Statins: Can we advocate them for primary prevention of heart disease?

Abstract

a b s t r a c tThe discovery of cholesterol-lowering agents, namely HMG-CoA reductase inhibitors or statins, ushered in a series of large cholesterol reduction trials. The first of these studies was the Scandinavian Simvastatin Survival Study (4S) in which hypercholesterolemic men with CHD who were treated with simvastatin had a reduction in major coronary events of 44% and a reduction in total mortality of 30%. Many more secondary prevention trials followed to establish unequivocally the benefit of cholesterol reduction. Strategies that aim to improve primary prevention are important for managing the overall burden of disease.Recently therefore, the role of statin in primary prevention is being debated. The JUPITER trial and more recently the Cholesterol Treatment Trialists collaborators, proved that incidences of first major cardiovascular events in apparently healthy individuals were reduced by statins. Statins have also been discussed to be having certain pleiotropic effects on other diseases like diabetes, cancer and osteoporosis. However, issues of cost effectiveness and adverse effects like myositis, and transaminitis still loom large. The medical community needs to debate and evolve a possible consensus on the path breaking subject.ª 2013, Armed Forces Medical Services (AFMS). All rights reserved.

Atorvastatin improves left ventricular remodeling and cardiac function in rats with congestive heart failure by inhibiting RhoA/Rho kinase‑mediated endothelial nitric oxide synthase

“…Ato is a lipid-regulating statin that functions by inhibiting the synthesis of 3-hydroxy-3-methyl glutaryl coenzyme A reductase (30). However, its non-lipid-regulating roles have not yet been fully elucidated.…”

“…Statins are able to block 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, which reduces the cholesterol synthesis (30) and blocks the production of isoprenylated products in the mevalonate pathway (38). As RhoA protein can therefore not be prenylated, a large number of inactive RhoA protein accumulate in the cytoplasm, extending the half-life of eNOS mRNA (38).…”

Effect of <i>Carica papaya</i> Leaf Extract on Serum Lipids and Liver Metabolic Parameters of Rats Fed a High Cholesterol Diet

“…Therefore, alternative approaches are eagerly needed; plant-based therapies attract much interest as they are effective in reducing lipid levels [3]. The treatment for hypercholesterolemia and CVDs with medicinal plants has increased and seems to produce lower undesirable side effects [4]. Several reports have shown that herbal medicine reduces lipid peroxidation in blood, has anti-cancer activity in vitro and it is useful for treating infectious disease [5].…”

Toxicology and Pharmacokinetics Study of Intradiscal Injection of Simvastatin in Rabbits

“…Consumption of isoprenoid compounds (the so-called "multiple action" effect of statins) results in a loss of protein isoprene and reduction of coenzyme Q-10, which promotes apoptosis, oxidation and permanent mitochondrial localization defect (Mammen and Amato, 2010). Uncommon adverse events include arthropathy, liver toxicity, insomnia, memory loss, insanity, peripheral neuropathy, erectile dysfunction, diabetes, impaired myocardial contractility, and autoimmune diseases (Godlee, 2014;Ray et al, 2014). Therefore, the method of local administration chosen in this study is to reduce the adverse effects of simvastatin on the system.…”