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Expression of Longevity Genes Induced by a Low-Dose Fluvastatin and Valsartan Combination with the Potential to Prevent/Treat "Aging-Related Disorders". Int J Mol Sci 2019; 20:ijms20081844. [PMID: 31013989 PMCID: PMC6514706 DOI: 10.3390/ijms20081844] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 12/24/2022] Open
Abstract
The incidence of aging-related disorders may be decreased through strategies influencing the expression of longevity genes. Although numerous approaches have been suggested, no effective, safe, and easily applicable approach is yet available. Efficacy of low-dose fluvastatin and valsartan, separately or in combination, on the expression of the longevity genes in middle-aged males, was assessed. Stored blood samples from 130 apparently healthy middle-aged males treated with fluvastatin (10 mg daily), valsartan (20 mg daily), fluvastatin-valsartan combination (10 and 20 mg, respectively), and placebo (control) were analyzed. They were taken before and after 30 days of treatment and, additionally, five months after treatment discontinuation. The expression of the following longevity genes was assessed: SIRT1, PRKAA, KLOTHO, NFE2L2, mTOR, and NF-κB. Treatment with fluvastatin and valsartan in combination significantly increased the expression of SIRT1 (1.8-fold; p < 0.0001), PRKAA (1.5-fold; p = 0.262) and KLOTHO (1.7-fold; p < 0.0001), but not NFE2L2, mTOR and NF-κB. Both fluvastatin and valsartan alone significantly, but to a lesser extent, increased the expression of SIRT1, and did not influence the expression of other genes. Five months after treatment discontinuation, genes expression decreased to the basal levels. In addition, analysis with previously obtained results revealed significant correlation between SIRT1 and both increased telomerase activity and improved arterial wall characteristics. We showed that low-dose fluvastatin and valsartan, separately and in combination, substantially increase expression of SIRT1, PRKAA, and KLOTHO genes, which may be attributed to their so far unreported pleiotropic beneficial effects. This approach could be used for prevention of ageing (and longevity genes)–related disorders.
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Turk Veselič M, Eržen B, Hanžel J, Piletič Ž, Šabovič M. Improving Arterial Wall Characteristics in Patients After Myocardial Infarction with a Very Low Dose of Fluvastatin and Valsartan: A Proof-of-Concept Study. Med Sci Monit 2018; 24:6892-6899. [PMID: 30266894 PMCID: PMC6247743 DOI: 10.12659/msm.908967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background We tested the concept of improving arterial wall characteristics by treatment with a very low-dose combination of fluvastatin and valsartan (low-flu/val) in stable, post-myocardial infarction (MI) patients. Material/Methods We enrolled 36 post-MI middle-aged males in the treatment (n=20) or control (n=16) group receiving low-flu/val (10 mg/20 mg) or placebo, respectively. The parameters of endothelial function (flow-mediated dilatation (FMD), reactive hyperemia index), and arterial stiffness (carotid-femoral pulse wave velocity (cf-PWV), local carotid PWV, and beta stiffness coefficient) were measured before and after 30 days of therapy, and 10 weeks later. Results Treatment with low-flu/val improved FMD from 3.1±1.3% to 4.8±1.5% (p<0.001; by 54.8%) and cf-PWV from 7.8±1.1 to 6.7±1.5 m/s (p<0.01; by 14.1%) without affecting either lipids or blood pressure. In the treatment group, FMD and/or cf-PWV significantly improved in 17 patients, but the improvements did not correlate. The benefits obtained were still detectable 10 weeks after complete treatment cessation. No changes were obtained in the control group. No other vascular parameters changed. Conclusions Low-flu/val added “on top of” optimal therapy substantially improves endothelial function and arterial stiffness in post-MI patients. Since these improved parameters are well-known predictors of future coronary events, such treatment could decrease cardiovascular risk. Further studies are therefore warranted.
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Affiliation(s)
- Martina Turk Veselič
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Barbara Eržen
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jurij Hanžel
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Žiga Piletič
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mišo Šabovič
- Department of Vascular Diseases, University of Ljubljana Medical Centre, Ljubljana, Slovenia
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Turk Veselič M, Žorž N, Eržen B, Škerl P, Novaković S, Janić M, Šabovič M. Improvement of arterial wall phenotype in subjects at moderate cardiovascular risk induced by very low-dose fluvastatin/valsartan combination: a pilot study. INT ANGIOL 2018; 37:356-364. [PMID: 29952159 DOI: 10.23736/s0392-9590.18.03983-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The largest population that suffers from cardiovascular events are subjects at moderate cardiovascular risk. However, no effective and safe preventive treatment is available for this population. We investigated whether their arterial wall phenotype could be turned to a lower risk direction by low-dose fluvastatin/valsartan combination (low-flu/val). METHODS Twenty males at moderate cardiovascular risk (as classified by SCORE) were blindly randomized into the intervention group (N.=10, low-flu/val: 10 mg/20 mg) or control group (N.=10, placebo). At inclusion and after 30 days of treatment, brachial flow-mediated dilatation (FMD), β-stiffness coefficient, carotid pulse wave velocity (c-PWV), carotid-femoral PWV, Reactive Hyperemia Index, high-sensitivity C-reactive protein (hs-CRP), interleukin 6, vascular cell adhesion molecule 1, total antioxidant status and expression of several protective genes (SIRT1, mTOR, NF-κB1, NFE2L2, PRKAA1) were followed. RESULTS Treatment resulted in improved FMD (from 3% to 4.2%, P=0.008), c-PWV (from 6.7 to 6.2 m/s, P=0.006), hs-CRP (from 5.39 to 3.35 mg/L, P=0.041) and SIRT1 expression (3.34-fold difference, P=0.047). No other vascular, inflammation and genetic parameters changed. The hs-CRP values after intervention correlated significantly with SIRT1 expression. The improved FMD persisted even 10 weeks after treatment discontinuation. The obtained changes were not followed by changes of lipids or blood pressure. Overall, the results revealed improvement in three different, although interrelated preventive arterial wall characteristics. CONCLUSIONS This pilot study revealed that intervention with low-flu/val importantly shifts the arterial wall phenotype in a lower risk direction. This improvement could be interpolated into clinical benefits that remain to be further studied.
