Thesis (Ph.D.)--The University of Texas Southwestern Medical Center at Dallas, 2006. / Embargoed. Vita. Bibliography.

In February 2012, the FDA issued safety label changes and monitoring requirements for statin therapy. A risk of cognitive impairment was noted, although evidence was largely based on observational data, including case reports. In 2014, the National Lipid Association's safety task force found that evidence does not support cognitive decline as a classwide effect for statins. Some evidence has shown that statins may actually have beneficial effects on cognition. This article discusses management of statin therapy in patients with cardiovascular risk who may experience cognitive decline or have cognitive impairment, such as Alzheimer disease.

No description available.

There is conflicting data on the effects of statins on cerebral vasospasm and clinical outcomes in aneurysmal subarachnoid hemorrhage (aSAH) patients. In this retrospective cohort study, patients were divided into those who received pravastatin (PRAV group) 40mg/d and those who did not (NP group). Data were analyzed using multivariate logistic regression. Eighty-one patients met inclusion criteria. There was a statistically significant decreased in the incidence of vasospasm in the PRAV group; however, this association did not retain significance after adjusting for WFNS, race, elevated WBC, and clipping (59% PRAV vs. 88% NP, p=0.08). There was no statistically significant difference in proportion of severe radiological vasospasm or mortality between groups. However, there was a trend towards a decreased mean length of stay (P=0.06) and a significantly higher proportion of survivors discharged to home in the PRAV group (P<0.0001). In conclusion, there was a trend towards a decrease in the incidence of vasospasm in the aSAH receiving pravastatin, but this trend did not achieve statistical significance after adjusting for potential confounders. Pravastatin was associated with other favorable clinical outcomes.

