Wednesday, May 10, 2006

More uses of statins

Statins (HMG Co A reductase) eg pravastatin, simvastatin, atorvastatin, fluvastatin, rosuvastatin, has revolutionalised treatment of coronary artery disease. They started as agents that very effectively lower cholesterol, especially LDL-cholesterol (bad cholesterol). They were then shown to significantly reduce death and cardiac events (eg angina, heart attacks and strokes) on longterm followup in patients with known heart disease and also in those with no know heart disease. This was partly attributable to their LDL-lowering effect, and partly to their pleotrophic effect. These pleotrophic effect was thought to be mainly anti-inflammatory. More and more studies have began to unveil more and more extra-cholesterol lowering of statins, not all of which are anti-inflammatory.

In the May 2006 issue of the American Heart Journal, Dr S. Atar of the University of Texas, Galveston, reported that in a retrospective analysis of the OPUS-TIMI 16 study on acute coronary syndrome, he noted that patients on "statins" had a lower incidence of GIT bleed in this trial which studied 10,288patients with chest pains and who were given aspirin and also orbofiban (a Glycoprotein 2B3A, a bleeding causing agent). This is indeed interesting, because one possible reason for this findings maybe the induction of prostacyclin, which may be gastro-protective. By the way, prostacyclin is also myocardial protective, and may indeed be a COX2 effect. See the linkage. This gastro-protective effect may be another anti-inflammatory effect. COX2 inhibitors is currently standing trial, especially vioxx, on it's potential cardio harmful effects. So we now have a new pleotrophic effect in this remarkable agent.

No comments: