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Resumen La inflamación es un factor patogénico importante para el desarrollo de la enfermedad cardiovascular aterosclerótica. Actualmente, el biomarcador utilizado con mayor frecuencia que refleja la inflamación sistémica es la proteína C reactiva (PCR), una proteína de fase aguda producida principalmente por los hepatocitos bajo la influencia de la interleucina 6, la interleucina 1 beta y el factor de necrosis tumoral. La evidencia proveniente de estudios epidemiológicos ha demostrado una fuerte asociación entre las concentraciones elevadas de PCR en suero o plasma y la incidencia de un primer evento cardiovascular (incluido infarto agudo de miocardio, accidente vascular cerebral isquémico y muerte cardíaca súbita) en la población general, así como la recurrencia de eventos cardiovasculares adversos en los pacientes con enfermedad establecida. El valor aditivo que la medición de la PCR otorga a los factores de riesgo tradicionales se refleja en novedosas calculadoras de riesgo cardiovascular y en los actuales regímenes de intervención, que ya consideran a la PCR como objetivo terapéutico. Sin embargo, las variaciones en los niveles de PCR, que dependen del sexo, la etnia, el estado hormonal y algunas peculiaridades de los ensayos de medición, deben tenerse en cuenta al decidir implementar la PCR como un biomarcador útil en el estudio y el tratamiento de la enfermedad cardiovascular aterosclerótica. Esta revisión pretende ofrecer una visión actualizada de la importancia de medir la PCR como biomarcador de riesgo cardiovascular más allá de los factores tradicionales que estiman el riesgo de enfermedad aterosclerótica.
Abstract Inflammation is an important pathogenic factor for the development of atherosclerotic cardiovascular disease. Currently, the most frequently used biomarker reflecting systemic inflammation is C-reactive protein (CRP), an acute-phase protein produced primarily by hepatocytes under the influence of interleukin-6, interleukin-1 beta, and tumor necrosis factor. Growing evidence from epidemiological studies has shown a robust association between elevated serum or plasma CRP concentrations and the incidence of a first cardiovascular adverse event (including acute myocardial infarction, ischemic stroke, and sudden cardiac death) in the general population, as well as recurrence of major adverse cardiovascular events among patients with established disease. The additive value that CRP measurement gives to traditional risk factors is reflected in novel cardiovascular risk calculators and in current intervention regimens, which already consider CRP as a target therapeutic. However, the variations in CRP levels, that depend on sex, ethnicity, hormonal status, and some peculiarities of the measurement assays, must be taken into consideration when deciding to implement CRP as a useful biomarker in the study and treatment of atherosclerotic cardiovascular disease. This review aims to offer an updated vision of the importance of measuring CRP levels as a biomarker of cardiovascular risk beyond the traditional factors that estimate the risk of atherosclerotic disease.
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OBJECTIVE To systematically evaluate the effects of C3435T polymorphism in ABCB1 gene on lipid-lowering efficacy of statins. METHODS Retrieved from PubMed, Web of Science, the Cochrane Library, CNKI and VIP, the cohort studies on the use of statins were collected from the inception to November 1, 2023. After literature screening, data extraction and quality evaluation, meta-analysis was performed by using RevMan 5.4 software. RESULTS A total of 11 literature involving 1 575 patients were included. The results showed that under the dominant genetic model, the reduction of low-density lipoprotein cholesterol (LDL-C) [MD=-1.87, 95%CI (-3.62, -0.13), P=0.04], total cholesterol (TC) [MD=-1.42, 95%CI (-2.80, -0.04), P=0.04] in patients with CT+TT genotype was significantly higher than CC genotype. There was no significant difference in the increase of high-density lipoprotein cholesterol (HDL-C) [MD=-0.65, 95%CI (-2.48, 1.18), P=0.49] or the decrease of triglyceride (TG) [MD=-0.05, 95%CI (-2.94, 2.84), P=0.97] between patients with CT+TT genotype and CC genotype. Under the recessive genetic model, the reduction of TC [MD=2.26, 95%CI (0.97, 3.56), P=0.000 6] and the increase of HDL-C [MD=2.38, 95%CI (0.42, 4.35), P=0.02] in patients with TT genotype were significantly higher than CC+ CT genotype. There was no significant difference in the reduction of LDL-C [MD=1.53, 95%CI (-0.10, 3.15), P=0.07] or TG [MD=0.06, 95%CI (-2.98, 3.10), P=0.97] between CC+CT genotype and TT genotype. Under the additive genetic model, the reduction of TC [MD=2.98, 95%CI (1.27, 4.69), P=0.000 6] and LDL-C [MD=2.84, 95%CI (0.67, 5.01), P=0.01] in patients with TT genotype were significantly higher than CC genotype. There was no significant difference in the increase of HDL-C [MD=2.40, 95%CI (-0.17, 4.97), P=0.07] or the decrease of TG [MD=0.97, 95%CI (-2.93, 4.87), P=0.63] between patients with TT genotype and CC genotype. CONCLUSIONS The reduction of LDL-C and TC in patients with dyslipidemia treated with statins may be related to the heterozygous and homozygous mutation of C3435T in ABCB1 gene, and the reduction of LDL-C and TC in patients with CT or TT genotype is more obvious, compared with patients with CC genotype. The elevation of HDL-C may be related to homozygous mutation, and the effect of HDL-C elevation may be more obvious in patients with TT genotype, compared with CC+CT genotype. However, the change of TG may not be related to the C3435T polymorphism in ABCB1 gene.