As dislipidemias são importantes fatores de risco para desenvolvimento de Doenças Cardiovasculares (DCV) comprovado através de grandes estudos observacionais. Estudos demonstraram que a prescrição regular de hipolipemiantes (estatinas e fibratos) pode reduzir a ocorrência de eventos cardiovasculares e diminuir a mortalidade. Objetivou-se realizar uma análise econômica e a influência de atorvastatina, sinvastatina, bezafibrato e ciprofibrato sobre a morbimortalidade cardiovascular em indivíduos que fizeram uso destes medicamentos em 2007 dispensados no Programa de Medicamentos Excepcionais do Ministério da Saúde distribuídos pela Farmácia Ambulatorial do Hospital das Clínicas da FMRP-USP. Trata-se de um estudo observacional, descritivo e de caráter transversal. A casuística foi composta por 332 (31,11%) indivíduos sorteados aleatoriamente dentre 1067 pacientes (erro padrão de 5%), de ambos os sexos, encaminhados pelo Sistema Único de Saúde (SUS) e consultórios particulares. Os indivíduos selecionados foram submetidos a uma entrevista e seus prontuários médicos analisados. Dos 310 pacientes entrevistados, 157 (51%) eram do sexo masculino. A faixa etária variou de 15 a 63 anos (X= 62,0 ± 12,23). Constatou-se 5 óbitos em 2007, sendo 100% do sexo masculino, com idade variando de 57 a 74 anos (X= 68,2 ± 6,95). 227 (73,22%) pacientes fizeram uso de estatinas, 54 (17,42%) de fibratos e 31 (10%) controles (sem uso de medicamentos). De 246 (79,35%) indivíduos analisados, a média do índice de massa corpórea (IMC) foi >28,7 Kg/m2; 121 (39%) pacientes fizeram uso de sinvastatina, 104 (34%) atorvastatina, 25 (8%) ciprofibrato, 29 (9%) bezafibrato. O perfil lipídico apresentou-se mais elevado no grupo atorvastatina e bezafibrato. Em relação aos eventos e/ou procedimentos, houve um total de 253. 132 (52,17%) pacientes apresentaram aterosclerose documentada, 60 (23,71%), angina pectoris, 28 (11,47%) insuficiência cardíaca, 6 (2,44%) infarto agudo do miocárdio, 6 (2,44%) aneurisma arterial e 4 (1,62%) acidente vascular encefálico. Quanto aos procedimentos, constatou-se a realização de 11 cateterismos cardíacos e 7 angioplastias. Quanto à análise econômica, o tratamento do grupo atorvastatina apresentou o maior custo (R$994,69 paciente/ano), já no grupo da sinvastatina (R$337,61 paciente/ano) houve maiores gastos com exames laboratoriais e complementares. Entre o grupo dos fibratos não houve diferenças importantes com relação ao custo do tratamento. Conclui-se que entre os indivíduos estudados, prevaleceu a população idosa, maior número de óbitos no sexo masculino; houve a prevalência de sobrepeso/obesidade (IMC > 25 kg/m2); aterosclerose documentada e angina pectoris foram os eventos cardiovasculares predominantes e o cateterismo cardíaco o procedimento mais realizado. O tratamento com atorvastatina foi o mais oneroso, entretanto, seus pacientes apresentaram menor ocorrência de eventos e procedimentos cardiovasculares, além do menor custo com exames laboratoriais. / Dyslipidemias are a major risk factor for the development of cardiovascular diseases. Several studies have shown that regular prescribing of lipid-lowering drugs (statins and fibrates) can reduce cardiovascular events and decrease overall mortality. The objectives of this study were to perform a economic analysis and the influence of atorvastatin, simvastatin, bezafibrate or ciprofibrate on the cardiovascular morbimortality in individuals who used these drugs during the year of 2007, dispensed by the Outpatient Pharmacy of Clinical Hospital of FMRP-USP according to the Exceptional Medicines Program of Ministry of Health. This is an observational and descriptive study of transversal character. The sample was composed of 332 (31,11%) individuals, randomly selected among 1067 patients (standard error of 5%), of both sexes, living in Ribeirão Preto-SP conveyed by the Single System of Health (SUS) and private clinics. Individuals were submitted to an interview and had their medical records examined. Among the 310 patients interviewed, 157 (51%) were males with ages ranging from 15 to 63 years old (X= 62,0 ± 12,23). Five deaths were reported in 2007, and of those patients, 100% were males, with ages ranging from 57 to 74 years old (X= 68,2 ± 6,95). 227 (73,22%) patients were using statins, 54 (17,42%) fibrates and 31 (10%) controls (no use of drugs). The average of body mass index (BMI) of 246 (79,35%) patients evaluated was above 28,7 Kg/m2; 121 (39%) patients were using simvastatin, 104 (34%) atorvastatin, 25 (8%) ciprofibrate and 29 (9%) bezafibrate. The lipid profile was more elevated in atorvastatin and bezafibrate groups. A total of 253 events and/or procedures were found. 132 (52,17%) patients had atherosclerosis documented, 60 (23,71%) angina pectoris, 28 (11,47%) heart failure, 6 (2,44%) acute myocardial infarction, 6 (2,44%) arterial aneurysm, 4 (1,62%) vascular brain accident. Regarding the procedures, 11 cardiac catheterism and 7 angioplasties were verified. Regarding the economic analysis, atorvastatin treatment group showed to be the most expensive one (R$ 994,69 patient/year). For the simvastatin group (R$337,61 patient/year), there were increased costs for lab and complementary tests, while among the group of fibrates there were no substantial differences in the cost of treatments. It is concluded that among the evaluated individuals, there was a prevalence of elderly people, deaths of male patients and overweight (BMI > 25kg/m2). The presence of atherosclerosis and angina pectoris were the predominant cardiovascular events and the cardiac catheterism procedure was the most performed. Although treatment with atorvastatin was the most expensive, patients in that treatment had a lower incidence of cardiovascular events and procedures, and lower costs with lab and complementary tests.

