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Rupasinghe CD, Kantas T, Sani R, Avendaño Capriles NM, dadabhoy R, Gul A, Avendaño Capriles CA, Khurshid Ahmed N, Tousif S. Comparison of High-Statin Therapy vs Moderate-Statin Therapy in Achieving Positive Low-Density Lipoprotein Change in Patients After Acute Coronary Syndrome: A Randomized-Control Trial. Cureus 2021; 13:e20710. [PMID: 35106245 PMCID: PMC8788888 DOI: 10.7759/cureus.20710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: Statin use in secondary prevention after acute coronary syndrome (ACS) can play an important role in enhancing clinical outcomes, this has been proven in several randomized trials. This study was conducted to compare the efficacy of moderate-intensity and high-intensity statins in controlling low-density lipoprotein (LDL) after ACS. Methodology: A randomized control trial was conducted at the Cardiology Department of Liaquat National Hospital, Karachi, Pakistan, from July 2020 to September 2021. During admission, patients were either started on a high-intensity statin dose (rosuvastatin 20 mg) or moderate-intensity statin (rosuvastatin 10 mg) by a computer-generated allocation sequence. Patients were followed-up in the outpatient department (OPD) after 3 months, and a lipid profile at follow-up was obtained. The percentage of LDL change was determined on 3 months of follow-up. Results: A total of 590 patients were enrolled in the study. Out of all participants enrolled, 334 (80.48%) completed the 3-month follow-up. The mean age of participants was 58.08 (+12.06) years. High-intensity statin therapy is positively associated with positive LDL change (adjusted odds ratio [AOR]=4.45, P-value=0.001). Conclusion: Our data implies that high-intensity statin medication may be an initial therapeutic option to decrease LDL. However, future randomized clinical trials should corroborate these findings.
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Hirono K, Takarada S, Okabe M, Miyao N, Nakaoka H, Ibuki K, Ozawa S, Origasa H, Ichida F, Imanaka-Yoshida K. Clinical significance of chronic myocarditis: systematic review and meta-analysis. Heart Vessels 2021; 37:300-314. [PMID: 34365565 DOI: 10.1007/s00380-021-01914-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
Chronic myocarditis is a prolonged inflammatory condition in the myocardium and its histological manifestation is defined by the presence of an inflammatory infiltrate. Chronic myocarditis has not been well known and its treatment of chronic myocarditis has not been established. Primary outcome of this study was to assess the efficacy of immunomodulatory treatment in addition to conventional treatment, and secondary outcomes were to clarity the prognosis of natural history of chronic myocarditis and incidence of chronic myocarditis in patients with dilated cardiomyopathy (DCM). We searched for studies in Medline, Embase, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi published between January 1946 and June 2020. Sixteen studies met the inclusion criteria. A meta-analysis revealed that patients receiving immunomodulatory treatment showed an improvement in left ventricular ejection fraction after immunomodulatory treatment compared to the control group (hazard ratio, 16.65; confidence interval, 4.55-28.74; p = 0.007). Five-year survival rate of the patients with inflammatory DCM (iDCM) and DCM was 52.7-70.3% and 51.9-91.1%, respectively. Moreover, 51.5%-62.7% of patients with DCM met the criteria of iDCM. Our systematic review revealed that patients with chronic myocarditis had poor prognosis and immunomodulatory treatment was significantly effective in addition to conventional treatment.
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Affiliation(s)
- Keiichi Hirono
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.