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BACKGROUND:Observational studies have suggested that statins may have a protective effect against osteoarthritis,including knee osteoarthritis and hip osteoarthritis.However,the association between statins and the risk of osteoarthritis remains unclear. OBJECTIVE:To investigate the association between statins and the risk of osteoarthritis through Mendelian randomization analysis using summary data from large-scale population-based genome-wide association studies(GWAS). METHODS:Firstly,single nucleotide polymorphism data related to statins were obtained from the latest 9th edition of the FinnGen database,while data of osteoarthritis,knee osteoarthritis and hip osteoarthritis were obtained from the IEU Open GWAS,UK Biobank,and ArcOGEN(Genetics of Osteoarthritis)databases,respectively.The inverse variance weighted method was used as the primary analysis approach to evaluate the causal effects.The weighted median method,simple median method,weighted mode-based method,and MR-Egger regression were used as supplementary analyses.The causal relationship between statins and the risk of osteoarthritis,knee osteoarthritis and hip osteoarthritis was assessed using odds ratios(OR)with 95%confidence intervals(CI).Sensitivity analyses were conducted to validate the reliability of the results,including the Cochran's Q test for heterogeneity and the MR-Egger-intercept test for horizontal pleiotropy,as well as leave-one-out analysis to identify potentially influential single nucleotide polymorphisms. RESULTS AND CONCLUSION:The inverse variance weighted analysis demonstrated a negative causal relationship between genetically predicted statins and the risk of osteoarthritis(OR=0.998,95%CI:0.996-0.999,P=0.01),knee osteoarthritis(OR=0.964,95%CI:0.940-0.989,P=0.005),and hip osteoarthritis(OR=0.928,95%CI:0.901-0.955,P=4.28×10-7).MR-Egger intercept analysis did not detect potential horizontal pleiotropy(osteoarthritis:P=0.658;knee osteoarthritis:P=0.600;hip osteoarthritis:P=0.141).The results of this study provide evidence that statins reduce the risks of osteoarthritis,knee osteoarthritis and hip osteoarthritis as described in observational studies.Further research is needed to explore the specific mechanisms of statin treatment for osteoarthritis.
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Defined as a common gynecologic en-docrine disease,endometriosis is characterized by the presence of endometrium outside of the uterus cavity,affecting about 10%to 15%of reproductive-aged women worldwide.Moreover,Asian women tend to have a nine-fold increased risk of endome-triosis compared with their white counterparts in Europe and the United States.Endometriosis not only causes chronic pelvic pain,dysmenorrhea,painful sex and other pain symptoms,but also leads to infertility,pushing the patients into a state of fatigue,high sensitivity and anxiety,thus reduc-ing their quality of life.As the aging of Chinese pop-ulation intensifies and the women's childbearing age delays,it is highly urgent to find solutions to those gynecological endocrine diseases such as en-dometriosis,which hamper women's fertility.In re-cent years,studies have shown that patients with endometriosis have abnormal serum lipid metabo-lism and an increased risk of cardiovascular diseas-es.At the same time,as a type of cholesterol-lower-ing drug,statins can inhibit the progression of en-dometriosis at the cellular and animal levels.Also,a few clinical studies have exhibited that statins ex-ert a positive effect on the treatment of endometri-osis.Therefore,this article aims to review the re-searches regarding the relationship between endo-metriosis and the cardiovascular disease,as well as the research progress of statin therapy on endome-triosis based on the level of cells,animals and hu-man beings.
