Pitavastatin calcium improves endothelial function and delays the progress of atherosclerosis in patients with hypercholesterolemia

Efficacy and Safety of Pitavastatin in Patients with Impaired Glucose Tolerance: An Updated Review

This review provides an updated overview of the efficacy and safety of pitavastatin in patients with impaired glucose tolerance (IGT). IGT is a prediabetic state characterized by elevated blood glucose levels that do not meet the criteria for diabetes. The review explores the potential benefits of pitavastatin in reducing cardiovascular risk and improving lipid profiles in individuals with IGT. It also examines the glycemic effects of pitavastatin, including its impact on fasting blood glucose levels, insulin sensitivity, and beta-cell function. The review highlights the need for individualized treatment approaches, taking into account the patient's overall cardiovascular risk profile and glycemic control needs. While pitavastatin has shown modest improvements in glycemic control, it is not a substitute for lifestyle modifications or standard antidiabetic medications. Future directions for research include long-term follow-up studies, mechanistic investigations, and comparative analyses to further understand the glycemic effects of pitavastatin in IGT. Overall, this narrative review provides valuable insights for healthcare professionals involved in the management of individuals with IGT, emphasizing the importance of a comprehensive approach to reduce cardiovascular risk and optimize glycemic control.

Regular Tennis Exercise May Improve the Vascular Endothelial Function in Postmenopausal Women: The Influence of Hemodynamics

Physical inactivity plays a role in the incidence of cardiovascular disease (CVD). Although the current guidelines for physical activity, such as the prescription of exercise, seek to combat CVD, attaining the recommended targets remains challenging. Tennis exercise has been proven to have a unique advantage in reducing the mortality of CVD, but little is known about the influence of playing tennis on impaired vascular endothelial function (VEF), which initiates CVD. Thus, this study aimed to investigate whether regular tennis participation could protect the VEF better than merely meeting the physical activity recommended by the current guidelines. A cross-sectional design was performed based on a sample of 38 healthy postmenopausal women who were matched for physical activity, of which 17 subjects had long-term tennis experience and 21 age-matched subjects regularly exercised but did not play tennis. The cardiovascular function and the body composition of all subjects were measured. We used cluster analysis to assess the overall health status. The modeling results showed that the tennis players performed better in terms of VEF than the nonplayers (10.55 ± 0.58 vs. 8.69 ± 0.52, p < 0.01, R²_ad = 0.367), while the wall shear stress positively correlated with VEF (r = 0.505, p < 0.05), after controlling for age and physical activity levels. Regular tennis exercise may be a protective factor for VEF, and further study should be performed to research the role of hemodynamics in tennis exercise.

A comprehensive review on the lipid and pleiotropic effects of pitavastatin

The 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, or statins, are administered as first line therapy for hypercholesterolemia, both in primary and secondary prevention. There is a growing body of evidence showing that beyond their lipid-lowering effect, statins have a number of additional beneficial properties. Pitavastatin is a unique lipophilic statin with a strong effect on lowering plasma total cholesterol and triacylglycerol. It has been reported to have pleiotropic effects such as decreasing inflammation and oxidative stress, regulating angiogenesis and osteogenesis, improving endothelial function and arterial stiffness, and reducing tumor progression. Based on the available studies considering the risk of statin-associated muscle symptoms it seems to be also the safest statin. The unique lipid and non-lipid effects of pitavastatin make this molecule a particularly interesting option for the management of different human diseases. In this review, we first summarized the lipid effects of pitavastatin and then strive to unravel the diverse pleiotropic effects of this molecule.

Midkine: A multifaceted driver of atherosclerosis

Atherosclerosis constitutes the pathological basis of life-threatening events, including heart attack and stroke. Midkine is a heparin-binding growth factor and forms a small protein family with pleiotrophin. Under inflammatory or hypoxic conditions, midkine expression is up-regulated. Upon binding to its receptors, midkine can activate multiple signal pathways to regulate cell survival and migration, epithelial-to-mesenchymal transition, and oncogenesis. Circulating midkine levels are significantly increased in patients with essential hypertension, obesity or severe peripheral artery disease. Importantly, midkine exerts a proatherogenic effect by altering multiple pathophysiological processes involving atherogenesis, including macrophage lipid accumulation, vascular inflammation, neointima formation, insulin resistance and macrophage apoptosis. Midkine represents a potential therapeutic target for atherosclerosis-associated diseases. This review described the structure characteristics, expression patterns and signal transduction pathways of midkine with an emphasis on its role in atherosclerosis.