| | - Shinya Takarada
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Mako Okabe
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Nariaki Miyao
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Hideyuki Nakaoka
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Keijiro Ibuki
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Sayaka Ozawa
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Hideki Origasa
- Biostatistics and Clinical Epidemiology, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health&Welfare, Tokyo, Japan
| | - Kyoko Imanaka-Yoshida
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Mie, Japan
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Experimental evidence and network pharmacology-based analysis reveal the molecular mechanism of Tongxinluo capsule administered in coronary heart diseases. Biosci Rep 2021; 40:226543. [PMID: 32990315 PMCID: PMC7560518 DOI: 10.1042/bsr20201349] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Tongxinluo (TXL) capsule, a polypharmacy derived from traditional Chinese medicine (TCM), has been widely used in coronary heart disease (CHD), while the underlying mechanism of TXL capsule is still unclear. The present study aimed at investigating the underlying mechanism of TXL acting on CHD patients and providing substantial evidence in molecular evidence by means of a network pharmacological analysis. METHOD Active compounds and targeted genes of TXL were retrieved from TCM systems pharmacology (TCMSP) and TCM integrative database (TCMID). CHD and coronary artery disease were treated as search queries in GeneCards and Online Mendelian Inheritance in Man (OMIM) databases to obtain disease-related genes. Visualization of disease-targets network was performed under administration of Cytoscape software. Besides, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were administered. H9c2 cells were used to validate the predicted results in cardiomyocytes/reoxygenation model, and anti-inflammatory ability was examined. RESULTS A network of a total of 212 nodes and 1016 edges was obtained. Peptide and ubiquitin-like protein ligase binding occupied a leading position of GO enrichment. For KEGG analysis, fluid shear stress and atherosclerosis, as well as inflammation-related pathways were enriched. Cellular validation revealed the anti-inflammatory effect of β-sitosterol, eriodictyol, odoricarpin, and tirucallol as active compounds of TXL. CONCLUSION Our study provided substantial molecular evidence that TXL capsule possessed the characteristics of multitargets with safe profile, and the main component is capable of regulating cytokine level in CHD patients.
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Park MW, Park GM, Han S, Yang Y, Kim YG, Roh JH, Park HW, Suh J, Cho YR, Won KB, Ann SH, Kim SJ, Kim DW, Her SH, Lee SG. Moderate-intensity versus high-intensity statin therapy in Korean patients with angina undergoing percutaneous coronary intervention with drug-eluting stents: A propensity-score matching analysis. PLoS One 2018; 13:e0207889. [PMID: 30532220 PMCID: PMC6286068 DOI: 10.1371/journal.pone.0207889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/07/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES It is unclear whether high-intensity statin therapy provides incremental clinical benefits over moderate-intensity statin therapy in Asian patients with angina. This study sought to compare the clinical outcomes of moderate- and high-intensity statin therapies in patients undergoing percutaneous coronary intervention (PCI) for angina in Korean patients. METHODS Based on the national health insurance claims data in South Korea, patients aged 18 years or older without a known history of coronary artery disease, who underwent PCI with drug-eluting stents due to angina between 2011 and 2015, were enrolled. According to the intensity of statin therapy, patients were categorized into moderate-intensity statin therapy (n = 23,863) and high-intensity statin therapy (n = 9,073) groups. The primary endpoint, defined as a composite of all-cause death and myocardial infarction, was compared between the two groups using a propensity-score matching analysis. RESULTS During the follow-up period (median, 2.0 years; interquartile range, 1.1-3.1), 1,572 patients had 1,367 deaths and 242 myocardial infarctions. After propensity-score matching, there were 8,939 matched pairs. There was no significant difference in the incidence of the primary endpoint between the two groups (adjusted hazard ratio of high-intensity statin therapy, 1.093; 95% confidence interval: 0.950-1.259; p = 0.212). CONCLUSIONS In Korean patients undergoing PCI with drug-eluting stents for angina, the high-intensity statin therapy did not provide additional clinical benefits over the moderate-intensity statin therapy.