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Affiliation(s)
- Martina Turk Veselič
- Department of Vascular Diseases, University Medical Centre of Ljubljana, Ljubljana Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Neža Žorž
- Department of Vascular Diseases, University Medical Centre of Ljubljana, Ljubljana Slovenia
| | - Barbara Eržen
- Department of Vascular Diseases, University Medical Centre of Ljubljana, Ljubljana Slovenia
| | - Petra Škerl
- Department of Molecular Diagnostics, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Srdjan Novaković
- Department of Molecular Diagnostics, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Miodrag Janić
- Department of Vascular Diseases, University Medical Centre of Ljubljana, Ljubljana Slovenia
| | - Mišo Šabovič
- Department of Vascular Diseases, University Medical Centre of Ljubljana, Ljubljana Slovenia - .,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Abstract
BACKGROUND Fluvastatin is thought to be the least potent statin on the market, however, the dose-related magnitude of effect of fluvastatin on blood lipids is not known. OBJECTIVES Primary objectiveTo quantify the effects of various doses of fluvastatin on blood total cholesterol, low-density lipoprotein (LDL cholesterol), high-density lipoprotein (HDL cholesterol), and triglycerides in participants with and without evidence of cardiovascular disease.Secondary objectivesTo quantify the variability of the effect of various doses of fluvastatin.To quantify withdrawals due to adverse effects (WDAEs) in randomised placebo-controlled trials. SEARCH METHODS The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to February 2017: the Cochrane Central Register of Controlled Trials (CENTRAL) (2017, Issue 1), MEDLINE (1946 to February Week 2 2017), MEDLINE In-Process, MEDLINE Epub Ahead of Print, Embase (1974 to February Week 2 2017), the World Health Organization International Clinical Trials Registry Platform, CDSR, DARE, Epistemonikos and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. No language restrictions were applied. SELECTION CRITERIA Randomised placebo-controlled and uncontrolled before and after trials evaluating the dose response of different fixed doses of fluvastatin on blood lipids over a duration of three to 12 weeks in participants of any age with and without evidence of cardiovascular disease. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility criteria for studies to be included, and extracted data. We entered data from placebo-controlled and uncontrolled before and after trials into Review Manager 5 as continuous and generic inverse variance data, respectively. WDAEs information was collected from the placebo-controlled trials. We assessed all trials using the 'Risk of bias' tool under the categories of sequence generation, allocation concealment, blinding, incomplete outcome data, selective reporting, and other potential biases. MAIN RESULTS One-hundred and forty-five trials (36 placebo controlled and 109 before and after) evaluated the dose-related efficacy of fluvastatin in 18,846 participants. The participants were of any age with and without evidence of cardiovascular disease, and fluvastatin effects were studied within a treatment period of three to 12 weeks. Log dose-response data over doses of 2.5 mg to 80 mg revealed strong linear dose-related effects on blood total cholesterol and LDL cholesterol and a weak linear dose-related effect on blood triglycerides. There was no dose-related effect of fluvastatin on blood HDL cholesterol. Fluvastatin 10 mg/day to 80 mg/day reduced LDL cholesterol by 15% to 33%, total cholesterol by 11% to 25% and triglycerides by 3% to 17.5%. For every two-fold dose increase there was a 6.0% (95% CI 5.4 to 6.6) decrease in blood LDL cholesterol, a 4.2% (95% CI 3.7 to 4.8) decrease in blood total cholesterol and a 4.2% (95% CI 2.0 to 6.3) decrease in blood triglycerides. The quality of evidence for these effects was judged to be high. When compared to atorvastatin and rosuvastatin, fluvastatin was about 12-fold less potent than atorvastatin and 46-fold less potent than rosuvastatin at reducing LDL cholesterol. Very low quality of evidence showed no difference in WDAEs between fluvastatin and placebo in 16 of 36 of these short-term trials (risk ratio 1.52 (95% CI 0.94 to 2.45). AUTHORS' CONCLUSIONS Fluvastatin lowers blood total cholesterol, LDL cholesterol and triglyceride in a dose-dependent linear fashion. Based on the effect on LDL cholesterol, fluvastatin is 12-fold less potent than atorvastatin and 46-fold less potent than rosuvastatin. This review did not provide a good estimate of the incidence of harms associated with fluvastatin because of the short duration of the trials and the lack of reporting of adverse effects in 56% of the placebo-controlled trials.
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Affiliation(s)
- Stephen P Adams
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Sciences Mall, Medical Block CVancouverBCCanadaV6T 1Z3
| | - Sarpreet S Sekhon
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Sciences Mall, Medical Block CVancouverBCCanadaV6T 1Z3
| | - Michael Tsang
- McMaster UniversityDepartment of Internal Medicine, Internal Medicine Residency Office, Faculty of Medicine1200 Main Street WestHSC 3W10HamiltonONCanadaL8N 3N5
| | - James M Wright
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Sciences Mall, Medical Block CVancouverBCCanadaV6T 1Z3
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Affiliation(s)
- Kristen L Nowak
- From the University of Colorado Anschutz Medical Campus, Aurora (K.L.N., M.C.); and University of Colorado Boulder (M.J.R., D.R.S.).
| | - Matthew J Rossman
- From the University of Colorado Anschutz Medical Campus, Aurora (K.L.N., M.C.); and University of Colorado Boulder (M.J.R., D.R.S.)
| | - Michel Chonchol
- From the University of Colorado Anschutz Medical Campus, Aurora (K.L.N., M.C.); and University of Colorado Boulder (M.J.R., D.R.S.)
| | - Douglas R Seals
- From the University of Colorado Anschutz Medical Campus, Aurora (K.L.N., M.C.); and University of Colorado Boulder (M.J.R., D.R.S.)
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Markers of arterial health could serve as accurate non-invasive predictors of human biological and chronological age. Aging (Albany NY) 2018; 9:1280-1292. [PMID: 28455973 PMCID: PMC5425127 DOI: 10.18632/aging.101227] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/17/2017] [Indexed: 12/23/2022]
Abstract
The decline in functional capacity is unavoidable consequence of the process of aging. While many anti-aging interventions have been proposed, clinical investigations into anti-aging medicine are limited by lack of reliable techniques for evaluating the rate of ageing. Here we present simple, accurate and cost-efficient techniques for estimation of human biological age, Male and Female Arterial Indices. We started with developing a model which accurately predicts chronological age. Using machine learning, we arrived on a set of four predictors, all of which reflect the functioning of the cardiovascular system. In Arterial Indices models, results of carotid artery duplex scan that show the thickness of the intima media complex and quantitatively describe the degree of stenosis are combined with pulse wave velocity and augmentation index measurements performed by applanation tonometry. In our cohort, the age of men was determined with MAE = 6.91 years (adjusted R-squared = 0.55), and the age of women with MAE = 5.87 years (adjusted R2 = 0.69). The Epsilon-accuracies of age-predicting models were at 86.5% and 80% for women and men, respectively. Substantially higher differences between the predicted age and the calendar age were noted for patients with Type 2 Diabetes Mellitus (T2D) as compared to non-T2D controls, indicating that the model could serve as a good approximation for an elusive biological age. Notably, in females with chronological and biological ages mismatching by 5 or more years, significant increases in in Framingham CVD scores and lower levels of IGF-1 were observed. Proposed Male and Female Arterial Indices derive biological age from the results of functional tests which do not require specialized laboratory equipment and, therefore, could be performed in hospitals and community health clinics.
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Stolarczyk M, Apola A, Maślanka A, Kwiecień A, Opoka W. Spectrophotometric method for simultaneous determination of valsartan and substances from the group of statins in binary mixtures. ACTA PHARMACEUTICA 2017; 67:463-478. [PMID: 29337671 DOI: 10.1515/acph-2017-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 11/15/2022]
Abstract
Applicability of derivative spectrophotometry for the determination of valsartan in the presence of a substance from the group of statins was checked. The obtained results indicate that the proposed method may be effective by using appropriate derivatives: for valsartan and fluvastatin - D1, D2 and D3, for valsartan and pravastatin - D1 and D3, for valsartan and atorvastatin - D2 and D3. The method was characterized by high sensitivity and accuracy. Linearity was maintained in the following ranges: 9.28-32.48 mg mL-1 for valsartan, 8.16-28.56 mg mL-1 f or fluvastatin, 14.40-39.90 mg mL-1 for atorvastatin and 9.60-48.00 mg mL-1 for pravastatin. Determination coefficients were in the range of 0.989-0.999 depending on the analyte and the order of derivative. The precision of the method was high with RSD from 0.1 to 2.5 % and recovery of individual components was within the range of 100 ± 5 %. The developed method was successfully applied to the determination of valsartan combined with fluvastatin, atorvastatin and pravastatin in laboratory prepared mixtures and in pharmaceutical preparations.