The Effect of Atorvastatin + Aspirin on the Endothelial Function Differs with Age in Patients with HIV: A Case-Control Study

BACKGROUND

Patients with HIV are more likely to present with cardiovascular disease when compared to the general population.

OBJECTIVE

This was a case-control study that aimed to assess which factors were associated with a reduction in the carotid intima-media thickness (IMT) and an increase in the brachial artery flow-mediated dilation (FMD) in HIV patients who received atorvastatin + aspirin during a period of 6 months.

METHODS

A secondary analysis of a clinical trial was conducted, which included people living with HIV infection and low cardiovascular risk. A total of 38 patients allocated to the intervention arm and treated for 6 months with a combination of atorvastatin + aspirin were included. All participants underwent a carotid and brachial artery ultrasound, both at the beginning and the end of the study. Cases that responded with an increase of >10% of the brachial dilatation (FMD) and reduction of the carotid intima-media thickness (IMT) were considered cases, and those who did not respond were considered controls. We assessed the factors associated with the positive responses obtained through IMT and FMD.

RESULTS

A reduction in the IMT was not significantly associated with any of the evaluated risk factors: age (p=0.211), gender (p=0.260), smoking (p=0.131) or time since HIV diagnosis (p=0.836). An increase in the FMD was significantly associated with age amongst those in the 40-59 age group, p = 0.015 (OR = 4.37; 95% CI: 1.07-17.79).

CONCLUSIONS

Older individuals were more likely to present with an increased FMD after 6 months of treatment with atorvastatin + aspirin.

Celosins inhibit atherosclerosis in ApoE-/- mice and promote autophagy flow

ETHNOPHARMACOLOGICAL RELEVANCE

Semen celosiae is a traditional Chinese medicine for purging hepatic pathogenic fire and removing nebula to improve eyesight, treating hepatopyretic vertigo and hypertension. It possesses a serial of potential bioactivities such as hepatoprotection, anti-tumor and anti-inflammatory, anti-diabetes. The triterpenoid saponins celosins from it were proved to have hepatoprotection, lipid lowing and anti-inflammatory. However, the anti-atherosclerosis activities were not reported to date.

AIM OF THE STUDY

This study was designed to examine the therapeutic effects of celosins (CES), the active constituents extracted from Semen celosiae.

MATERIALS AND METHODS

Atherosclerosis model by feeding high fat diet for 12 weeks in ApoE^-/- mice and foam cell model by ox-LDL-treated peritoneal macrophages were performed. The lipid plaque was measured by histopathological analysis. The LC3 dots in the aortic root lesion examined through tissue immunofluorescence. The peritoneal macrophage phagocytosis, formation of foam cells, genes associated protein expression and autophagy flux were measured on foam cell model by oxidized low-density lipoprotein (Ox-LDL) stimulating peritoneal macrophages. The mRNA expression of CD36, SR-A1, ABCA1 and ABCG1 were determined by Real-Time PCR method. The expressions of LC3 and beclin 1 were measured using Western blot.

RESULTS

CES (10, 30, 90mg/kg; p.o.) administrated for 4 weeks significantly reduced the prevalence of the relative area of plaque in mouse aorta, and showed the therapeutic effect on atherosclerosis. In the tissue section of immunofluorescence for aortic root, compared with high fat diet model group, the number of autophagy bodies in CES group increased significantly, suggesting that inhibiting atherosclerosis effect of CES may be related to its promoting autophagy. In vitro, CES significantly reduced phagocytosis of macrophages on lipid and formation rate of foam cells. CES down-regulated the mRNA expression of CD36 and SR-A1 while up-regulated mRNA expression of ABCA1 and ABCG1. Further, CES increased the autophagy specific protein LC3 and beclin 1, and it also increased the level of autophagy in the cells, and promoted the process of autophagy.