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Affiliation(s)
- Mahn-Won Park
- Department of Cardiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Gyung-Min Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- * E-mail: (GMP); (SH)
| | - Seungbong Han
- Department of Applied Statistics, Gachon University, Seongnam, Korea
- * E-mail: (GMP); (SH)
| | - Yujin Yang
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yong-Giun Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jae-Hyung Roh
- Department of Cardiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyun Woo Park
- Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon, Korea
| | - Jon Suh
- Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon, Korea
| | - Young-Rak Cho
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Ki-Bum Won
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soe Hee Ann
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Shin-Jae Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dae-Won Kim
- Department of Cardiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Sung Ho Her
- Department of Cardiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Sang-Gon Lee
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Inhibition of plaque progression and promotion of plaque stability by glucagon-like peptide-1 receptor agonist: Serial in vivo findings from iMap-IVUS in Watanabe heritable hyperlipidemic rabbits. Atherosclerosis 2017; 265:283-291. [PMID: 28693828 DOI: 10.1016/j.atherosclerosis.2017.06.920] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/28/2017] [Accepted: 06/22/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Glucagon-like peptide-1 (GLP-1) is thought to inhibit development of aortic atherosclerosis and plaque formation. However, whether GLP-1 stabilizes fully developed atherosclerotic plaque or alters the complicated plaque composition remains unclarified. METHODS Ten Watanabe heritable hyperlipidemic (WHHL) rabbits were divided into GLP-1 receptor agonist treatment group and control group. After confirmation of atherosclerotic plaques in brachiocephalic arteries by iMap intravascular ultrasound (iMAP-IVUS), GLP-1 receptor agonist lixisenatide was administered to WHHL rabbits at 30 nmoL/kg/day for 12 weeks by osmotic pump. An equal volume of normal saline was administered in a control group. After evaluation by iMAP-IVUS at 12 weeks, brachiocephalic arteries were harvested for pathological histological analysis. RESULTS iMAP-IVUS analysis revealed larger fibrotic plaque components and smaller necrotic and calcified plaque components in the GLP-1 group than in the control group; %fibrotic area: 66.30 ± 2.06% vs. 75.14 ± 2.62%, p < 0.01, %necrotic area: 23.25 ± 1.87% vs. 16.17 ± 2.27%, p = 0.02, %calcified area: 2.15 ± 0.24% vs. 1.00 ± 0.18%, p < 0.01), indicating that GLP-1 receptor agonist might modify plaque composition and increase plaque stability. Histological analysis confirmed that GLP-1 receptor agonist treatment improved smooth muscle cell (SMC)-rich plaque with increased fibrotic content. Furthermore, plaque macrophage infiltration and calcification were significantly reduced by GLP-1 receptor agonist treatment; %SMC area: 6.93 ± 0.31% vs. 8.14 ± 0.48%, p = 0.02; %macrophage area: 9.11 ± 0.80% vs. 6.19 ± 0.85%, p < 0.01; %fibrotic area: 54.75 ± 1.63% vs. 69.60 ± 2.12%, p = 0.02; %calcified area: 3.25 ± 0.67% vs. 0.75 ± 0.15%, p = 0.02). CONCLUSIONS GLP-1 receptor agonist inhibited plaque progression and promoted plaque stabilization by inhibiting plaque growth and modifying plaque composition.
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Kim NH, So MS, Kang JG, Cho DS, Byrne CD, Lee SJ, Sung KC. Application of new guidelines for the primary prevention of atherosclerotic cardiovascular disease in a Korean population. J Atheroscler Thromb 2014; 22:293-303. [PMID: 25284329 DOI: 10.5551/jat.26682] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM We investigated the proportion of people who would qualify for statin treatment with an atherosclerotic cardiovascular disease (ASCVD) 10-year risk of ≥7.5% and who exhibit an LDL cholesterol (LDL-C) of 70 to 189 mg/dL according to the new ACC/AHA guidelines for the treatment of increased cardiovascular risk. METHODS The study population (8,742 subjects) included individuals who underwent health examinations at Kangbuk Samsung Hospital in South Korea in 2010. We also evaluated the data obtained from the 2008-2010 Korea National Health and Nutrition Examination Survey (KNHANES) of 16,892 adults. RESULTS Approximately 90% of men ≥60 years of age and women ≥70 years of age had an ASCVD 10-year risk of ≥7.5% and LDL-C level of ≥70 mg/dL. The proportions of subjects with a Framingham 10-year risk of ≥10%, coronary artery calcium score of >20 and >100 and fatty liver each increased in association with an increasing ASCVD 10-year risk quartile in both sexes. Furthermore, age was significantly associated with the ASCVD 10-year risk in both sexes (all p-value <0.001). The KNHANES data also showed that over 85.0% of men ≥60 years of age and 95.0% of women ≥70 years of age had an ASCVD 10-year risk of ≥7.5% and an LDL-C level of ≥70 mg/dL. CONCLUSIONS Adopting the new ASCVD prevention guidelines would result in the treatment of almost all Korean men and women (≥60 years and ≥70 years of age, respectively) without evidence of cardiovascular disease. Therefore, Asian-specific guidelines are needed to avoid unnecessary over treatment in an aging global population.