Orientador: Anibal Eugenio Vercesi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-09-11T21:10:31Z (GMT). No. of bitstreams: 1 Velho_JesusAntonio_D.pdf: 7243183 bytes, checksum: e41359a2677f40435f99f0f40830ee99 (MD5) Previous issue date: 2007 / Resumo: Resultados recentes do nosso grupo demonstram que mitocôndrias de camundongos hipercolesterolêmicos por deficiência do receptor de LDL (LDLR-1-) apresentam uma baixa capacidade antioxidante em função do alto consumo de NADPH para sustentar elevadas taxas de lipogênese (Oliveira et al., FASEB J. 19: 278-280; 2005). Neste trabalho, o estresse oxidativo mitocondrial dos camundongos LDLK-/- foi caracterizado, mostrando uma diminuição da razão GSH/GSSG e altos níveis de grupos carbonilas protéicos quando comparado com camundongos controles. Não foram encontradas diferenças significativas na atividade do sistema antioxidante glutationa peroxidase/redutase. Catalase exógena preveniu a oxidação espontânea de NAD(p)H endógeno em mitocôndrias isoladas de camundongos LDLR-/-, indicando que esta oxidação é mediada por 'H IND. 2' 'O IND. 2' gerado pela mitocôndria. A alta taxa de liberação de 'H IND. 2' 'O IND. 2' por mitocôndrias de camundongos LDLR-/- também foi previnida na presença de rotenona e isocitrato exógeno, os quais mantém o conteúdo endógeno de NAD(p) completamente reduzido. A nossa hipótese de que altas taxas de lipogênese diminuem a razão NADPH/NADP+ devido à redução do conteúdo de substratos ligados ao NADP é suportada pela observação de que o consumo de oxigênio mantido por substratos endógenos foi menor em mitocôndrias de camundongos LDLR-/- quando comparado com mitocôndrias controles, mas foi similar na presença de isocitrato exógeno. De fato, os níveis mitocondriais de isocitrato foram significativamente menores em camundongos LDLK-/-. Na segunda parte do trabalho, nós utilizamos estatinas (inibidores da 3- hidróxi-3-metilglutaril CoA redutase) na tentativa de corrigir o estresse oxidativo observado em camundongos LDLR-/-, mas descobrimos que o tratamento com a lovastatina piora este efeito. Mitocôndrias isoladas de figado de camundongos LDLR-/- tratados durante 15 dias com doses terapêuticas (100 mg/kg, v.o.) de lovastatina apresentaram uma maior susceptibilidade para desenvolver transição de permeabilidade mitocondrial (TPM). Em experimentosin vitro, lovastatinainduziuTPM de forma dose-dependente (10-80 'mu'M) por um mecanismo sensível a ciclosporina A (inibidor de ciclofilina), ditiotreitol (agente redutor), ADP (inibidor do translocador de nucleotídeo de adenina), catalase (redutor de 'H IND. 2' 'O IND. 2') e EGTA (quelante de cálcio). Em concordância com a inibição do inchamento mitocondrial por ditiotreitol, a lovastatina também diminuiu o conteúdo de grupos tiólicos de proteínas de membrana. Sinvastatina teve efeitos similares a lovastatina sobre as mitocôndrias; entretanto a pravastatina, uma estatina hidrofilica, apresentou menor capacidade de induzir a TPM. Estes resultados demonstram que estatinas podem atuar diretamente na mitocôndria tanto in vivo quanto in vitro induzindo transição de permeabilidade, que é um processo envolvido na morte celular / Abstract: Recent results from our group demonstrated that hypercholesterolemic LDL receptor knockout (LDLR-/-) mice mitochondria possess a lower antioxidant capacity due to a large consumption of reducing equivalents from NADPH to sustain high rates of lipogenesis (Oliveira et al., FASEB J.; 19: 278-280; 2005). In this work, LDLR-/- mice oxidative stress was further characterized by showing a lower mitochondrial GSH/GSSG ratio and a higher liver content of protein carbonyls as compared to control mice. No differences in the activity of the antioxidant enzyme system glutathione reductase/peroxidase was observed. Exogenous catalase prevented the spontaneous oxidation of endogenous NAD(p)H in mitochondria isolated from LDLR-/- mice, indicating that this oxidation is mediated by mitochondrial generated 'H IND. 2' 'O IND. 2'. The higher rate of 'H IND. 2' 'O IND. 2' release in LDLK/- mitochondria was also prevented by the presence of exogenous isocitrate and rotenone, which maintain NADP fully reduced. Our hypothesis that high rates of lipogenesis decreases NADPH/NADP+ ratio due to a decreased content of NADP-linked substrates is supported by observations that oxygen consumption supported by endogenous substrates was lower in LDLR-/- mice than in control mitochondria, but was similar in the presence of exogenous isocitrate. Indeed, endogenous mitochondriallevels of isocitrate were significantly lower in LDLK-/- mice. ln the second part ofthis work, we used statins (3-hydroxy-3-methylglutaryl-CoA reductase inhibitors) in an attempt to Correct the oxidative stress observed in LDLK-/- mice, but we found that the drug treatment worsened this defect. We report here that liver mitochondria isolated from hypercholesterolemic LDL receptor knockout mice treated during 15 days with therapeutic doses (100 mg/kg, p.o.) of lovastatin presented a higher susceptibility to develop membrane permeability transition (MPT). In experiments in vitro, lovastatin induced MPT in a dose-dependent manner (10-80 'mu' M) by a mechanism sensitive to cyclosporin A (cyclophilin inhibitor), dithiothreitol (reducing agent), ADP (adenine nucleotide carrier inhibitor), catalase ('H IND. 2' 'O IND. 2' reductant) and EGTA (calcium chelator). In agreement with the inhibition of the mitochondrial swelling by dithiothreitol, lovastatin also decreased the content of total mitochondrial membrane protein thiol groups. Simvastatin had similar effects on mitochondria; however, pravastatin, a hydrophilic statin, had a weaker effect in inducing MPT. These results demonstrate that statins can act directly on mitochondria either in vivo or in vitro inducing permeability transition, which is a process involved in cell death / Doutorado / Biologia Estrutural, Celular, Molecular e do Desenvolvimento / Doutor em Fisiopatologia Medica