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Affiliation(s)
- Mariusz Stolarczyk
- Department of Inorganic and Analytical Chemistry Jagiellonian University Medical College, Faculty of Pharmacy 30-688 Kraków , Poland
| | - Anna Apola
- Department of Inorganic and Analytical Chemistry Jagiellonian University Medical College, Faculty of Pharmacy 30-688 Kraków , Poland
| | - Anna Maślanka
- Department of Inorganic and Analytical Chemistry Jagiellonian University Medical College, Faculty of Pharmacy 30-688 Kraków , Poland
| | - Anna Kwiecień
- Department of Inorganic and Analytical Chemistry Jagiellonian University Medical College, Faculty of Pharmacy 30-688 Kraków , Poland
| | - Włodzimierz Opoka
- Department of Inorganic and Analytical Chemistry Jagiellonian University Medical College, Faculty of Pharmacy 30-688 Kraków , Poland
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Sub-therapeutic doses of fluvastatin and valsartan are more effective than therapeutic doses in providing beneficial cardiovascular pleiotropic effects in rats: A proof of concept study. Vascul Pharmacol 2017; 99:45-52. [PMID: 28951255 DOI: 10.1016/j.vph.2017.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 08/07/2017] [Accepted: 09/20/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Statins and sartans can, in therapeutic doses, induce pleiotropic cardiovascular effects. Similar has recently been shown also for sub-therapeutic doses. We thus explored and compared the cardiovascular pleiotropic efficacy of sub-therapeutic vs. therapeutic doses. METHODS Wistar rats were randomly divided into 7 groups receiving fluvastatin, valsartan and their combination in sub-therapeutic and therapeutic doses, or saline. After 6weeks, the animals were euthanised, their hearts and thoracic aortas isolated, and blood samples taken. Endothelium-dependent relaxation of the thoracic aortae and ischaemic-reperfusion injury of the isolated hearts were assessed along with the related serum parameters and genes expression. RESULTS Fluvastatin and valsartan alone or in combination were significantly more effective in sub-therapeutic than therapeutic doses. The sub-therapeutic combination greatly increased thoracic aorta endothelium-dependent relaxation and maximally protected the isolated hearts against ischaemia-reperfusion injury and was thus most effective. Beneficial effects were accompanied by increased levels of nitric oxide (NO) and decreased levels of asymmetric dimethylarginine (ADMA) in the serum (again prominently induced by the sub-therapeutic combination). Furthermore, nitric oxide synthase 3 (NOS3) and endothelin receptor type A (EDNRA) genes expression increased, but only in both combination groups and without significant differences between them. In the therapeutic dose groups, fluvastatin and valsartan decreased cholesterol values and systolic blood pressure. CONCLUSION Sub-therapeutic doses of fluvastatin and valsartan are more effective in expressing cardiovascular pleiotropic effects than therapeutic doses of fluvastatin and/or valsartan. These results could be of significant clinical relevance.
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Radenkovic M, Stojanović M, Nešić IM, Prostran M. Angiotensin receptor blockers & endothelial dysfunction: Possible correlation & therapeutic implications. Indian J Med Res 2017; 144:154-168. [PMID: 27934794 PMCID: PMC5206866 DOI: 10.4103/0971-5916.195022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The endothelium is one of the most important constituents of vascular homeostasis, which is achieved through continual and balanced production of different relaxing and contractile factors. When there is a pathological disturbance in release of these products, endothelial dysfunction (ED) will probably occur. ED is considered to be the initial step in the development of atherosclerosis. This pathological activation and inadequate functioning of endothelial cells was shown to be to some extent a reversible process, which all together resulted in increased interest in investigation of different beneficial treatment options. To this point, the pharmacological approach, including for example, the use of angiotensin-converting enzyme inhibitors or statins, was clearly shown to be effective in the improvement of ED. One of many critical issues underlying ED represents instability in the balance between nitric oxide and angiotensin II (Ang II) production. Considering that Ang II was confirmed to be important for the development of ED, the aim of this review article was to summarize the findings of up to date clinical studies associated with therapeutic application of angiotensin receptor blockers and improvement in ED. In addition, it was of interest to review the pleiotropic actions of angiotensin receptor blockers linked to the improvement of ED. The prospective, randomized, double-blind, placebo or active-controlled clinical trials were identified and selected for the final evaluation.
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Affiliation(s)
- Miroslav Radenkovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Stojanović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Milićević Nešić
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Prostran
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Nakamura M, Sugiura M, Shibata Y, Ojima T. Effect of β-cryptoxanthin–rich Satsuma mandarin juice supplementation on pulse wave velocity: A randomized controlled trial. JOURNAL OF NUTRITION & INTERMEDIARY METABOLISM 2017. [DOI: 10.1016/j.jnim.2017.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Lunder M, Janić M, Savić V, Janež A, Kanc K, Šabovič M. Very low-dose fluvastatin-valsartan combination decreases parameters of inflammation and oxidative stress in patients with type 1 diabetes mellitus. Diabetes Res Clin Pract 2017; 127:181-186. [PMID: 28384560 DOI: 10.1016/j.diabres.2017.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/13/2017] [Accepted: 03/16/2017] [Indexed: 11/30/2022]
Abstract
AIMS Previously we revealed the effectiveness of a new therapeutic approach with a short-term, very-low dose fluvastatin-valsartan combination on the improvement of arterial function in type 1 diabetes mellitus patients (T1DM). In this study we explored whether this approach influences inflammation and oxidative stress and explored any association of these effects with arterial function improvement. METHODS This was a supplementary analysis of the two previous double blind randomized studies (included 44 T1DM patients). Treatment group received very-low dose fluvastatin-valsartan, the control group received placebo. Blood samples were collected and inflammation parameters: high-sensitivity CRP (hsCRP), interleukin 6 (IL-6), vascular cell adhesion molecule-1 (VCAM-1) and oxidative stress parameter total antioxidant status (TAS) were measured. RESULTS Treatment decreased hsCRP values (by 56.5%, P<0.05) and IL-6 values (by 33.6%, P<0.05) and increased TAS values (by 21.1%; P<0.05) after 30days of treatment. High sensitivity CRP and TAS remained decreased 3months after treatment discontinuation. Importantly, the anti-inflammatory and anti-oxidative action significantly correlated with arterial function improvement. CONCLUSIONS The approach consisting of short-term (30days) treatment with a very low-dose fluvastatin-valsartan combination acts anti-inflammatory and anti-oxidative in T1DM patients. These observations along with the improvement of arterial function support the assumption that this approach could have an important clinical benefit in T1DM patients.
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Affiliation(s)
- Mojca Lunder
- Department of Vascular Diseases, Ljubljana University Medical Center, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia; Department of Endocrinology, Diabetes and Metabolic Diseases, Ljubljana University Medical Center, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia
| | - Miodrag Janić
- Department of Vascular Diseases, Ljubljana University Medical Center, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia
| | - Vedran Savić
- Department of Vascular Diseases, Ljubljana University Medical Center, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia
| | - Andrej Janež
- Department of Endocrinology, Diabetes and Metabolic Diseases, Ljubljana University Medical Center, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia
| | - Karin Kanc
- Diabetes & Me, Diabetes Center, Židovska cesta 1, SI-1000 Ljubljana, Slovenia
| | - Mišo Šabovič
- Department of Vascular Diseases, Ljubljana University Medical Center, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia.