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Affiliation(s)
- Nan Hee Kim
- Department of Internal Medicine, Gangnam CHA Medical Center, CHA University, School of Medicine
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Nakajima N, Miyauchi K, Yokoyama T, Ogita M, Miyazaki T, Tamura H, Nishino A, Yokoyama K, Okazaki S, Kurata T, Suwa S, Daida H. Effect of combination of ezetimibe and a statin on coronary plaque regression in patients with acute coronary syndrome. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.ijcme.2014.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Effect of insulin resistance associated with compensatory hyperinsulinemia on the long-term prognosis in patients with vasospastic angina. Int J Cardiol 2013; 167:2222-7. [DOI: 10.1016/j.ijcard.2012.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 06/07/2012] [Indexed: 11/21/2022]
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Miyauchi K, Ray K. A review of statin use in patients with acute coronary syndrome in Western and Japanese populations. J Int Med Res 2013; 41:523-36. [PMID: 23569015 DOI: 10.1177/0300060513476428] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Early high-dose statin therapy to reduce low-density lipoprotein cholesterol (LDL-C) is associated with improved cardiovascular outcomes in Western patients with stable coronary heart disease or acute coronary syndromes (ACS), but many patients remain undertreated and do not attain LDL-C treatment goals. Early statin therapy has also been shown to improve cardiovascular outcomes in Japanese patients with ACS, and pretreatment with high-dose statin prior to percutaneous coronary intervention has been shown to reduce cardiovascular events in these patients. As is the case in Western populations, many Japanese patients may be undertreated and a residual cardiovascular risk remains. While differences in treatment practice, dosing and genetic factors exist between Japan and Western countries, similarities are also evident when Japanese statin studies are compared with those performed in Western populations. With the increasing prevalence of cardiovascular risk factors in Japan, aggressive statin treatment may be beneficial in achieving optimal cardiovascular outcomes.
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Affiliation(s)
- Katsumi Miyauchi
- Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan.
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Koya D, Campese VM. Statin use in patients with diabetes and kidney disease: the Japanese experience. J Atheroscler Thromb 2013; 20:407-24. [PMID: 23518468 DOI: 10.5551/jat.16261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Diabetes is a leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in developed nations, including Japan and the United States. Japan has the unenviable distinction of having one of the world's highest rates of dialysis: in 2011, there were over 300,000 dialysis patients (2,383 per million people), with diabetic patients accounting for almost half of all incident cases. Concomitance of CKD and diabetes predicts a greater risk of cardiovascular disease (CVD) than either condition in isolation. Hence, appropriate management of modifiable cardiovascular (CV) risk factors, including dyslipidemia, is paramount in this high-risk group. The United States and Japan have distinct approaches to cholesterol management, with more stringent therapeutic targets for lipid control advocated in US guidelines. However, upward trends in cholesterol levels and coronary heart disease incidence in Japan may provide justification for more intensive CV risk factor management strategies by Japanese physicians to achieve maximum benefit. Attainment of recommended lipid goals in Japan is poor, particularly in patients with diabetes and/or CKD in whom CV risk factors are often undertreated. Statin therapy has been shown to be safe and effective in reducing CV risk in patients with diabetes and/or CKD stages 1-5. Moreover, statins may impart a renoprotective effect by preventing or delaying progressive loss of kidney function. This review summarizes evidence from studies in Western and Japanese populations to highlight the CV and renal benefits of lipid-lowering agents in CKD patients, including those with diabetes.
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Affiliation(s)
- Daisuke Koya
- Division of Diabetology and Endocrinology, Kanazawa Medical University, Japan.