Cheung, Chi Yun. / "September 2011." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 57-59). / Abstracts in English and Chinese. / Acknowledgment --- p.i / Table of Contents --- p.ii / Abstract --- p.iii / Abstract (Chinese Version) --- p.iv / Abbreviation --- p.v / Chapter 1. --- Introduction --- p.1 / Chapter 1.1 --- General Background --- p.1 / Chapter 1.2 --- Mechanism of action --- p.3 / Chapter 1.2.1 --- Biosynthetic pathway of cholesterol --- p.3 / Chapter 1.2.2 --- Inhibition of HMG-CoA reductase by statins --- p.4 / Chapter 1.2.3 --- Plasma cholesterol reduction effect --- p.5 / Chapter 1.3 --- Previous syntheses of statin analogs --- p.5 / Chapter 1.3.1 --- Synthesis from (S)-malic acid --- p.6 / Chapter 1.3.2 --- Synthesis via enantioselective deprotonation --- p.7 / Chapter 1.3.3 --- Synthesis via asymmetric Diels-Alder reaction --- p.9 / Chapter 2. --- Results and Discussion --- p.11 / Chapter 2.1 --- Approaches towards construction of statin analogs --- p.11 / Chapter 2.2 --- Attempt to synthesize alkene 49 from D-arabinose --- p.12 / Chapter 2.3 --- Construction of alkene 49 from D-mannitol --- p.14 / Chapter 2.4 --- Olefin metathesis and conversion to statin analogs --- p.28 / Chapter 3. --- Conclusion --- p.32 / Chapter 4. --- Experimental Section --- p.33 / Chapter 5. --- References --- p.57 / Chapter 6. --- Appendix ii --- p.60

The endothelium plays an essential role in the regulation of vascular homeostasis and a state of endothelial dysfunction, which develops in the presence of cardiovascular risk factors, may contribute to the development and progression of cardiovascular disease. As such, the measurement of endothelial function, beyond being an experimental tool, may serve as an important tool to complement current risk assessment algorithms in the identification of high-risk patients. Flow-mediated dilation (FMD) is a non-invasive measure of peripheral conduit artery endothelial function that holds great promise. Presently, FMD suffers from methodological heterogeneity and a poor understanding of the various biological components involved in eliciting the dilatory response to a given shear stimulus. We compared both traditional and alternative methods of arterial diameter characterization with regards to their repeatability, nitric oxide-dependency, and their sensitivity in distinguishing between normal and dysfunctional endothelial responses. Our findings emphasize the importance of continuous arterial diameter measurement and suggest that the time to peak FMD is not a useful adjunctive measure of the FMD response. Given that endothelial dysfunction may be of clinical importance, strategies to correct it or prevent it from occurring may be of benefit. The 3-hydroxy-3-methylglutaryl coenzyme A inhibitors are agents that have demonstrated marked cholesterol-independent, endothelial-protective effects. We investigated the ability of rosuvastatin and atorvastatin to protect against endothelial dysfunction associated with ischemia and reperfusion (IR) injury, and chronic nitrate therapy. Using the FMD technique, we demonstrated, for the first time in humans, that acute rosuvastatin administration protects against IR-induced conduit artery endothelial dysfunction. Additionally, we demonstrated that this effect likely occurred by a cyclooxygenase-2-dependent mechanism, which may provide mechanistic insight into the observed cardio-toxicity with cyclooxygenase-2 inhibitors. In contrast, we observed that this endothelial-protective effect was lost upon sustained rosuvastatin administration, which may have important implications regarding the generation of sustained cardioprotective phenotypes. Finally, we demonstrated that atorvastatin co-administration prevented the development of tolerance and endothelial dysfunction associated with continuous transdermal nitroglycerin therapy in humans, likely through an antioxidant mechanism. Future studies are needed in disease patients to determine whether the concept of nitrate tolerance needs reconsideration in the presence of vascular-protective agents.