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Resumen Las estatinas son ampliamente utilizadas para el control de los niveles de colesterol en pacientes con hipercolesterolemia, lo cual permite prevenir enfermedades cardiovasculares. Además de controlar la síntesis endógena de colesterol, las estatinas tienen efectos pleiotrópicos diversos, como son las propiedades antiinflamatoria, antioxidante y de inmunomodulación. La enfermedad causada por el virus SARS-CoV-2 (COVID-19) provoca una tormenta de citocinas que contribuye a la generación del síndrome respiratorio agudo, que puede llevar a cuadros graves de esta enfermedad e incluso a la muerte del paciente. Diversos estudios realizados en enfermos con COVID-19 que recibieron estatinas, antes o durante el curso de la enfermedad, registraron cuadros menos graves, estancias hospitalarias más cortas y menor mortalidad. El beneficio de las estatinas en la COVID-19 debe ser explorado más ampliamente, ya que potencialmente pueden contribuir al control de esta pandemia que ha postrado a la humanidad.
Abstract Statins are widely used to control cholesterol levels in patients with hypercholesterolemia, which helps prevent cardiovascular diseases. In addition to controlling endogenous cholesterol synthesis, statins have diverse pleiotropic effects, such as anti-inflammatory, antioxidant, and immunomodulatory properties. The disease caused by the SARS-CoV-2 virus (COVID-19) causes a cytokine storm that contributes to the generation of acute respiratory syndrome, which can lead to severe symptoms of this disease and even the death of the patient. Various studies carried out on patients with COVID-19 who received statins, before or during the disease, registered less severe symptoms, shorter hospital stays and lower mortality. The benefit of statins in COVID-19 should be explored more widely, as they can potentially contribute to the control of this pandemic that has devastated humanity.
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Introducción: El ictus isquémico representa la tercera causa de mortalidad en el mundo y la primera causa de discapacidad. Objetivos: Describir los efectos beneficiosos de la prescripción de las estatinas en la prevención primaria, secundaria y terciaria del ictus isquémico. Métodos: Se realizó una revisión bibliográfica sobre la prescripción de estatinas en la prevención primaria, secundaria y terciaria del ictus isquémico. Se revisaron más de 400 artículos publicados en PubMed, Cochrane y Medline. Conclusiones: El empleo de estatinas disminuye la mortalidad en la prevención primaria y secundaria, se utiliza precozmente en la fase aguda (prevención terciaria), disminuye el área infartada, existe una mejoría clínica y disminuyen los reactantes de la fase aguda como la proteína C reactiva(AU)
Introduction: Ischemic stroke represents the third cause of mortality worldwide and the first cause of disability. Objective: To describe the beneficial effects of the prescription of statins in the primary, secondary and tertiary prevention of ischemic stroke. Methods: A bibliographic review on the prescription of statins in the primary, secondary and tertiary prevention of ischemic stroke was carried out. More than 400 articles published in MEDLINE/PubMed and Cochrane were reviewed. Only 50 articles met the selection criteria, which were published from May 2021 to June 2022. Conclusions: The use of statins decreases mortality in primary and secondary prevention. If they are used early in the acute phase (tertiary prevention), the infarcted area decreases, there is clinical improvement and acute phase reactants such as C-reactive protein decrease(AU)
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Humains , Mâle , Femelle , Soins de santé primaires , Soins secondaires , Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase/usage thérapeutique , Accident vasculaire cérébral/mortalité , Accident vasculaire cérébral/épidémiologieRésumé
Introdução: A literatura tem apontado uma possível relação entre diversas condições sistêmicas e as doenças periodontais. Dentro das doenças sistêmicas que podem gerar o uso crônico de medicamentos, com potencial associação com as doenças periodontais, destacam-se a hipercolesterolemia e o uso de estatinas; e as doenças do metabolismo ósseo e o uso de bisfosfonatos. Objetivo: Dessa maneira, o presente estudo objetivou revisar a literatura sobre o efeito das estatinas e dos bisfosfonatos nos parâmetros clínicos e radiográficos periodontais de indivíduos adultos. Resultados: Apenas estudos observacionais em humanos foram incluídos. Um estudo mostrou que, em pacientes que apresentam doença periodontal e usam estatina, houve 37% menos bolsas periodontais (profundidade de sondagem ≥4mm) quando comparadas aos que não utilizam a medicação, além de apresentarem menor índice de carga inflamatória e menor perda de inserção clínica. Em relação aos bisfosfonatos em indivíduos com doenças que envolvem o metabolismo ósseo, sugere-se que a utilização do fármaco tem obtido resultados positivos nos parâmetros periodontais, como menores sinais clínicos de inflamação gengival, menor profundidade de sondagem, menor perda de inserção clínica e maior nível de osso alveolar, quando comparados aos que nunca realizam essa terapia. Conclusão: Dessa forma, as estatinas e os bisfosfonatos apresentam efeitos promissores, em pacientes sob tratamento para suas respectivas condições sistêmicas, na melhoria dos parâmetros periodontais, porém é importante salientar que são necessários mais estudos sobre o assunto para melhor entender os reais efeitos a longo prazo do uso desses fármacos.(AU)
