no statistically significant change in large artery stiffness during the study. Conclusion Improved depressive symptoms were associated with improved cholesterol ratios even after adjustment, suggesting possible mechanism by which acute mood states may influence cardiovascular disease risk. Future longitudinal studies with extended and intensive follow-up investigating cardiovascular disease risk related to acute changes and persistence of mood symptoms is warranted.
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Affiliation(s)
- Jonathan W Birdsall
- Department of Psychiatry, The University of Iowa, Iowa City, Iowa, 52242.,Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, 52242
| | - Samantha L Schmitz
- Department of Psychiatry, The University of Iowa, Iowa City, Iowa, 52242
| | - Oluchi J Abosi
- Department of Psychiatry, The University of Iowa, Iowa City, Iowa, 52242.,Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, 52242
| | - Lyndsey E DuBose
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa, 52242
| | - Gary L Pierce
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa, 52242.,François M. Abboud Cardiovascular Research Center, The University of Iowa, Iowa City, Iowa, 52242
| | - Jess G Fiedorowicz
- Department of Psychiatry, The University of Iowa, Iowa City, Iowa, 52242.,Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, 52242.,Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, 52242.,François M. Abboud Cardiovascular Research Center, The University of Iowa, Iowa City, Iowa, 52242.,Department of Internal Medicine, The University of Iowa, Iowa City, Iowa, 52242.,Iowa Neuroscience Institute, Obesity Research and Education Initiative, The University of Iowa, Iowa City, Iowa, 52242
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吕 斌, 寻 添, 吴 树, 占 霞, 荣 艳, 张 庆, 杨 西. [Interaction between atorvastatin and voriconazole in rat plasma: a HPLC-MS/MS-based study]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:337-343. [PMID: 31068304 PMCID: PMC6765680 DOI: 10.12122/j.issn.1673-4254.2019.03.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To develop a high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method for simultaneous determination of atorvastatin and voriconazole in rat plasma and investigate the pharmacokinetics of atorvastatin and the changes in voriconazole concentration in rats after administration. METHODS Plasma samples were collected from rats after intragastric administration of atorvastatin alone or in combination with voriconazole. The samples were treated with sodium acetate acidification, and atorvastatin and voriconazole in the plasma were extracted using a liquidliquid extraction method with methyl tert-butyl ether as the extractant. The extracts were then separated on a Thermo Hypersil Gold C18 (2.1×100 mm, 1.9 μm) column within 6 min with gradient elution using acetonitrile and water (containing 0.1% formic acid) as the mobile phase; mass spectrometry detection was achieved in selective reaction monitoring (SRM) mode under the positive ion scanning mode of heated electrospray ion source (H-ESI) and using transition mass of m/z 559.2→440.2 for atorvastatin and m/z 350→280 for voriconazole, with m/z370.2→252 for lansoprazole (the internal standard) as the quantitative ion. RESULTS The calibration curves were linear within the concentration range of 0.01-100 ng/mL (r=0.9957) for atorvastatin and 0.025-100 ng/mL (r=0.9966) for voriconazole. The intra-day and inter-day precisions were all less than 13%, and the recovery was between 66.50% and 82.67%; the stability of the plasma samples met the requirements of testing. The AUC0-24 h of atorvastatin in rat plasma after single and combined administration was 438.78±139.61 and 927.43±204.12 h·μg·L-1, CLz/F was 23.89±8.14 and 10.43±2.58 L·h-1·kg-1, Cmax was 149.62±131.10 and 159.37±36.83 μg/L, t1/2 was 5.08±1.63 and (5.58±2.11 h, and Tmax was 0.37±0.14 and 3.60±1.52 h, respectively; AUC0-24 h, CLZ/F and Tmax of atorvastatin in rat plasma differed significantly between single and combined administration. The HPLC-MS/MS system also allowed simultaneous determination of voriconazole concentration in rat plasma after combined administration. CONCLUSIONS The HPLC-MS/MS system we established in this study is simple, rapid and sensitive and allows simultaneous determination of atorvastatin and voriconazole in rat plasma. Some pharmacokinetic parameters of atorvastatin are changed in the presence of voriconazole, and their clinical significance needs further investigation.
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Affiliation(s)
- 斌 吕
- 南方医科大学 南方医院药学部, 广东 广州 510515Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 添荣 寻
- 南方医科大学 南方医院药学部, 广东 广州 510515Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 树龙 吴
- 深圳医院 药剂科, 广东 深圳 518100Department of Pharmacy, Shenzhen Hospital Affiliated to Southern Medical University, Shenzhen 518100, China
| | - 霞 占
- 南方医科大学 南方医院药学部, 广东 广州 510515Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 艳 荣
- 深圳医院 呼吸科, 广东 深圳 518100Department of Respiratory, Shenzhen Hospital Affiliated to Southern Medical University, Shenzhen 518100, China
| | - 庆 张
- 南方医科大学 南方医院药学部, 广东 广州 510515Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 西晓 杨
- 南方医科大学 南方医院药学部, 广东 广州 510515Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
- 深圳医院 药剂科, 广东 深圳 518100Department of Pharmacy, Shenzhen Hospital Affiliated to Southern Medical University, Shenzhen 518100, China
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