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Cardiovascular autonomic dysfunction and carotid stiffness in adults with repaired tetralogy of Fallot. Clin Auton Res 2017; 27:185-192. [DOI: 10.1007/s10286-017-0411-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 02/21/2017] [Indexed: 10/20/2022]
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Boncelj Svetek M, Eržen B, Kanc K, Šabovič M. Impaired endothelial function and arterial stiffness in patients with type 2 diabetes - The effect of a very low-dose combination of fluvastatin and valsartan. J Diabetes Complications 2017; 31:544-550. [PMID: 28012835 DOI: 10.1016/j.jdiacomp.2016.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 11/22/2016] [Accepted: 12/10/2016] [Indexed: 01/08/2023]
Abstract
AIM Patients with type 2 diabetes are at increased cardiovascular risk. The aim was to explore whether the impaired arterial wall characteristics typical of these patients could be improved by the unique beneficial effects of a very low-dose combination of fluvastatin and valsartan (low-flu/val). METHODS Forty middle-aged males (50.4±6.1years) with type 2 diabetes were recruited to a double-blind, randomized study. Patients (N=20) received low-flu/val (10/20mg) or placebo (N=20) over 30days in addition to their regular therapy. Brachial artery flow mediated dilation (FMD), common carotid artery pulse wave velocity (PWV) and β-stiffness were assessed before and after treatment, and 3 and 6months after treatment discontinuation. The treatment was then repeated. RESULTS Arterial wall characteristics significantly improved. After 30days of intervention, FMD increased from 2.4±0.3 to 4.2±0.3 (p<0.001), PWV decreased from 6.4±0.1 to 5.8±0.2 (p<0.001) and β stiffness decreased from 7.8±0.4 to 6.7±0.4 (p<0.001). Lipids and arterial pressure did not change. After treatment discontinuation, the beneficial effects decreased over the following months. The repetition of treatment completely regained the initial benefits. No changes were observed in the placebo group. CONCLUSIONS Low-flu/val added on-top of optimal therapy substantially improves arterial wall characteristics in patients with type 2 diabetes.
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Affiliation(s)
- Maja Boncelj Svetek
- Department of Vascular Diseases, University Clinical Center Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia
| | - Barbara Eržen
- Department of Vascular Diseases, University Clinical Center Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia
| | - Karin Kanc
- Diabetes & Me, Private Clinic for Diabetes, Židovska 1, 1000 Ljubljana, Slovenia
| | - Mišo Šabovič
- Department of Vascular Diseases, University Clinical Center Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia.
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The “Rise–Peak–Fall” Pattern of Time Dependency of the Cardiovascular Pleiotropic Effects of Treatment With Low-dose Atorvastatin, Losartan, and a Combination Thereof in Rats. J Cardiovasc Pharmacol 2016; 68:74-80. [DOI: 10.1097/fjc.0000000000000393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Janić M, Lunder M, Cerkovnik P, Prosenc Zmrzljak U, Novaković S, Šabovič M. Low-Dose Fluvastatin and Valsartan Rejuvenate the Arterial Wall Through Telomerase Activity Increase in Middle-Aged Men. Rejuvenation Res 2016. [PMID: 26214555 DOI: 10.1089/rej.2015.1722] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIM Previously, we have shown that slightly to moderately aged arteries in middle-aged males can be rejuvenated functionally by sub-therapeutic, low-dose fluvastatin and valsartan treatment. Here, we explore whether this treatment could also increase telomerase activity. We hypothesized that telomerase activity might be associated with (1) an improvement of arterial wall properties and (2) a reduction of inflammatory/oxidative stress parameters (both observed in our previous studies). METHODS The stored blood samples from 130 apparently healthy middle-aged males treated with fluvastatin (10 mg daily), valsartan (20 mg daily), fluvastatin and valsartan combination (10 and 20 mg), respectively, and placebo (control), were analyzed. The samples were taken before and after treatment lasting 30 days, and 5 months after treatment discontinuation. Telomerase activity was measured in blood leukocytes by a TaqMan Gene Expression Assay. RESULTS Low-dose fluvastatin or valsartan increased telomerase activity (106.9% and 59.5% respectively; both p < 0.05, vs. control), whereas their combination was even more effective (an increase of 228.0%; p < 0.001, vs. control). No change was noted in the control group. Importantly, increased telomerase activity obtained in the combination group significantly correlated with arterial function, measured by flow-mediated dilation (FMD) (r = 0.79; p < 0.001) and C-reactive protein concentration (r = -0.54; p = 0.02) and total anti-oxidative status (r = 0.50; p = 0.03). CONCLUSION We found that a low-dose combination of fluvastatin and valsartan substantially increased telomerase activity, which significantly correlated with an improvement of endothelial function and a decrease of inflammation/oxidative stress. These findings could lead to a new innovative approach to arterial rejuvenation.
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Affiliation(s)
- Miodrag Janić
- 1 Department of Vascular Diseases, Ljubljana University Medical Centre , Ljubljana, Slovenia
| | - Mojca Lunder
- 1 Department of Vascular Diseases, Ljubljana University Medical Centre , Ljubljana, Slovenia
| | - Petra Cerkovnik
- 2 Department of Molecular Diagnostics, Institute of Oncology Ljubljana , Ljubljana, Slovenia
| | - Uršula Prosenc Zmrzljak
- 2 Department of Molecular Diagnostics, Institute of Oncology Ljubljana , Ljubljana, Slovenia
| | - Srdjan Novaković
- 2 Department of Molecular Diagnostics, Institute of Oncology Ljubljana , Ljubljana, Slovenia
| | - Mišo Šabovič
- 1 Department of Vascular Diseases, Ljubljana University Medical Centre , Ljubljana, Slovenia
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Stojanović M, Prostran M, Radenković M. Thiazolidinediones improve flow-mediated dilation: a meta-analysis of randomized clinical trials. Eur J Clin Pharmacol 2015; 72:385-98. [PMID: 26690770 DOI: 10.1007/s00228-015-1999-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 12/14/2015] [Indexed: 02/02/2023]
Abstract
AIMS Thiazolidinediones administration is assumed to be related with an improvement of endothelial dysfunction (ED); nevertheless, previous studies have been inconsistent. For this reason, the present meta-analysis was directed to estimate if thiazolidinediones were related to endothelial dysfunction improvement by using flow-mediated dilation (FMD) measurement. METHODS Literature search of the PubMed, the Cochrane Library, the Web of Science, and the Scopus databases was performed covering the period until July 01, 2015, for randomized clinical trials that investigated an influence of thiazolidinediones on FMD. For the calculation of the pooled overall effect, a random effect model was used. Meta-regression and subgroup analyses were performed to evaluate the impact of study characteristics on the effect of thiazolidinediones administration on FMD. RESULTS This meta-analysis included 16 studies with 812 subjects. The obtained results demonstrated an improvement of endothelial dysfunction measured with FMD (16 studies, 812 subjects; WMD: 2.4 %, 95 % CI = 1.1 to 3.69 %; p = 0.0003). The significant heterogeneity was noted (I (2) = 95 %, p < 0.00001). Subgroup analysis demonstrated that pioglitazone and rosiglitazone were able to improve FMD. Also, thiazolidinediones improved FMD if treatment was longer than 12 weeks and if patients were younger than 65 years. Additionally, a lipid profile was found to influence thiazolidinediones effect on FMD. CONCLUSION The results of this meta-analysis demonstrated that thiazolidinediones were able to improve FMD, which in clinical terms can be further translated to the improvement of an impaired endothelial function. Nevertheless, the link between FMD and its predictive clinical relevance still requires further clarification.
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Affiliation(s)
- Marko Stojanović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, PO Box 38, Belgrade, 11129, Serbia
| | - Milica Prostran
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, PO Box 38, Belgrade, 11129, Serbia
| | - Miroslav Radenković
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, PO Box 38, Belgrade, 11129, Serbia.
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A Combination of Low Doses of Fluvastatin and Valsartan Decreases Arterial Stiffness in Patients After Myocardial Infarction: A Pilot Study. Curr Ther Res Clin Exp 2015. [PMID: 26199676 PMCID: PMC4506977 DOI: 10.1016/j.curtheres.2015.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Despite optimum treatment, patients who experience myocardial infarction are still at high risk for future events. Objective We evaluated the effect of 30 days of treatment with combination of low, subtherapeutic doses of fluvastatin and valsartan on arterial stiffness in patients after myocardial infarction, a therapy that has not been used yet. Methods Fourteen male patients with a history of myocardial infarction were enrolled into a pilot double-blind randomized controlled study. They were allocated to receive 10 mg fluvastatin and 20 mg valsartan or placebo for 30 days in addition to their regular pharmacotherapy. Carotid–femoral pulse wave velocity was measured on inclusion, after 30 days, and after 3 months. Results Mean (SD) carotid–femoral pulse wave velocity decreased significantly in the treatment group after 30 days and persisted at lower values after 3 months (from 8.4 [1.5] m/sec to 7.3 [1.1] m/sec to 7.2 [0.8] m/sec; P < 0.05). The 95% CI for decrease after 30 days in the treatment group was 0.5–1.6. Only nonsignificant changes were observed in the control group. Serum lipid levels and arterial blood pressure did not change significantly in any group. Conclusions The treatment resulted in a significant and sustained improvement of arterial stiffness in male patients with a history of myocardial infarction, which highlights the need for further study of this new approach.
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Savić V, Janić M, Lunder M, Kanc K, Janež A, Eržen B, Šabovič M. Long-term improvement of arterial wall characteristics in patients with diabetes mellitus type 1 using cyclic, intermittent treatment with a low-dose fluvastatin and valsartan combination. Exp Ther Med 2015; 10:1207-1211. [PMID: 26622466 DOI: 10.3892/etm.2015.2622] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/01/2015] [Indexed: 01/22/2023] Open
Abstract
Improvement of arterial wall (AW) characteristics decreases cardiovascular risk. In a previous study, it was observed that AW characteristics in patients with diabetes mellitus type 1 are significantly improved by short-term treatment with a low-dose combination of fluvastatin and valsartan. Additionally, a unique phenomenon of prolonged effect after treatment discontinuation was suggested. The present study tested whether repeated treatm ent after a certain period results in the same beneficial effect, th ereby advancing the hypothesis that cyclic treatment can provide a long-term improvement of AW characteristics. A total of 44 patients with diabetes mellitus type 1 that participated in the previous study were recruited. Six months after the discontinuation of the initial treatment, the same treatment with a low-dose fluvastatin (10 mg daily) and valsartan (20 mg daily) combination (n=22) or placebo (n=22) was repeated. Brachial artery flow-mediated dilation (FMD), pulse wave velocity (PWV) and carotid artery β-stiffness were measured. It was found that the beneficial effect achieved with an initial 1-month treatment was completely regained following treatment repetition: FMD improved by 50.9% (P<0.01), PWV by 5.7% (P<0.001) and β-stiffness by 9.9% (P<0.001). In addition, a gradual decline of the obtained effects was observed, reaching the level of 9.6% for FM D, 6.3% for PWV and 9.5% for β-stiffness 6 months after treatm ent discontinuation. It was observed that repetition of treatment was similarly effective as the initial intervention. The benefits achieved by treatment steadily declined with time. Combining these findings, cyclic intermittent treatment with a low-dose fluvastatin and valsartan combination is proposed as a new cardiovascular preventive strategy in patients with DM1.
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Affiliation(s)
- Vedran Savić
- Department of Vascular Diseases, Ljubljana University Medical Centre, Ljubljana SI-1000, Slovenia
| | - Miodrag Janić
- Department of Vascular Diseases, Ljubljana University Medical Centre, Ljubljana SI-1000, Slovenia
| | - Mojca Lunder
- Department of Vascular Diseases, Ljubljana University Medical Centre, Ljubljana SI-1000, Slovenia
| | - Karin Kanc
- Diabetes & Me, Private Diabetes Centre, Ljubljana SI-1000, Slovenia
| | - Andrej Janež
- Department of Endocrinology, Diabetes and Metabolic Diseases, Ljubljana University Medical Centre, Ljubljana SI-1000, Slovenia
| | - Barbara Eržen
- Department of Vascular Diseases, Ljubljana University Medical Centre, Ljubljana SI-1000, Slovenia
| | - Mišo Šabovič
- Department of Vascular Diseases, Ljubljana University Medical Centre, Ljubljana SI-1000, Slovenia
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Seals DR, Kaplon RE, Gioscia-Ryan RA, LaRocca TJ. You're only as old as your arteries: translational strategies for preserving vascular endothelial function with aging. Physiology (Bethesda) 2015; 29:250-64. [PMID: 24985329 DOI: 10.1152/physiol.00059.2013] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Endothelial dysfunction develops with age and increases the risk of age-associated vascular disorders. Nitric oxide insufficiency, oxidative stress, and chronic low-grade inflammation, induced by upregulation of adverse cellular signaling processes and imbalances in stress resistance pathways, mediate endothelial dysfunction with aging. Healthy lifestyle behaviors preserve endothelial function with aging by inhibiting these mechanisms, and novel nutraceutical compounds that favorably modulate these pathways hold promise as a complementary approach for preserving endothelial health.
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Affiliation(s)
- Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Rachelle E Kaplon
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Rachel A Gioscia-Ryan
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Thomas J LaRocca
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
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A low-dose combination of fluvastatin and valsartan: a new "drug" and a new approach for decreasing the arterial age. BIOMED RESEARCH INTERNATIONAL 2015; 2015:235709. [PMID: 25821790 PMCID: PMC4363554 DOI: 10.1155/2015/235709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 10/27/2014] [Indexed: 12/20/2022]
Abstract
We have developed a new “drug” and approach that appear to be effective in reducing arterial age. This “drug” represents a low, subtherapeutic dose of statin and sartan and particularly their low-dose combination. The improvement of arterial wall characteristics, also reflecting in a decrease of arterial age, was achieved after a short period of treatment (one month) with the above-mentioned drugs. In addition, we have also implemented a new, innovative therapeutic approach, consisting of intermittent (cyclic) treatment—alternating short “treatment” periods and much longer “rest” periods (when the beneficial effects are still present but gradually decline). This new “drug” and approach both merit further investigation in order to confirm their antiaging efficacy.
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A combination of low-dose fluvastatin and valsartan decreases inflammation and oxidative stress in apparently healthy middle-aged males. J Cardiopulm Rehabil Prev 2015; 34:208-12. [PMID: 24263076 DOI: 10.1097/hcr.0000000000000027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We have previously shown that a "short-term, low-dose" treatment approach with statins, angiotensin receptor blockers, and especially their low-dose combination, is effective in improving arterial wall properties in apparently healthy middle-age men. This study was performed to expand investigation of its effects on inflammation and oxidative stress. METHODS The study was performed supplementary to 3 previous studies, overall 65 treated participants (25 received fluvastatin 10 mg, 20 valsartan 20 mg, 20 their combination) and 65 participants placebo. The stored blood samples (collected at inclusion and after 30 days of treatment) were used to measure high-sensitivity CRP, interleukin-6, vascular cell adhesion molecule-1, total antioxidant status, glutathione peroxidase, and selenium concentration. RESULTS A low-dose combination decreased inflammation parameters (high-sensitivity CRP: from 1.2 ± 0.1 to 0.7 ± 0.1 mg/L; P < .001; vascular cell adhesion molecule-1: from 523 ± 21 to 482 ± 12 pg/mL; P < .05; while interleukin-6 did not reach the level of significance). It also increased antioxidant defenses, as measured by total antioxidant status and glutathione peroxidase (from 1.4 ± 0.04 to 1.5 ± 0.04 mmol/L; P < .01, and from 1.2 ± 0.06 to 1.4 ± 0.06 μkat/g hemoglobin; P < .05, respectively), accompanied by decreased selenium levels. Low-dose valsartan was separately less effective than the combination. No changes were observed in the control groups. CONCLUSIONS Low-dose combination of fluvastatin and valsartan and, to a lesser extent low-dose valsartan alone, produced important anti-inflammatory and anti-oxidative effects. These results confirm and extend the potential of the "short-term, low-dose" preventive strategy.
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Santos-Parker JR, LaRocca TJ, Seals DR. Aerobic exercise and other healthy lifestyle factors that influence vascular aging. ADVANCES IN PHYSIOLOGY EDUCATION 2014; 38:296-307. [PMID: 25434012 PMCID: PMC4315444 DOI: 10.1152/advan.00088.2014] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/08/2014] [Indexed: 05/18/2023]
Abstract
Cardiovascular diseases (CVDs) remain the leading cause of death in the United States and other modern societies. Advancing age is the major risk factor for CVD, primarily due to stiffening of the large elastic arteries and the development of vascular endothelial dysfunction. In contrast, regular aerobic exercise protects against the development of large elastic artery stiffness and vascular endothelial dysfunction with advancing age. Moreover, aerobic exercise interventions reduce arterial stiffness and restore vascular endothelial function in previously sedentary middle-aged/older adults. Aerobic exercise exerts its beneficial effects on arterial function by modulating structural proteins, reducing oxidative stress and inflammation, and restoring nitric oxide bioavailability. Aerobic exercise may also promote "resistance" against factors that reduce vascular function and increase CVD risk with age. Preventing excessive increases in abdominal adiposity, following healthy dietary practices, maintaining a low CVD risk factor profile, and, possibly, selective use of pharmaceuticals and nutraceuticals also play a major role in preserving vascular function with aging.
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Affiliation(s)
| | - Thomas J LaRocca
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
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Tan W, Madhavan K, Hunter KS, Park D, Stenmark KR. Vascular stiffening in pulmonary hypertension: cause or consequence? (2013 Grover Conference series). Pulm Circ 2014; 4:560-80. [PMID: 25610594 PMCID: PMC4278618 DOI: 10.1086/677370] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/27/2014] [Indexed: 12/24/2022] Open
Abstract
Recent studies have indicated that systemic arterial stiffening is a precursor to hypertension and that hypertension, in turn, can perpetuate arterial stiffening. Pulmonary artery (PA) stiffening is also well documented to occur in pulmonary hypertension (PH), and there is evidence that pulmonary vascular stiffness (PVS) may be a better predictor of outcome than pulmonary vascular resistance (PVR). We have hypothesized that the decreased flow-damping function of elastic PAs in PH likely initiates and/or perpetuates dysfunction of pulmonary microvasculature. Recent studies have shown that large-vessel stiffening increases flow pulsatility in the distal pulmonary vasculature, leading to endothelial dysfunction within a proinflammatory, vasoconstricting, and profibrogenic environment. The intricate role of stiffening-stimulated high pulsatile flow in endothelial cell dysfunction includes stepwise molecular events underlying PA hypertrophy, inflammation, endothelial-mesenchymal transition, and fibrosis. In addition to contributing to microenvironmental alterations of the distal vasculature, disordered proximal-distal PA coupling likely also plays a role in increasing ventricular afterload, ultimately causing right ventricle (RV) dysfunction and death. Current therapeutic treatments do not provide a realistic approach to destiffening arteries and, thus, to potentially abrogating the effects of high pulsatile flow on the distal pulmonary vasculature or the increased work imposed by stiffening on the RV. Scrutinizing the effect of PA stiffening on high pulsatile flow-induced cellular and molecular changes, and vice versa, might lead to important new therapeutic options that abrogate PA remodeling and PH development. With a clear understanding that PA stiffening may contribute to the progression of PH to an irreversible state by contributing to chronic microvascular damage in lungs, future studies should be aimed first at defining the underlying mechanisms leading to PA stiffening and then at improved treatment approaches based on these findings.
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Affiliation(s)
- Wei Tan
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Cardiovascular Pulmonary Research Laboratories, University of Colorado Denver, Aurora, Colorado, USA
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado, USA
| | - Krishna Madhavan
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Department of Bioengineering, University of Colorado Denver, Aurora, Colorado, USA
| | - Kendall S. Hunter
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Department of Bioengineering, University of Colorado Denver, Aurora, Colorado, USA
| | - Daewon Park
- Department of Bioengineering, University of Colorado Denver, Aurora, Colorado, USA
| | - Kurt R. Stenmark
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Cardiovascular Pulmonary Research Laboratories, University of Colorado Denver, Aurora, Colorado, USA
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Janić M, Lunder M, Zupan J, Černe D, Marc J, Drevenšek G, Šabovič M. The low-dose atorvastatin and valsartan combination effectively protects the arterial wall from atherogenic diet-induced impairment in the guinea pig. Eur J Pharmacol 2014; 743:31-6. [PMID: 25261034 DOI: 10.1016/j.ejphar.2014.09.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/28/2014] [Accepted: 09/06/2014] [Indexed: 11/25/2022]
Abstract
New preventive strategies for atherosclerosis are needed. In this study, we tested whether a new therapeutic approach consisting of low-dose treatment with a statin and sartan combination could prevent atherogenic diet-induced impairment of the arterial wall in guinea pigs. Twenty-five Dunkin-Hartley guinea pigs were randomly assigned to five experimental groups: 1) normal diet; 2) atherogenic diet (AD); 3) AD + a low-dose atorvastatin and valsartan combination (5mg/kg/day and 2.4mg/kg/day, respectively); 4) AD + low-dose atorvastatin (5mg/kg/day); 5) AD + low-dose valsartan (2.4mg/kg/day). After 8 weeks of treatment, the animals were killed, blood samples collected and thoracic and abdominal aortas isolated. The atherogenic diet significantly impaired maximal thoracic aorta endothelium-dependent relaxation by 40.1% relative to the normal diet. The low-dose combination, compared to the separate drugs, completely preserved thoracic aorta endothelium-dependent relaxation at the level of the group receiving normal diet. This substantial effect was associated with a significant change in the expression of NOS3 (R=0.93; P=0.0002) and IL1b (R=-0.79; P=0.003) genes. In addition, treatment with the low-dose combination or the separate drugs also prevented atherosclerotic plaque formation. We found that treatment with the low-dose atorvastatin and valsartan combination has the capability to completely protect the arterial wall from atherogenic diet-induced damage in the guinea pig model. Further studies evaluating this new therapeutic approach are desirable.
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Affiliation(s)
- Miodrag Janić
- Department of Vascular Diseases, University of Ljubljana Medical Centre, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia.
| | - Mojca Lunder
- Department of Vascular Diseases, University of Ljubljana Medical Centre, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia; Institute of Pharmacology and Experimental Toxicology, Faculty of Medicine, University of Ljubljana, Korytkova 2, SI-1000 Ljubljana, Slovenia.
| | - Janja Zupan
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, Askerčeva cesta 7, SI-1000 Ljubljana, Slovenia.
| | - Darko Černe
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, Askerčeva cesta 7, SI-1000 Ljubljana, Slovenia.
| | - Janja Marc
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, Askerčeva cesta 7, SI-1000 Ljubljana, Slovenia.
| | - Gorazd Drevenšek
- Institute of Pharmacology and Experimental Toxicology, Faculty of Medicine, University of Ljubljana, Korytkova 2, SI-1000 Ljubljana, Slovenia.
| | - Mišo Šabovič
- Department of Vascular Diseases, University of Ljubljana Medical Centre, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia.