Introduction: The literature showed a possible relationship between several systemic conditions and periodontal diseases. Within the systemic diseases that can generate the chronic use of these drugs, potentially related with periodontal diseases, it may be cited the hypercholesterolemia and the use of statins; and bone metabolism diseases and the use of bisphosphonates. Objective: In this sense, the present study aimed to review the literature about the effect of statins and bisphosphonates in the periodontal parameters of adults individuals. Results: Only observational studies in humans were included. A study showed that, in patients with periodontal disease and users of statins, there 37% fewer periodontal pockets (probing depth ≥4mm) when compared to those who do not use the medication, as well as having a lower rate of inflammatory burden and less loss of clinical insertion. Regarding the bisphosphonates in individuals diagnosed with diseases involving bone metabolism, it was suggested that the use of the drug has obtained positive results in periodontal parameters, such as a greater absence of plaque, less clinical signs of gingival inflammation, less probing depth, lower level of clinical insertion and higher level of alveolar bone when compared to those who never undergo this therapy. Conclusion: Thus, statins and bisphosphonates have promising effects in patients under treatment for their respective systemic condition in improving periodontal parameters, but it is important to emphasize that further studies on the subject are needed to better understand the long-term effects of the use of these drugs.(AU)
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Humains , Maladies parodontales/induit chimiquement , Parodonte/effets des médicaments et des substances chimiques , Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase/effets indésirables , Diphosphonates/effets indésirables , Maladies osseuses métaboliques/complications , Maladies osseuses métaboliques/traitement médicamenteux , Facteurs de risque , Hypercholestérolémie/complications , Hypercholestérolémie/traitement médicamenteuxRésumé
Cholesterol metabolism is vital for the progression of prostate cancer (PCa), especially in the occurrence and development. Statins can affect the progression of PCa by reducing cholesterol. This paper will review how cholesterol metabolism affects the progression of PCa.
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Statins are a kind of prescription drug that is widely used to treat hyperlipidemia, coronary artery disease, and other atherosclerotic diseases. A common side effect of statin use is a mild rise in liver aminotransferases, which occurs in less than 3% of patients. Statin-related liver injury is most commonly caused by atorvastatin and simvastatin, but severe liver injury is uncommon. Therefore, understanding and evaluating hepatotoxicity and weighing the benefits and risks is of great significance to better realize the protective effect of statins.
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Humains , Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase/effets indésirables , Atorvastatine/effets indésirables , Simvastatine/effets indésirables , Lésions hépatiques dues aux substances/traitement médicamenteux , Effets secondaires indésirables des médicaments/traitement médicamenteuxRésumé
INTRODUCTION@#Normal stress myocardial perfusion imaging (MPI) carries a favourable prognosis. Conversely, elevated coronary artery calcium (CAC) is associated with increased major adverse cardiovascular events (MACE). There is limited information on the prognosis and management of patients with elevated CAC and normal MPI. We aimed to assess the outcomes of patients with elevated CAC and normal MPI in relation to post-MPI statin use.@*METHODS@#A retrospective review of normal MPI with CAC score >300 was performed between 1 March 2016 and 31 January 2017 in a Singapore tertiary hospital. Patients with known atherosclerotic cardiovascular disease or left ventricular ejection fraction <50% on MPI were excluded. Patient demographics, prescriptions and MACE (cardiac death, nonfatal myocardial infarction and/or ischaemic stroke) at 24 months after MPI were traced using electronic records. Binary logistic regression was used to evaluate for independent predictors of MACE.@*RESULTS@#We included 311 patients (median age 71 years, 56.3% male), of whom 65.0% were on moderate to high-intensity statins (MHIS) after MPI. MACE was significantly lower in the post-MPI MHIS group (3.5% vs. 9.2%, P = 0.035). On univariate binary logistic regression, post-MPI MHIS use was the only significant predictor for MACE (odds ratio [OR] 0.355 [95% confidence interval (CI) 0.131-0.962], P = 0.042), even after multivariate adjustment (adjusted OR 0.363, 95% confidence interval 0.134-0.984, P = 0.046).@*CONCLUSION@#Post-MPI MHIS use is associated with lower MACE and is an independent negative predictor for 24-month MACE among patients with normal MPI and CAC >300.