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Treatment of rheumatoid arthritis with marine and botanical oils: influence on serum lipids. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2011:827286. [PMID: 22007257 PMCID: PMC3189621 DOI: 10.1155/2011/827286] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 06/06/2011] [Accepted: 07/25/2011] [Indexed: 11/17/2022]
Abstract
The gap in mortality between patients with rheumatoid arthritis (RA) and the general population (1.5-3.0 fold risk) is increasing. This disparity is attributable mainly to cardiovascular disease (CVD), as the CVD risk is comparable to patients with diabetes mellitus. The purpose of this study is to determine whether borage seed oil rich in gamma-linolenic acid, fish oil rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), or the combination of both oils are useful treatments for dyslipidemia in patients with RA. We randomized patients into a double blind, 18 month trial. Mixed effects models were used to compare trends over time in serum lipids. No significant differences were observed between the three groups: All three treatment groups exhibited similar meaningful improvement in the lipid profile at 9 and 18 months. When all groups were combined, these treatments significantly reduced total and LDL-cholesterol and triglycerides, increased HDL-cholesterol, and improved the atherogenic index. All improvements observed at 9 months persisted at 18 months (P < 0.001 verses baseline). Conclusion. Marine and botanical oils may be useful treatment for rheumatoid arthritis patients who are at increased risk for cardiovascular disease compared to the general population.
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Hongo M, Kumazaki S, Izawa A, Hidaka H, Tomita T, Yazaki Y, Kinoshita O, Ikeda U. Low-dose rosuvastatin improves arterial stiffness in high-risk Japanese patients with dyslipdemia in a primary prevention group. Circ J 2011; 75:2660-7. [PMID: 21857142 DOI: 10.1253/circj.cj-11-0497] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The treatment effects of rosuvastatin on arterial stiffness were assessed and compared to those of fluvastatin in high-risk Japanese patients with dyslipidemia in a primary prevention group. METHODS AND RESULTS Patients were randomly assigned to either 2.5-5 mg/day of rosuvastatin (Group A) or 20-40 mg/day of fluvastatin (Group B) and followed up for 12 months. In Group A (n=38), there was a progressive reduction in brachial-ankle pulse wave velocity (baPWV) along with a decrease in the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (L/H) ratio and high-sensitivity C-reactive protein (hsCRP), and the change in baPWV correlated significantly with that of the L/H ratio and that of hsCRP after rosuvastatin treatment. In Group B (n=37), although fluvastatin achieved a significant improvement in baPWV, L/H ratio, and hsCRP, baPWV was significantly greater than that in Group A and showed a significant correlation with that of hsCRP alone after fluvastatin treatment. In a subgroup of patients (n=26), switching from fluvastatin to rosuvastatin further improved baPWV and the L/H ratio without altering hsCRP after 12 months. CONCLUSIONS Low-dose rosuvastatin would be more effective than fluvastatin in improving arterial stiffness in high-risk Japanese patients with dyslipidemia. The results suggest that improvement in arterial stiffness by rosuvastatin mainly depends on its strong lipid-lowering effects, whereas that by fluvastatin is strongly dependent on the pleiotropic effects, especially an anti-inflammatory action.
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Affiliation(s)
- Minoru Hongo
- Department of Cardiovascular Medicine, Shinshu University School of Health Sciences, Japan.
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Kohro T, Yamazaki T, Izumi T, Daida H, Kurabayashi M, Miyauchi K, Tojo T, Nagai R. Intensively lowering both low-density lipoprotein cholesterol and blood pressure does not reduce cardiovascular risk in Japanese coronary artery disease patients. Circ J 2011; 75:2062-70. [PMID: 21817806 DOI: 10.1253/circj.cj-11-0695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Despite mounting evidence of the benefit of intensive lowering of low-density lipoprotein-cholesterol (LDL-C) in coronary artery disease (CAD) patients, it has not been shown that intensive lowering of both LDL-C and blood pressure (BP) reduces cardiovascular events in these patients. METHODS AND RESULTS 498 patients with hypertension and hypercholesterolemia with ≥ 75% stenosis in at least one major coronary artery, were recruited from 17 cardiovascular centers in eastern Japan. Patients were randomly assigned to conventional therapy (CT) or intensive therapy (IT). CT aimed to reduce BP to < 140/90 mm Hg and LDL-C to <100mg/dl, and IT aimed for < 120/80 mm Hg and < 80 mg/dl, respectively. The primary endpoint was a composite of all deaths, non-fatal myocardial infarction, unstable angina pectoris, coronary artery bypass graft surgery, non-fatal stroke, non-fatal major vascular disease, and peripheral artery disease. The mean follow-up period was 3.2 years. The achieved systolic BP was 126.8 mm Hg for the CT group, and 121.3 mm Hg for the IT group (P < 0.001). The achieved LDL-C was 92.1mg/dl for the CT group, and 79.6 mg/dl for the IT group (P < 0.001). We detected the primary endpoint in 18 (7.1%) patients in the CT group, and 26 (10.7%) in the IT group (hazard ratio 1.53, 95% confidence interval 0.84-2.80, P = 0.164). CONCLUSIONS We could not show that intensively lowering both BP and LDL-C reduced cardiovascular risks in Japanese CAD patients with hypertension and hypercholesterolemia (UMIN-CTR UMIN000000571).
