Article

Association of dyslipidemia and effects of statins on nonmacrovascular diseases.

Cardiovascular Medicine Department, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Clinical Therapeutics (impact factor: 2.32). 03/2004; 26(3):337-51. pp.337-51
Source: PubMed

ABSTRACT Statins have mechanisms of action that expand their effects beyond cholesterol lowering and atherosclerotic medical conditions.
This review summarizes clinical evidence for the association of dyslipidemia and the effects of statin use on aortic stenosis, Alzheimer's dementia (AD), osteoporosis, prevention of diabetes mellitus (DM), diabetic retinopathy, age-related macular degeneration, and diabetic/nondiabetic nephropathy.
An English-language literature search was conducted using MEDLINE (1966-June 2003). Bibliographies of retrieved articles were reviewed. Search terms included statin, HMG-CoA reductase inhibitors, aortic stenosis, Alzheimer's dementia, osteoporosis, prevention of diabetis, diabetic retinopathy, age-related macular degeneration, diabetic nephropathy, and nondiabetic nephropathy.
Three retrospective cohort trials have shown an association between statin use and the progression of aortic stenosis; one of these trials observed a 45% decrease in aortic valve area in 1 year. In AD, one cross-sectional analysis found 60% to 73% lower AD rates in lovastatin or pravastatin recipients ( P<0.001 ). Of the multiple observational studies on the effect of statins on fracture risk, some have shown a decreased risk, with an odds ratio as low as 0.50 (95% CI, 0.33-0.76); others have demonstrated no association. A post hoc analysis of the West of Scotland Coronary Prevention Study found a 30% reduction in the development of DM ( P=0.042 ), but this was not duplicated in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm. A small clinical trial of 6 patients (11 eyes) demonstrated improved retinal hard exudates with pravastatin treatment in patients with diabetic retinopathy. In a cross-sectional analysis, age-related macular degeneration was found to be less common among statin users than nonusers (4% [ 1/27 ] vs 22% [ 76/352 ]; P=0.02. Multiple small clinical trials of 19 to 56 patients with diabetic and nondiabetic nephropathy at various stages generated inconsistent results for an association between statin use and decreased albumin excretion rate and decreased rate of decline in glomerular filtration.
Data of variable quantity and quality support the use of statins as adjuncts in the treatment of nonmacrovascular diseases.

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    Chapter: Oxidative Stress in Diabetic Retinopathy
    Ruth B. Caldwell, Azza E. B. El-Remessy, Robert W. Caldwell
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    ABSTRACT: An association between oxidative stress and the development of diabetes complications has been recognized for over 20 years. An association between oxidative stress and the development of diabetes complications has been recognized for over 20 years. Increased production of reactive oxygen species has been strongly implicated in the pathogenesis of diabetic retinopathy. Increased production of reactive oxygen species has been strongly implicated in the pathogenesis of diabetic retinopathy. However, in spite of overwhelming evidence supporting the damaging consequences of oxidative stress and its established role However, in spite of overwhelming evidence supporting the damaging consequences of oxidative stress and its established role in experimental models of diabetes, the results of large-scale clinical trials with classic antioxidants have failed to show in experimental models of diabetes, the results of large-scale clinical trials with classic antioxidants have failed to show any benefit for diabetic patients. The disappointing results of antioxidant trials in patients underline the importance of any benefit for diabetic patients. The disappointing results of antioxidant trials in patients underline the importance of identifying the specific sites and sources of oxidative stress in the tissues of diabetic patients. This chapter summarizes identifying the specific sites and sources of oxidative stress in the tissues of diabetic patients. This chapter summarizes the current perspective on how diabetes induces oxidative stress in the retina, how diabetes-induced oxidative stress may the current perspective on how diabetes induces oxidative stress in the retina, how diabetes-induced oxidative stress may lead to the development of diabetic retinopathy and reviews strategies for treatment or prevention of diabetic retinopathy strategies for treatment or prevention of diabetic retinopathy by reducing oxida-tive stress. by reducing oxida-tive stress. Key WordsDiabetic retinopathy–oxidative stress–reactive oxygen species–antioxidants–inflammation–cytokines Key WordsDiabetic retinopathy–oxidative stress–reactive oxygen species–antioxidants–inflammation–cytokines
    12/2007: pages 217-242;
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Keywords

56 patients
 
6 patients
 
73% lower AD rates
 
age-related macular degeneration
 
Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm
 
aortic stenosis
 
diabetic nephropathy
 
diabetic/nondiabetic nephropathy
 
English-language literature search
 
multiple observational studies
 
nondiabetic nephropathy
 
nonmacrovascular diseases
 
post hoc analysis
 
pravastatin recipients
 
pravastatin treatment
 
retrospective cohort trials
 
review summarizes clinical evidence
 
Scotland Coronary Prevention Study
 
small clinical trial
 
statin use
 

Sarkis B Baghdasarian