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Humains , Mâle , Sujet âgé , Femelle , Maladie des artères coronaires , Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase , Imagerie de perfusion myocardique/méthodes , Calcium , Débit systolique , Encéphalopathie ischémique , Facteurs de risque , Fonction ventriculaire gauche , Accident vasculaire cérébral , PronosticRésumé
Statins are a class of hydroxymethylglutaryl-CoA reductase inhibitors (HMG-CoA reductase inhibitors), which are widely used to reduce blood lipid in clinic, and are especially important for the prevention and treatment of cardiovascular diseases. In recent years, many studies at home and abroad believe that statins have a unique role in tumor prevention and treatment, and have been widely concerned. In terms of epigenetic regulation mechanism, statins mainly affect the progress of tumor through DNA methylation, histone modification and miRNA regulation. In addition, statins can also achieve their anti-tumor effects by promoting tumor cell autophagy, regulating tumor cell cycle, and promoting tumor cell apoptosis and other signaling pathways. Therefore, the research on statins provides ideas for the discovery of new anti-tumor treatments. In this paper, the role of statins in the prevention and treatment of common tumors is reviewed, including its mechanism of inhibiting the occurrence and development of tumors through epigenetic regulation and other related mechanisms, as well as its clinical research status.
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Worldwide, the leading cause of death is cardiovascular disease. The study details the prescription of statins at the Pablo Arturo Suarez Hospital in Ecuador between March 2021 and February 2022 following the ASCVD risk scale of the American College of Cardiology and the American Heart Association. There are 563 people in this cross-sectional and retrospective study: 70% women, 30% men, 93.30% mestizos, 48.10% diabetics, 62.30% hypertensives, and 18.70% smokers. 26.10% of all patients received statins, with simvastatin being the most common (96.60%). The mean cardiovascular risk in the general population was 15.52 ± 14.51%, 44.99% of subjects had a risk lower than 7.50%, and 29% had a risk higher than 20%, with a statistically significant difference (p<0.001) according to sex. The study determined that 58.60% of the population received a statin or an inadequate dosage.
A nivel mundial, la principal causa de muerte es la enfermedad cardiovascular. El estudio detalla la prescripción de estatinas en el Hospital Pablo Arturo Suárez de Ecuador entre marzo de 2021 y febrero de 2022, siguiendo la escala de riesgo ASCVD del Colegio Americano de Cardiología y la Asociación Americana del Corazón. Son 563 personas en este estudio transversal y retrospectivo: 70% mujeres, 30% hombres, 93.30% mestizos, 48.10% diabéticos, 62.30% hipertensos y 18.70% fumadores. El 26.10% de los pacientes recibía estatinas, siendo la simvastatina la más frecuente (96.60%). El riesgo cardiovascular medio en la población general fue de 15.52 ± 14.51%, el 44.99% de los sujetos tenía un riesgo inferior al 7.50%, y el 29% tenía un riesgo superior al 20%, con una diferencia estadísticamente significativa (p<0.001) según el sexo. El estudio determinó que el 58.60% de la población recibía una estatina o una dosis inadecuada.
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Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Sujet âgé , Maladies cardiovasculaires/prévention et contrôle , Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase/administration et posologie , Athérosclérose/prévention et contrôle , Maladies cardiovasculaires/diagnostic , Maladies cardiovasculaires/épidémiologie , Ethnies , Fumer/effets indésirables , Fumer/épidémiologie , Études transversales , Analyse multifactorielle , Études rétrospectives , Appréciation des risques/méthodes , Simvastatine/administration et posologie , Complications du diabète , Diabète/épidémiologie , Athérosclérose/diagnostic , Athérosclérose/épidémiologie , Atorvastatine/administration et posologie , Hypertension artérielle/complications , Hypertension artérielle/épidémiologieRésumé
La diabetes mellitus tipo 2 (DM2) es un factor de riesgo cardiovascular (FRCV) mayor. La DM confiere dos a cuatro veces más riesgo cardiovascular (RCV). El riesgo es aún más elevado en el paciente con DM2 que ha sufrido un infarto agudo de miocardio (IAM) o un accidente cerebrovascular (ACV). La dislipidemia de la DM2 consiste en triglicéridos elevados de ayuno, con mayor excursión posprandial, bajos niveles de HDLc, y alteraciones cuantitativas y cualitativas de LDLc y HDLc. El control glucémico apropiado en DM2 mejora en gran medida las alteraciones lipoproteicas. La terapia hipolipemiante es clave para reducir el RCV en la DM2. La reducción del RCV que se consigue con estatinas se basa en la reducción del LDLc y sus efectos pleiotrópicos. En pacientes que persisten con el perfil lipídico alterado, a pesar de dosis altas de estatinas, se debe considerar el agregado de otros agentes hipolipemiantes para reducir las lipoproteínas aterogénicas.