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Affiliation(s)
- Takahide Kohro
- Department of Translational Research for Healthcare and Clinical Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Current world literature. Curr Opin Lipidol 2011; 22:308-10. [PMID: 21743305 DOI: 10.1097/mol.0b013e3283499d3b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Maruyama T, Takada M, Nishibori Y, Fujita K, Miki K, Masuda S, Horimatsu T, Hasuike T. Comparison of preventive effect on cardiovascular events with different statins. -The CIRCLE study-. Circ J 2011; 75:1951-9. [PMID: 21673458 DOI: 10.1253/circj.cj-10-1163] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although statins vary in their effectiveness in lowering low-density lipoprotein cholesterol (LDL-C) and increasing high-density lipoprotein cholesterol (HDL-C) levels, there is little evidence that the degree of these changes can explain cardiac risk reduction in Japan. Our objective was to compare the efficacy of statins on serum lipid levels and to explore the association between those changes and cardiac events in patients after percutaneous coronary intervention (PCI). METHODS AND RESULTS The 743 consecutive patients who underwent PCI from 2001 to 2008 were retrospectively investigated. Treatment with either atorvastatin or pitavastatin significantly reduced LDL-C compared with pravastatin or no statin. In contrast, only pitavastatin treatment significantly increased HDL-C (13.4 ± 22.9%, P=0.01 vs. no statin). Each statin significantly prevented major adverse cardiac events (MACE) compared with no statin, and pitavastatin was the most effective of all. Multivariate-adjusted analysis revealed that percent changes of both LDL-C and HDL-C independently predicted the incidence of MACE (hazard ratio [HR]: 1.015; 95% confidence interval [CI]: 1.010-1.020, HR: 0.988; 95%CI: 0.981-0.996, respectively). This relationship was preserved in patients with a baseline HDL-C level ≤ 45 mg/dl, but not HDL-C level > 45 mg/ml. CONCLUSIONS The extent of changes in LDL-C and HDL-C with statin treatment would independently alter the risk of cardiac events in Japanese patients for secondary prevention. Statins with varying lipid-modifying ability might provide differing prognosis in patients after PCI.
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Affiliation(s)
- Takao Maruyama
- Department of Cardiology, Kawasaki Hospital, Kobe, Japan.
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Imaizumi S, Navab M, Morgantini C, Charles-Schoeman C, Su F, Gao F, Kwon M, Ganapathy E, Meriwether D, Farias-Eisner R, Fogelman AM, Reddy ST. Dysfunctional high-density lipoprotein and the potential of apolipoprotein A-1 mimetic peptides to normalize the composition and function of lipoproteins. Circ J 2011; 75:1533-8. [PMID: 21628835 DOI: 10.1253/circj.cj-11-0460] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although high-density lipoprotein-cholesterol (HDL-C) levels in large epidemiological studies are inversely related to the risk of coronary heart disease (CHD), increasing the level of circulating HDL-C does not necessarily decrease the risk of CHD events, CHD deaths, or mortality. HDL can act as an anti- or a pro-inflammatory molecule, depending on the context and environment. Based on a number of recent studies, it appears that the anti- or pro-inflammatory nature of HDL may be a more sensitive indicator of the presence or absence of atherosclerosis than HDL-C levels. The HDL proteome has been suggested to be a marker, and perhaps a mediator, of CHD. Apolipoprotein A-1 (apoA-I), the major protein in HDL is a selective target for oxidation by myeloperoxidase, which results in impaired HDL function. Improving HDL function through modification of its lipid and/or protein content maybe a therapeutic target for the treatment of CHD and many inflammatory disorders. HDL/apoA-I mimetic peptides may have the ability to modify the lipid and protein content of HDL and convert dysfunctional HDL to functional HDL. This review focuses on recent studies of dysfunctional HDL in animal models and human disease, and the potential of apoA-I mimetic peptides to normalize the composition and function of lipoproteins.
