Are There Potential Non???Lipid-Lowering Uses of Statins?

Wheeler, David C.

doi:10.2165/00003495-199856040-00001

Cited by 49 publications

(27 citation statements)

References 47 publications

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“…Following the same logic, it should not be concluded that if for a certain group the association of hyperlipidemia with poor survival is found in observational studies, then only that group would benefit from lipid-lowering interventions. Studies to identify unique characteristics of distinct sub-populations of MHD patients and patients with CHF and more clinical trials on the effect of cholesterol-lowering interventions on CKD survival (50,51) are urgently needed.…”

Section: Perspectivementioning

confidence: 99%

Association between Serum Lipids and Survival in Hemodialysis Patients and Impact of Race

Kilpatrick¹,

McAllister²,

Kövesdy³

et al. 2007

Journal of the American Society of Nephrology

211

180

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Despite the enormous cardiovascular disease epidemic among maintenance hemodialysis (MHD) patients, total hypercholesterolemia seems paradoxically to be associated with better survival. It was hypothesized that similar paradoxic associations also exist for serum LDL, HDL, and triglycerides. A 3-yr (July 2001 through June 2004) cohort of 15,859 MHD patients was studied in the United States from DaVita dialysis clinics where lipid profile was measured in at least 50% of all outpatients during a given calendar quarter. Cox proportional hazard models were adjusted for case mix and surrogates of malnutritioninflammation complex. Both total and LDL hypercholesterolemia showed a paradoxic association with better survival. Hypertriglyceridemia (>200 mg/dl) also showed a similar trend, but serum HDL cholesterol did not have any clear association with survival. The association between a low serum LDL <70 mg/dl, which was prevalent among almost 50% of all MHD patients, and a higher all-cause death risk was robust to multivariate adjustment. In the subgroup analyses, these paradoxic associations persisted among most subgroups, although they tended to be stronger among hypoalbuminemic (<3.8 mg/dl) patients and those with a lower dietary protein intake (<1 g/kg per d). However, in black patients, a high serum LDL (>100 mg/ml) was associated with adjusted cardiovascular death hazard ratio of 1.94 (95% confidence interval 1.12 to 2.38; P ‫؍‬ 0.02). Despite inverse associations between hyperlipidemia and survival, black MHD patients with high LDL show almost two-fold increase in cardiovascular death risk. Although these associations may not be causal, they call into question whether specific subgroups of dialysis patients are better targets for cholesterol-lowering therapy. T he number of maintenance dialysis outpatients in the United States, currently approximately 350,000, is expected to surpass one half million by 2010 and reach 1.5 million by 2016 (1). These individuals experience a low quality of life, high hospitalization rates, and a high mortality rate, currently Ͼ20% annually in the United States, despite many recent improvements in dialysis treatment and techniques (1). Two thirds of all dialysis patients die within 5 yr of initiation of dialysis treatment, a 5-yr survival worse than that of many cancers (1). The causes of death in dialysis patients are diverse; however, approximately half of all dialysis patients die of cardiovascular disease (1).Extrapolation of findings from the general population has led to decades of treating such conventional cardiovascular risk factors in dialysis patients as hypercholesterolemia and hypertension (2). , which utilizes data from the DOPPS study to define the factors that predict early mortality in the first 4 months after transplantation and document the benefit of predialysis care by a nephrologist who can identify and modify these risk factors.guidelines for managing dyslipidemia (3) and cardiovascular disease in dialysis patients (4) have focused on these conventional risk fa...

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Section: Perspectivementioning

confidence: 99%

Association between Serum Lipids and Survival in Hemodialysis Patients and Impact of Race

Kilpatrick¹,

McAllister²,

Kövesdy³

et al. 2007

Journal of the American Society of Nephrology

211

180

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“…These benefits appear to derive largely from a stabilizing effect on vulnerable plaques through modification of lipid profiles even in patients with normal cholesterol levels, as well as anti-inflammatory actions and other properties not directly related to lipid lowering. [24][25][26][27] These mechanisms by which statins make plaques less vulnerable are not well understood. Intravascular ultrasound can now delineate statin-induced changes in plaque constituents.…”

Section: Discussionmentioning

confidence: 99%

“…[19][20][21][22][23] These benefits appear to derive largely from a stabilizing effect on high-risk atherosclerotic plaques through modification of lipid profiles as well as other properties not directly related to lipid lowering. [24][25][26][27] The purpose of this study was to assess the effect of statins on expression of CRP, interleukin-6 (IL-6), adhesion molecules, and anti-oxLDL Ab in patients with unstable angina undergoing coronary stenting.…”

Section: Introductionmentioning

confidence: 99%

Effect of preexisting statin use on expression of C-reactive protein, adhesion molecules, interleukin-6, and antioxidized low-density lipoprotein antibody in patients with unstable angina undergoing coronary stenting

Doo

Han

et al. 2005

Clin Cardiol

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SummaryBackground: Statins are believed to reduce coronary heart disease by mechanisms in addition to their well-known cholesterol lowering effect.Hypothesis: We studied the effect of statins on expression of C-reactive protein (CRP), interleukin-6 (IL-6), adhesion molecules, and antioxidized low-density lipoprotein antibody (anti-oxLDL Ab) in patients with unstable angina (Braunwald class IIb or IIIb) undergoing coronary stenting.Methods: Consecutive 50 patients with unstable angina were included in the study. We classified the study subjects as patients using statins (Group A, n = 20, men 10, mean age 62 years) and patients not using statins (Group B, n = 30, men 15, mean age 60 years).Results: Baseline levels of inflammatory markers were similar in the two groups. However, 24 h after coronary stenting, serum levels of CRP (2.00 vs. 4.63 mg/l, p < 0.05), intercellular adhesion molecule-1 (ICAM-1) (217 vs. 261 ng/ml, p < 0.01), and anti-oxLDL Ab (8.97 vs. 12.96 U/ml, p < 0.05) were significantly higher in Group B than in Group A. Furthermore, 72 h after coronary stenting, serum levels of CRP (3.00 vs. 5.50 mg/l, p < 0.01) and ICAM-1 (222 vs. 277 ng/ml, p < 0.05) were significantly higher in Group B than in Group A.

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“…There is a growing body of evidence to suggest that statins have pleiotropic effects that help to stabilize vulnerable atherosclerotic plaques [6,7]. These include improved endothelial function and vasomotion, antiproliferative and anti-inflammatory actions, and diminished platelet reactivity and thrombogenicity.…”

Section: Opinion Statementmentioning

confidence: 99%

Dyslipidemia

Cohen

Rader

2001

Curr Treat Options Cardio Med

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The major goal in treatment of patients with dyslipidemia is to decrease the short- and long-term incidence of cardiovascular events, including myocardial infarction, unstable angina, stroke, and death. A second goal in patients with severe hypertriglyceridemia is to decrease the risk of acute pancreatitis. Improvement of the lipid profile can be achieved through a combination of aggressive lifestyle modification and effective drug therapy. Treatment should be tailored to the individual patient, based on the specific lipid abnormalities, the presence or absence of pre-existing coronary artery or other atherosclerotic vascular disease, and an assessment of overall cardiovascular risk.

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Are There Potential Non???Lipid-Lowering Uses of Statins?

Cited by 49 publications

References 47 publications

Association between Serum Lipids and Survival in Hemodialysis Patients and Impact of Race

Association between Serum Lipids and Survival in Hemodialysis Patients and Impact of Race

Effect of preexisting statin use on expression of C-reactive protein, adhesion molecules, interleukin-6, and antioxidized low-density lipoprotein antibody in patients with unstable angina undergoing coronary stenting

Dyslipidemia

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