Type 2 diabetes (T2D) is a major cardiovascular risk factor (CVRF). Diabetes confers two to four times more cardiovascular risk (CVR). The risk is even higher in patients with T2D who have suffered an acute myocardial infarction (AMI) or cerebrovascular accident (CVA). The dyslipidemia of T2D consists of high fasting triglycerides, with greater postprandial excursion, low levels of HDLc and qualitative alterations of LDLc and HDLc. Appropriate glycemic control in T2D greatly improves lipoprotein abnormalities. Lipid-lowering therapy is key to reducing CVR in T2D. The CVR reduction achieved with statins is based on the reduction of LDLc. In patients who persist with an altered lipid profile despite highdose statins, the addition of other lipid-lowering agents to reduce atherogenic lipoproteins may be considered.
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Diabète , Cholestérol , Facteurs de risque , Facteurs de risque de maladie cardiaque , Régulation de la glycémie , Cholestérol HDLRésumé
3 - Hydroxy - 3 - methylglutaryl - coenzyme, a reductase inhibitors (statins) are widely used drugs to reduce lipid levels by inhibiting cholesterol biosynthesis. Simvastatin, a lipophilic statin is one of the most frequently prescribed statin drugs throughout th e world due to profound reductions in LDL - C with excellent tolerability, with very little risk of important adverse effects, to a lower extent. It also reduce triglycerides and increase high - density lipoprotein cholesterol levels. Beside this, studies on simvastatin have shown to exhibit numerous pleiotropic effects, has beneficial effect on endothelial function, smooth muscle cell function, haemostasis, vascular wall function, LDL oxidation, kidney diseases, inflammation and anticarcinogenic effects on ma ny types of cancer including prostate, breast hepatic and colon carcinoma. In this review, we present a
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La diabetes mellitus tipo 2 (DM2) es un factor de riesgo cardiovascular (FRCV) mayor. La DM confiere dos a cuatro veces más riesgo cardiovascular (RCV). El riesgo es aún más elevado en el paciente con DM2 que ha sufrido un infarto agudo de miocardio (IAM) o un accidente cerebrovascular (ACV). La dislipidemia de la DM2 consiste en triglicéridos elevados de ayuno, con mayor excursión posprandial, bajos niveles de HDLc, y alteraciones cuantitativas y cualitativas de LDLc y HDLc. El control glucémico apropiado en DM2 mejora en gran medida las alteraciones lipoproteicas. La terapia hipolipemiante es clave para reducir el RCV en la DM2. La reducción del RCV que se consigue con estatinas se basa en la reducción del LDLc y sus efectos pleiotrópicos. En pacientes que persisten con el perfil lipídico alterado, a pesar de dosis altas de estatinas, se debe considerar el agregado de otros agentes hipolipemiantes para reducir las lipoproteínas aterogénicas.
Type 2 diabetes (T2D) is a major cardiovascular risk factor (CVRF). Diabetes confers two to four times more cardiovascular risk (CVR). The risk is even higher in patients with T2D who have suffered an acute myocardial infarction (AMI) or cerebrovascular accident (CVA). The dyslipidemia of T2D consists of high fasting triglycerides, with greater postprandial excursion, low levels of HDLc and qualitative alterations of LDLc and HDLc. Appropriate glycemic control in T2D greatly improves lipoprotein abnormalities. Lipid-lowering therapy is key to reducing CVR in T2D. The CVR reduction achieved with statins is based on the reduction of LDLc. In patients who persist with an altered lipid profile despite highdose statins, the addition of other lipid-lowering agents to reduce atherogenic lipoproteins may be considered.
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Introduction Intracranial aneurysm (IA) is a major healthcare concern. The use of statin to reduce serum cholesterol has shown evidence to reduce cardiovascular risk in various diseases, but the impact on IA has not been described. This study aims to determine whether statin use, and serum cholesterol levels interfere with outcomes after IA event. Methods A cohort of patients with IA was analyzed. Patients social and demographics data were collected.Modified Rankin scale (mRS) score after 6months of follow-up was the endpoint. The data regarding statins use, presence or not of atherosclerotic plaque in radiological images and serum cholesterol of 35 patients were included in our study. Linear regression models were used to determine the influence of those 6 variables in the clinical outcome. Results The prevalence of atherosclerotic plaque, high cholesterol and use of statins was 34.3%, 48.5%, and 14.2%, respectively. Statins and serum cholesterol did not impact the overall outcome,measured by mRS after 6 months (p>0.05), but did show different tendencies when separated by IA rupture status. Serum cholesterol shows na important association with rupture of aneurysm (p»0.0382). High cholesterol and use of statins show a tendency for worse outcome with ruptured aneurysm, and the opposite is true for unruptured aneurysm. The presence of atherosclerotic plaques was not related with worse outcomes. Conclusions Multiple and opposite mechanisms might be involved in the pathophysiology of IA. Ruptured aneurysms are associated with higher levels of serum cholesterol. Serum cholesterol and statins use were not correlated with worse outcomes, but further studies are important to clarify these relationships.
