Clinical efficacy and safety of statins in managing cardiovascular risk

Division of Cardiology, Tufts University, New England Medical Center, Boston, MA 02111, USA.
Vascular Health and Risk Management 02/2008; 4(2):341-53.
Source: PubMed

ABSTRACT Since their introduction in the 1980s, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) have emerged as the one of the best-selling medication classes to date, with numerous trials demonstrating powerful efficacy in preventing cardiovascular outcomes. As our understanding of low-density lipoprotein cholesterol (LDL-C) and atherosclerosis continues to grow, the concept of 'lower is better' has corresponded with a more is better' approach to statin-based therapy. This review provides a detailed understanding of the clinical efficacy and safety of statins with a particular emphasis on the third generation drug, rosuvastatin.

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    • "The most recent drugs developed for this purpose are statins or 3-hydroxy-3-methyglutaryl coenzyme A reductase inhibitors which used for prevention and treatment of CHD; they lower cholesterol levels by 20% -30%, and even more at higher doses, and this has been clinically proven to produce an equivalent decrease in the risk of myocardial infarction and death [4]. Statins have become one of the best-selling medication classes to date since their introduction into the marketplace in 1986, and include the following drugs commercially available in the US: atorvastatin, lovastatin, pravastatin, fluvastatin, simvastatin and rosuvastatin [5]. Statins are highly effective in reducing cardiovascular mortality and are widely prescribed with best selling. "
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    ABSTRACT: Statins, which are inhibitors of 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase, are consi-dered as one of the most important drugs and the drug of choice for reducing an abnormal choles-terol level. Statins are normally used to decrease the risk of coronary heart disease (CHD), but they tend to be associated with liver adverse effects. The objective of this prospective study was to investigate the effect of atorvastatin therapy on the liver function in patients with CHD. Study comprised of 66 newly diagnosed CHD patients who were selected from UNRWA clinics in the Gaza Strip. The patients were clinically examined and treated with atorvastatin (10 -40 mg/day). A questionnaire was used to collect the data concerning patient's characteristics. Total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), liver enzymes tests such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and total and direct blood bilirubin were measured before starting treatment and after 3 and 6 months of treatment. The results showed a significant increase in the mean values of ALT, AST, total bilirubin and direct bilirubin levels after 3 months then decreased after the next 3 months, but they were higher than the baseline with insignificant association.
    Pharmacology & Pharmacy 07/2014; 05(08). DOI:10.4236/pp.2014.58088
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    • "Pharmacology patients of non-ischaemic dilated cardiomyopathy with severe heart failure, independently of their lipid-lowering effects (Li et al., 2010). Statins possess, besides cholesterollowering action, numerous pleiotropic properties including nitric oxide-mediated improvement in endothelial function, antioxidant effects, anti-inflammatory properties and prevention of atherosclerotic plaque formation (Treasure et al., 1995; Masumoto et al., 2001; Kapur and Musunuru, 2008), all of which collectively could be involved in statin-mediated improvement of cardiovascular outcomes. PPARs are key transcriptional regulators of carbohydrate and lipid metabolism and energy production. "
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    ABSTRACT: Statins are best-selling medications in the management of high cholesterol and associated cardiovascular complications. They inhibit 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA)-reductase in order to prevent disproportionate cholesterol synthesis. Statins slow the progression of atherosclerosis, prevent the secondary cardiovascular events and improve the cardiovascular outcomes in patients with elevated cholesterol levels. The underlying mechanisms pertaining to the cardioprotective role of statins are linked with numerous pleiotropic actions including inhibition of inflammatory events and improvement of endothelial function, besides an effective cholesterol-lowering ability. Intriguingly, recent studies suggest possible interplay between statins and nuclear transcription factors like PPARs, which should also be taken into consideration while analysing the potential of statins in the management of cardiovascular complications. It could be suggested that statins have two major roles: (i) a well-established cholesterol-lowering effect through inhibition of HMG-CoA-reductase; (ii) a newly explored PPAR-activating property, which could mediate most of cardiovascular protective pleiotropic effects of statins including anti-inflammatory, antioxidant and anti-fibrotic properties. The present review addressed the underlying principles pertaining to the modulatory role of statins on PPARs.
    British Journal of Pharmacology 07/2011; 165(2):373-9. DOI:10.1111/j.1476-5381.2011.01597.x
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