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Arterial stiffness and cardiovascular therapy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:621437. [PMID: 25170513 PMCID: PMC4142148 DOI: 10.1155/2014/621437] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 07/14/2014] [Accepted: 07/14/2014] [Indexed: 12/12/2022]
Abstract
The world population is aging and the number of old people is continuously increasing. Arterial structure and function change with age, progressively leading to arterial stiffening. Arterial stiffness is best characterized by measurement of pulse wave velocity (PWV), which is its surrogate marker. It has been shown that PWV could improve cardiovascular event prediction in models that included standard risk factors. Consequently, it might therefore enable better identification of populations at high-risk of cardiovascular morbidity and mortality. The present review is focused on a survey of different pharmacological therapeutic options for decreasing arterial stiffness. The influence of several groups of drugs is described: antihypertensive drugs (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta-blockers, diuretics, and nitrates), statins, peroral antidiabetics, advanced glycation end-products (AGE) cross-link breakers, anti-inflammatory drugs, endothelin-A receptor antagonists, and vasopeptidase inhibitors. All of these have shown some effect in decreasing arterial stiffness. Nevertheless, further studies are needed which should address the influence of arterial stiffness diminishment on major adverse cardiovascular and cerebrovascular events (MACCE).
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Savić V, Eržen B, Janić M, Lunder M, Boncelj M, Kanc K, Janež A, Šabović M. Improvement of arterial wall characteristics by the low-dose fluvastatin and valsartan combination in type 1 diabetes mellitus patients. Diab Vasc Dis Res 2013; 10:420-5. [PMID: 23811602 DOI: 10.1177/1479164113485102] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We tested whether short-term, low-dose treatment with the fluvastatin and valsartan combination could improve impaired arterial wall characteristics in type 1 diabetes mellitus patients. A total of 44 type 1 diabetes mellitus patients were randomised into the treatment group [n = 22; received a low-dose combination of fluvastatin (10 mg daily) and valsartan (20 mg daily)] and the control group (n = 22; received placebo), both for 30 days. Brachial artery flow-mediated dilation (FMD), pulse wave velocity (PWV) and carotid artery β-stiffness were measured. Significant improvements in FMD (+73.2%), PWV (-7.5%) and β-stiffness (-10.0%) were achieved after 1-month treatment compared to the control group (all p values < 0.001). Three months after therapy discontinuation, important residual improvement in measured parameters was still present. No changes in lipids and blood pressure accompanied the beneficial improvements. We conclude that relatively simple intervention (low-dose, short-term fluvastatin/valsartan combination) produces substantial, long-term improvement of arterial wall characteristics in type 1 diabetes mellitus patients.
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Affiliation(s)
- Vedran Savić
- Department of Vascular Diseases, Ljubljana University Medical Centre, Ljubljana, Slovenia.
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Janić M, Lunder M, Sabovič M. A new anti-ageing strategy focused on prevention of arterial ageing in the middle-aged population. Med Hypotheses 2013; 80:837-40. [PMID: 23587479 DOI: 10.1016/j.mehy.2013.03.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 01/09/2013] [Accepted: 03/17/2013] [Indexed: 11/17/2022]
Abstract
Ageing is a progressive process that according to available knowledge cannot be effectively reversed, slowed or stopped. Here we propose a new anti-ageing approach that may lead to the design of effective therapeutic intervention. First, we hypothesize that the "organ system" oriented anti-ageing approach represents a better anti-ageing target than the "whole body" or "cellular ageing" concepts. The arterial system is the most suitable target, as it interconnects all the organs in the body, thus influencing them all. Second, we propose that an anti-ageing approach could be more successful in early than late ageing stages; middle-aged people seem to be the most appropriate candidates. Third, we believe that instead of searching for new medication, we should rely on already established medications with beneficial effects on the arterial wall. Renin-angiotensin system inhibitors and statins fulfill these criteria and are potential cornerstones of the new approach. The fourth hypothesis is based on the concept that in the early stages of arterial ageing only slight injury is present and therefore subtherapeutic, low-dose treatment would be effective. Fifth, we hypothesize that slight initial age-related arterial wall changes are reversible and could be corrected by a short-term (one month) treatment. Sixth, we hypothesize that the effects would be present for a certain period of time even after treatment termination. The listed assumptions combined represent the basis for a new, original anti-ageing approach - a subtherapeutic low-dose combination of a renin-angiotensin system inhibitor and a statin for one month (followed by approximately 6-12 months without treatment) could delay or even reverse the arterial ageing process and consequently decrease the incidence of cardiovascular disorders.
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Affiliation(s)
- Miodrag Janić
- Department of Vascular Diseases, University of Ljubljana Medical Centre, Zaloška cesta 7, 1000 Ljubljana, Slovenia.
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Carrelli AL, Walker MD, Di Tullio MR, Homma S, Zhang C, McMahon DJ, Silverberg SJ. Endothelial function in mild primary hyperparathyroidism. Clin Endocrinol (Oxf) 2013; 78:204-9. [PMID: 22757971 PMCID: PMC3479355 DOI: 10.1111/j.1365-2265.2012.04485.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 03/30/2012] [Accepted: 06/26/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is not known if endothelial dysfunction, an important early event in the pathogenesis of atherosclerosis, is present in mild primary hyperparathyroidism (PHPT) and if so, whether it improves following parathyroidectomy. DESIGN We measured flow-mediated vasodilation (FMD), which estimates endothelial function by ultrasound imaging, in patients prior to and 6 and 12 months after parathyroidectomy. RESULTS Forty-five patients with mild PHPT [80% female, 61 ± 1 (mean ± SE) years, serum calcium 2·65 ± 0·03 mm (10·6 ± 0·1 mg/dl), PTH 10·5 ± 0·7 pm (99 ± 7 pg/ml), 25-hydroxyvitamin D (25OHD) 70·3 ± 3·7 nm (28·2 ± 1·5 ng/ml)] were studied. Baseline FMD was normal (4·63 ± 0·51%; reference mean: 4·4 ± 0·1%) and was not associated with serum calcium, PTH or 25OHD levels. In the group as a whole, FMD did not change after surgery (6 months: 4·38 ± 0·83%, P = 0·72; 12 months: 5·07 ± 0·74%, P = 0·49). However, in those with abnormal baseline FMD (<2·2%; n = 15), FMD increased by 350%, normalizing by 6 months after surgery (baseline: 0·81± 0·19%; 6 months: 3·18 ± 0·79%, P = 0·02 vs baseline; 12months: 3·68 ± 1·22%, P = 0·04 vs baseline). Baseline calcium, PTH and 25OHD levels did not differ between those with abnormal vs normal FMD, nor did these indices predict postoperative change in FMD. CONCLUSIONS FMD is generally normal in patients with mild PHPT and is unchanged 1 year after parathyroidectomy. Although FMD may normalize after surgery in patients with baseline abnormalities, data do not support using endothelial dysfunction as an indicator for parathyroidectomy.
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Affiliation(s)
- A L Carrelli
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Lunder M, Janić M, Žiberna L, Drevenšek G, Šabovič M. A low-dose atorvastatin and losartan combination directly improves aortic ring relaxation and diminishes ischaemic-reperfusion injury in isolated rat hearts. Med Sci Monit 2013; 18:BR366-74. [PMID: 22936187 PMCID: PMC3560644 DOI: 10.12659/msm.883347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background The cardiovascular pleiotropic effects of statins and angiotensin receptor blockers (ARBs) could be of interest for innovative preventive approaches. We aimed to investigate whether low-dose atorvastatin and losartan, separately not possessing protective cardiovascular pleiotropic effects, express them when combined. Material/Methods Forty-five adult male Wistar rats were anaesthetized and their thoracic aortas and hearts were isolated. Relaxation of aortic rings, coronary flow rate and the extent of myocardial ischaemic-reperfusion injury were measured. Different concentrations (0.01, 0.1, 1.0 μM) of atorvastatin and losartan added to a perfusion medium were first tested. The separate drugs, which were ineffective, were then combined at the same concentrations and the concentration was tested in the same model. Results Low concentrations of atorvastatin or losartan (0.1 and 1 μM, respectively) produced no effects in isolated aorta. However, surprisingly, when these drug concentrations were combined, a significantly improved endothelium-dependent relaxation of the thoracic aorta was observed. Similarly, when combining individually ineffective concentrations of atorvastatin or losartan (0.01 and 0.1 μM, respectively), significantly increased coronary flow and a decreased extent of myocardial injury were observed. By using a nitric oxide-synthase inhibitor, we demonstrated that the vasodilatory effects obtained were nitric oxide-dependent. The degree of effectiveness by the combination was comparable to that obtained by 10-fold (atorvastatin) or 100-fold (losartan) higher concentrations of the separate drugs. Conclusions Our results revealed that remarkable additive/synergistic effects exist between low-doses of a statin (atorvastatin) and an ARB (losartan), resulting in important cardiovascular protection. This new concept could be valuable in cardiovascular prevention.