Introdução Aneurisma intracranial (AI) é uma grande preocupação para a saúde. Evidências apontam que o uso de estatina para reduzir o colesterol sérico diminui o risco cardiovascular em diversas doenças, mas o impacto em AI ainda não foi descrito. Este estudo almeja determinar se o uso de estatina e o nível sérico de colesterol interferem no desfecho clínico após a ocorrência de AIs. Métodos Uma coorte de pacientes com AI foi analisada. Os dados sociodemográficos dos pacientes foram coletados. Ao final de 6 meses de acompanhamento, aplicou-se a escala modificada de Rankin (mRS). Os dados sobre uso de estatina, existência de placa aterosclerótica em imagens radiológicas, e colesterol sérico de 35 pacientes foram incluídos no estudo. Modelos de regressão linear foram usados para determinar a influência dessas 6 variáveis nos desfechos clínicos. Resultados A prevalência de placa aterosclerótica, colesterol elevado, e uso de estatina foram respectivamente 34,3%, 48,5% e 14,2%. Estatina e colesterol sérico não impactaram nos desfechos medidos pela mRS em 6 meses (p > 0,05), mas mostraram diferentes tendências quando separados pelo estado de ruptura do AI. Colesterol sérico apresenta uma importante associação com ruptura de aneurisma (p » 0,0382). Colesterol elevado e uso de estatinas representam uma tendência a piores desfechos para aneurismas rompidos, e o oposto é verdade para os não rompidos. A presença de placa aterosclerótica não está relacionada com piores resultados. Conclusões Mecanismos múltiplos e opostos podem estar envolvidos na patofisio logia do AI. Aneurismas rompidos estão associados com maiores níveis de colesterol sérico. Colesterol sérico e estatinas não foram correlacionados com piores desfechos, mas mais estudos são importantes para clarificar a relação entre esses fatores
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Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Anévrysme intracrânien , Cholestérol/analyse , Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase/analyse , Plaque d'athérosclérose/épidémiologie , Modèles linéaires , Études de cohortes , Interprétation statistique de donnéesRésumé
High-intensity statins are the cornerstone of medical management in Acute Coronary Syndromes (ACS). However, their effect on neurocognition are less clear. In this prospective observational study, we gave guideline-directed high-intensity atorvastatin 40 mg to middle-aged statin-naïve ACS patients. Memory assessments were performed before and 6 months after statin therapy using 2 validated scales-the PostGraduate Institute Memory Scale (PGI-MS), and the Logical Memory Passage Test (LMPT). There was no significant difference in the mean PGI-MS test scores (baseline 75.4 ± 7.9, 6months 76.5 ± 8.2;p ¼ 0.26) or the overall composite scores (baseline 32.02 ± 3.2, 6months 32.8 ± 3.1; p ¼ 0.20), after 6 months of statin use. There was a small improvement in immediate recall (baseline score 8.5 ± 2.5, 6 months 9.04 ± 1.8; p ¼ 0.05), and delayed recall (baseline 6.1 ± 2.6, 6 months 6.9 ± 1.9, p ¼ 0.002). High-intensity atorvastatin use did not affect memory at 6 months among statin-naïve middle-aged patients with ACS.
Résumé
SUMMARY: Statins inhibit cholesterol synthesis, but also have other pleiotropic effects. There are indications that they affect macrophage survival trough the regulation of apoptosis. We analyzed 50 samples of aortic wall, selected based on statins in patients' therapy (n=25, Th-S group) or statin-free therapy (n=25, Th-nonS group). Each group had 5 samples of healthy aortic tissue, 10 samples of mild and 10 samples of severe atherosclerotic changes in aortic wall. Tissue was stained with hematoxylin-eosin and immunohistochemical methods (anti-Bcl-2 antibody). Presence of Bcl2-positive macrophages (Bcl-2+ MP) was determined semiquantitatively, and data were processed in Microsoft Excell and IMB SPSS 23 Statistics. 60 % of patients in the Th-S group had a mild increase of Bcl-2+ MP The use of statins leads to a significantly more frequent increase in Bcl2+ macrophages in the intima of the healthy aortic tissue. Analysis of all aortic samples with pathohistological diagnosis showed that statin therapy was statistically significantly more often leading to a markedly increased presence of Bcl-2+ MP. In the media, all samples of the Th-S group have a mild increase of Bcl-2+ MP, and in adventitia 40 % of patients. The use of statins more often leads to a markedly increased presence of Bcl-2+ MP in aortic tissue with diagnosed mild and severe atherosclerosis. In samples of severe atherosclerosis, statins lead to a markedly increased presence of Bcl-2+ MP in the parts of the plaque towards the intima and towards the media. Statins lead to an increased presence of Bcl-2+ macrophages, prolong their life, both in healthy and atherosclerotic altered aortic tissue. This indicates potentiation of inflammation and damage to the aortic wall, and calls into question the positive effect of statins on the aortic wall with atherosclerosis.