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Affiliation(s)
- Satoshi Imaizumi
- Department of Medicine, University of California, Los Angeles, CA, USA
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Kosugi M, Nakagomi A, Shibui T, Kato K, Kusama Y, Atarashi H, Mizuno K. Effect of Long-Term Nitrate Treatment on Cardiac Events in Patients With Vasospastic Angina. Circ J 2011; 75:2196-205. [DOI: 10.1253/circj.cj-11-0056] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Munenori Kosugi
- Department of Internal Medicine and Cardiology, Tama-Nagayama Hospital, Nippon Medical School
| | - Akihiro Nakagomi
- Department of Internal Medicine and Cardiology, Tama-Nagayama Hospital, Nippon Medical School
| | - Toshiyuki Shibui
- Department of Internal Medicine and Cardiology, Tama-Nagayama Hospital, Nippon Medical School
| | - Katsuhito Kato
- Department of Internal Medicine and Cardiology, Tama-Nagayama Hospital, Nippon Medical School
| | - Yoshiki Kusama
- Department of Internal Medicine and Cardiology, Tama-Nagayama Hospital, Nippon Medical School
| | - Hirotsugu Atarashi
- Department of Internal Medicine and Cardiology, Tama-Nagayama Hospital, Nippon Medical School
| | - Kyoichi Mizuno
- Department of Internal Medicine (Division of Cardiology, Hepatology, Geriatrics, and Integrated Medicine), Nippon Medical School
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Ikenaga H, Ishihara M, Inoue I, Kawagoe T, Shimatani Y, Miura F, Nakama Y, Dai K, Otani T, Ejiri K, Oda N, Nakamura M, Miki T. Usefulness of Lipoprotein (a) for Predicting Progression of Non-Culprit Coronary Lesions After Acute Myocardial Infarction. Circ J 2011; 75:2847-52. [DOI: 10.1253/circj.cj-11-0365] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Ichiro Inoue
- Department of Cardiology, Hiroshima City Hospital
| | | | | | | | | | - Kazuoki Dai
- Department of Cardiology, Hiroshima City Hospital
| | | | | | - Nozomu Oda
- Department of Cardiology, Hiroshima City Hospital
| | | | - Takashi Miki
- Department of Cardiology, Hiroshima City Hospital
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Sakamoto T, Ogawa H. "Just make it lower" is an alternative strategy of lipid-lowering therapy with statins in Japanese patients: LDL-cholesterol: the lower, the better; is it true for Asians? (Con). Circ J 2010; 74:1731-41. [PMID: 20671372 DOI: 10.1253/circj.cj-10-0537] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is well known that statins improve the prognosis of cardiovascular diseases (CVD). Recent randomized control trials (RCTs) of statins conducted in Western countries revealed greater avoidance of cardiovascular events if low-density-lipoprotein cholesterol (LDL-C) reached lower levels. However, it is obvious that this evidence cannot be unconditionally extrapolated to Asians because there are great differences between Japanese and Caucasians in the absolute onset rate of CVD. Results of RCTs with Japanese for primary or secondary prevention of cardiovascular events indicate that we could benefit from statins with a relatively higher target LDL-C as compared with Western populations. In this situation, not only strong but also standard statins are still advantageous and the so-called pleiotropic effects of the drugs come to the fore. In this review, we first discuss differences in the absolute event rate in different populations, and then the lack of evidence for recommended LDL-C treatment targets, particularly in Japanese, although there is reliable evidence for reductions in plaque volume in coronary arteries from RCTs recently conducted in Japan with aggressive lipid-lowering therapy with strong statins. Finally, based on recent data, we propose a new concept regarding the secondary prevention of CVD for current Japanese populations.
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Affiliation(s)
- Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto 861-4193, Japan.
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