The endothelium plays an essential role in the regulation of vascular homeostasis and a state of endothelial dysfunction, which develops in the presence of cardiovascular risk factors, may contribute to the development and progression of cardiovascular disease. As such, the measurement of endothelial function, beyond being an experimental tool, may serve as an important tool to complement current risk assessment algorithms in the identification of high-risk patients. Flow-mediated dilation (FMD) is a non-invasive measure of peripheral conduit artery endothelial function that holds great promise. Presently, FMD suffers from methodological heterogeneity and a poor understanding of the various biological components involved in eliciting the dilatory response to a given shear stimulus. We compared both traditional and alternative methods of arterial diameter characterization with regards to their repeatability, nitric oxide-dependency, and their sensitivity in distinguishing between normal and dysfunctional endothelial responses. Our findings emphasize the importance of continuous arterial diameter measurement and suggest that the time to peak FMD is not a useful adjunctive measure of the FMD response. Given that endothelial dysfunction may be of clinical importance, strategies to correct it or prevent it from occurring may be of benefit. The 3-hydroxy-3-methylglutaryl coenzyme A inhibitors are agents that have demonstrated marked cholesterol-independent, endothelial-protective effects. We investigated the ability of rosuvastatin and atorvastatin to protect against endothelial dysfunction associated with ischemia and reperfusion (IR) injury, and chronic nitrate therapy. Using the FMD technique, we demonstrated, for the first time in humans, that acute rosuvastatin administration protects against IR-induced conduit artery endothelial dysfunction. Additionally, we demonstrated that this effect likely occurred by a cyclooxygenase-2-dependent mechanism, which may provide mechanistic insight into the observed cardio-toxicity with cyclooxygenase-2 inhibitors. In contrast, we observed that this endothelial-protective effect was lost upon sustained rosuvastatin administration, which may have important implications regarding the generation of sustained cardioprotective phenotypes. Finally, we demonstrated that atorvastatin co-administration prevented the development of tolerance and endothelial dysfunction associated with continuous transdermal nitroglycerin therapy in humans, likely through an antioxidant mechanism. Future studies are needed in disease patients to determine whether the concept of nitrate tolerance needs reconsideration in the presence of vascular-protective agents.

Evidence suggests that there is an immunological response of the recipient to xenograft bioprosthetic heart valves. Information on the impact of HMG-CoA reductase inhibitors (statins) and their anti-inflammatory properties on bioprosthetic valve failure remains limited. We sought to examine the efficacy of statin therapy in a rodent model of bioprosthetic valve implantation. To mimic the human scenario, fresh or glutaraldehyde-fixed aortic valve root conduits from Lewis rats or Hartley guinea pigs were microsurgically implanted intravascularly into the infra-renal aorta of Lewis rats. The syngeneic control group consisted of a fresh rat valve conduit implanted into a rat. The xenogeneic control group consisted of a glutaraldehyde-fixed guinea pig valve conduit implanted into a rat. Treatment groups consisted of xenogeneic groups treated with either daily steroids or statins. Overall, steroid treatment attenuated the inflammatory response observed within the xenogeneic glutaraldehyde-fixed valve conduits. Treatment with statins did not decrease this inflammatory response.