CONCLUSIONS

The therapeutic effect of CES on atherosclerosis may be related to the promotion of autophagy.

Improvement of endothelial function by pitavastatin: a meta-analysis

OBJECTIVE

Dyslipidemia is commonly associated with endothelial dysfunction and increased cardiovascular risk. Pitavastatin has been shown to reduce total and low-density lipoprotein cholesterol, to increase high-density lipoprotein (HDL)-cholesterol and improve HDL function. Furthermore, several trials explored its effects on flow-mediated dilation (FMD), as an index of endothelial function. The authors evaluated the effect of pitavastatin therapy on FMD.

METHODS

The authors performed a systematic review and meta-analysis of all clinical trials exploring the impact of pitavastatin on FMD. The search included PubMed-Medline, Scopus, ISI Web of Knowledge and Google Scholar databases. Quantitative data synthesis was performed using a random-effects model, with weighted mean difference (WMD) and 95% confidence interval (CI) as summary statistics.

RESULTS

Six eligible studies comprising 7 treatment arms were selected for this meta-analysis. Overall, WMD was significant for the effect of pitavastatin on FMD (2.45%, 95% CI: 1.31, 3.60, p < 0.001) and the effect size was robust in the leave-one-out sensitivity analysis.

CONCLUSION

This meta-analysis of all available clinical trials revealed a significant increase of FMD induced by pitavastatin.

Pitavastatin attenuates atherosclerosis by suppressing NF-κB signaling in a high-cholesterol diet plus balloon catheter injury rabbit model

Atherosclerosis (AS) induced by endothelial cell (EC) dysfunction significantly contributes to the onset and development of cardiovascular disease. Pitavastatin is a member of the lipid-lowering drugs, statins that are widely used in clinics. In the current study, we evaluated the effect of pitavastatin on AS and nuclear factor-kappa-light-chain-enhancer of activated B cells (NF-κB) signaling in abdominal aortic ECs. We induced AS in rabbits by high-cholesterol diet plus balloon catheter injury. The anti-AS effect of pitavastatin was assessed by measuring the intima-media thickness of the abdominal aorta, minimal lumen area (MLA), minimal lumen diameter (MLD), and other hemodynamic parameters. In addition, we measured the production of total cholesterol (CHOL, high density lipoproteins (HDL), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) in the rabbits. To explore the underlying mechanism of pitavastatin on atherosclerosis, we isolated abdominal aortic ECs and determined the activity of NF-κB signaling. In our model, we found that the affected animals had structural impairments of the heart and arteries: reduced left atrium diameter, right ventricular internal diameter, MLA, and MLD and increased interventricular septal thickness, left ventricular internal diameter, left ventricular posterior wall thickness, right atrium diameter, and intima-media thickness of abdominal aorta. Most of these changes were restored by administration of pitavastatin. Moreover, concentrations of plasma lipids were also attenuated by pitavastatin. At the molecular level, pitavastatin inhibited the expression of NF-κB and Bax and induced the production of IL-1β and Bcl-2. In addition, we demonstrated that the anti-AS effect of pitavastatin depends on restoring normal function of ECs and eliminating dysfunctional ECs by inducing apoptosis.

Clinical benefits of pitavastatin: focus on patients with diabetes or at risk of developing diabetes

Despite attaining LDL-cholesterol targets, many patients with diabetes remain at risk of developing cardiovascular events. In addition, treatment with statins has been associated with a slight but significant increased risk of development of diabetes, particularly with high-intensity statins. Pitavastatin is a moderate- to high-intensity statin that effectively reduces LDL-cholesterol levels. Pitavastatin provides a sustained increase of HDL-cholesterol levels that may exhibit a neutral or positive effect on glucose metabolism, may not increase the risk of new-onset diabetes, may exhibit positive effects on renal function and urinary albumin excretion and the risk of drug–drug interactions is low. Therefore, it seems that pitavastatin should preferentially be considered in the treatment of dyslipidemia in diabetic patients or at risk of developing diabetes.