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Affiliation(s)
- Mojca Lunder
- Institute of Pharmacology and Experimental Toxicology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Lunder M, Drevenšek G, Černe D, Marc J, Janić M, Šabovič M. Treatment With Low-dose Atorvastatin, Losartan, and Their Combination Increases Expression of Vasoactive-Related Genes in Rat Aortas. J Cardiovasc Pharmacol Ther 2012; 18:177-83. [DOI: 10.1177/1074248412463966] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Recently it has been shown that statins and angiotensin receptor blockers (ARBs) at low doses express beneficial pleiotropic vascular effects. We aimed to explore whether these drugs at low doses induce the expression of vasoactive-related genes. Sixty adult Wistar rats were treated with low-dose atorvastatin (2 mg/kg), low-dose losartan (5 mg/kg), their combination or saline daily for 4, 6, or 8 weeks. Expression of the vasoactive-related genes endothelin receptor type A ( EDNRA), endothelial nitric oxide synthase 3 ( NOS3), inducible nitric oxide synthase 2 ( NOS2), and angiotensin II receptor type 1 ( AGTRL1a) was measured in isolated thoracic aortas. Expression of EDNRA gradually decreased, the lowest values being obtained after 8 weeks (low-dose atorvastatin, losartan [1.6- and 1-7-fold vs controls, respectively; both P < .05], and the combination [2.3-fold vs control, P < .001]). The highest values of NOS3 were obtained after 6 weeks (low-dose atorvastatin, losartan, and their combination, 3.1-fold, P < .01; 3.4-fold, P < .001; and 3.6-fold, P < .001 vs controls, respectively) and then declined after 8 weeks. The combination was more effective in inducing total NOS3 expression when compared to the separate drugs (1.4-fold; P < .05). Importantly, expression of NOS3 was associated with increased plasma NO levels and positively correlated with thoracic aorta relaxation. No changes in expression of NOS2 and AGTRL1a were observed. We showed that low-dose atorvastatin or losartan and especially their combination increases the expression of NOS3 and decreases the expression of EDNRA. These findings are valuable in explaining the effectiveness of the “low-dose pharmacological approach” for improvement in arterial function.
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Affiliation(s)
- Mojca Lunder
- Institute of Pharmacology and Experimental Toxicology, University of Ljubljana, Ljubljana, Slovenia
- Department of Vascular Diseases, University of Ljubljana Medical Centre, Ljubljana, Slovenia
| | - Gorazd Drevenšek
- Institute of Pharmacology and Experimental Toxicology, University of Ljubljana, Ljubljana, Slovenia
| | - Darko Černe
- Department of Clinical Biochemistry, University of Ljubljana, Ljubljana, Slovenia
| | - Janja Marc
- Department of Clinical Biochemistry, University of Ljubljana, Ljubljana, Slovenia
| | - Miodrag Janić
- Department of Vascular Diseases, University of Ljubljana Medical Centre, Ljubljana, Slovenia
| | - Mišo Šabovič
- Department of Vascular Diseases, University of Ljubljana Medical Centre, Ljubljana, Slovenia
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Walker MD, Rundek T, Homma S, DiTullio M, Iwata S, Lee JA, Choi J, Liu R, Zhang C, McMahon DJ, Sacco RL, Silverberg SJ. Effect of parathyroidectomy on subclinical cardiovascular disease in mild primary hyperparathyroidism. Eur J Endocrinol 2012; 167:277-85. [PMID: 22660025 PMCID: PMC3668344 DOI: 10.1530/eje-12-0124] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We recently demonstrated that mild primary hyperparathyroidism (PHPT) is associated with increased carotid intima-media thickness (IMT) and stiffness, and increased aortic valve calcification. It is unclear whether parathyroidectomy (PTX) improves these abnormalities. The purpose of this study was to determine whether cardiovascular abnormalities in PHPT improve with PTX. DESIGN Forty-four patients with PHPT were studied using carotid ultrasound and transthoracic echocardiography before and after PTX. Carotid IMT, carotid plaque and stiffness, left ventricular mass index (LVMI), myocardial and valvular calcification, and diastolic function were measured before, 1- and 2-year post-PTX. RESULTS Two years after PTX, increased carotid stiffness tended to decline to the normal range (17%, P=0.056) while elevated carotid IMT did not improve. Carotid plaque number and thickness, LVMI and cardiac calcifications did not change after PTX, while some measures of diastolic function (isovolumic relaxation time (IVRT) and tissue Doppler peak early diastolic velocity) worsened within the normal range. Indices did improve in patients with cardiovascular abnormalities at baseline. Increased carotid stiffness improved by 28% (P=0.004), a decline likely to be of clinical significance. More limited improvements also occurred in elevated IMT (3%, P=0.017) and abnormal IVRT (13%, P<0.05), a measure of diastolic dysfunction. CONCLUSIONS In mild PHPT, PTX led to modest changes in some cardiovascular indices. Improvements were mainly evident in those with preexisting cardiovascular abnormalities, particularly elevated carotid stiffness. These findings are reassuring with regard to current international guidelines that do not include cardiovascular disease as a criterion for PTX.
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Affiliation(s)
- M D Walker
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
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Low-dose atorvastatin, losartan, and particularly their combination, provide cardiovascular protection in isolated rat heart and aorta. Heart Vessels 2012; 28:246-54. [PMID: 22610592 DOI: 10.1007/s00380-012-0259-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 04/20/2012] [Indexed: 01/06/2023]
Abstract
Statins and angiotensin receptor blockers at therapeutic doses have beneficial cardiovascular effects, which can be applied for cardiovascular protection. We explored whether low doses of atorvastatin, losartan, and particularly their combination, possess important pleiotropic vasodilatory effects. Wistar rats were treated daily with low-dose atorvastatin (2 mg/kg, n = 15), low-dose losartan (5 mg/kg, n = 15), their combination (n = 15), or saline (n = 15). After 4, 6, or 8 weeks the animals were anesthetized, blood samples taken, and their hearts and thoracic aortas isolated. Two kinds of experiments were performed: the measurement of coronary flow rate after ischemia/reperfusion myocardial injury and endothelium-dependent relaxation of thoracic aorta. In both models, maximal vasodilation activity was obtained in rats treated for 6 weeks. In the ischemia/reperfusion myocardial injury model, coronary flow increased (atorvastatin or losartan 1.9-fold, P < 0.01; combination 2.4-fold, P < 0.001) compared with controls. In the thoracic aorta model, endothelium-dependent relaxation significantly increased only in the combination group compared with the control group (up to 1.4-fold; P < 0.01). Simultaneously, we detected increased anti-inflammatory activity and increased nitric oxide concentration, but no changes in lipids and blood pressure. In a rat model we showed important vasodilatory activity of low-dose atorvastatin, losartan, and particularly their combination. The effects of the low-dose combination were accompanied by, and probably at least partly achieved by, anti-inflammatory and nitric oxide pathways. Overall, these results could be valuable for the development of new vascular protective strategies focusing on a low-dose regimen of statins and sartans, and particularly their combination.
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