RESUMEN: Las estatinas inhiben la síntesis de colesterol, pero también tienen otros efectos pleiotrópicos. Hay indicios de que afectan la supervivencia de los macrófagos a través de la regulación de la apoptosis.Se analizaron 50 muestras de pared aórtica, seleccionadas en base a estatinas en tratamiento de pacientes (n=25, grupo Th-S) o en tratamiento libre de estatinas (n=25, grupo Th- nonS). Cada grupo tenía 5 muestras de tejido aórtico sano, 10 muestras de cambios ateroscleróticos leves y 10 muestras de cambios ateroscleróticos severos en la pared aórtica. El tejido se tiñó con hematoxilina-eosina y métodos inmunohistoquímicos (anticuerpo anti-Bcl-2). La presencia de macrófagos positivos para Bcl2 (Bcl- 2+ MP) se determinó semicuantitativamente y los datos se procesaron en Microsoft Excell e IMB SPSS 23 Statistics. El 60 % de los pacientes del grupo Th-S tuvo un aumento leve de Bcl-2+ MP. El uso de estatinas conduce a un aumento significativamente más frecuente de macrófagos Bcl2+ en la íntima del tejido aórtico sano. El análisis de todas las muestras aórticas con diagnóstico anatomopatológico mostró que la terapia con estatinas fue significativamente más frecuente desde el punto de vista estadístico, lo que condujo a una presencia marcadamente mayor de Bcl-2+ MP. En los medios, todas las muestras del grupo Th-S tienen un leve aumento de Bcl-2+ MP, y en adventicia en el 40 % de los pacientes. El uso de estatinas con mayor frecuencia conduce a una presencia marcadamente mayor de MP Bcl-2+ en el tejido aórtico con aterosclerosis leve y grave diagnosticada. En muestras de aterosclerosis severa, las estatinas conducen a una presencia aumentada de Bcl-2+ MP en las partes de la placa hacia la íntima y hacia la media. Las estatinas conducen a una mayor presencia de macrófagos Bcl-2+, prolongan su vida, tanto en tejido aórtico sano como aterosclerótico alterado. Esto indica la potenciación de la inflamación y el daño a la pared aórtica y pone en duda el efecto positivo de las estatinas en la pared aórtica con aterosclerosis.
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Humains , Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase/administration et posologie , Athérosclérose/métabolisme , Aorte/effets des médicaments et des substances chimiques , Facteurs de risque , Apoptose/effets des médicaments et des substances chimiques , Appréciation des risques , Gènes bcl-2/physiologie , Athérosclérose/traitement médicamenteux , Protéine bcl-X/métabolisme , Plaque d'athérosclérose , Macrophages/effets des médicaments et des substances chimiquesRésumé
Abstract The aim of our study was to assess risk factors for potential drug-drug interactions (pDDIs) of statins across different phases of treatment of acute coronary syndrome (ACS) patients: from the point of first medical contact to the coronary angiography (first phase), after coronary angiography to the last day of hospitalization (second phase) and at discharge from hospital (third phase). This was a post hoc analysis of the data collected during the retrospective observational cohort study conducted at the Clinic for Cardiology of the Clinical Centre Kragujevac, Serbia. Patients prescribed statins were identified from the original study population: 156, 240 and 236 patients for the first, second and third phases, respectively. At least one statin pDDI was present in 113 (72.4%), 161 (67.1%) and 139 (58.9%) patients in the first, second and third phases, respectively. Heart failure, arrhythmias after ACS, CRP, triglycerides, length of hospitalization, number of prescribed drugs, antiarrhythmic drugs, and clopidogrel seem to increase the risk of statin pDDIs in at least one treatment phase. Physicians should be vigilant to the possibility of statin pDDIs in ACS patients who have factors that may increase their rate.