Transcript Copyright ©2007 American Heart Association Khush, KK et al

By
MD ., FAC.C
Zagazig University
Statins
1. Improve endothelial function
2. Stimulate angiogenesis
3. Mobilize bone-marrow derived stem cells
4. Reduce systemic inflammation and control
it (Zaca et al., JACC, 2007)
Statins may slow lung
function decline :
• To less than half as much annual decline
over 10 years.
Alexeeff. SE et al., Am. J. Respir. Crit. Care. Med. October 12/2007
CRP and CHF
Cardiovascular mortality is increased in CHF
patients with CRP>3 mg/L especially in
ischemic cardiomyopathy.
The impact of CRP is independent of usual
prognostic parameters.
(Lamblin N. Monguet et al., EHJ, 2005)
Plasma oxidized low density lipoprotein (oxLDL) concentrations in the
aortic root (AO), coronary sinus (CS) and femoral vein (FV) in 8 control
subjects and in 22 patients with dilated cardiomyopathy
Tsutamoto, T. et al. J Am Coll Cardiol 2001;37:2086-2092
Copyright ©2001 American College of Cardiology Foundation. Restrictions may apply.
Correlation between the transcardiac gradient of plasma
tumor necrosis factor-alpha (TNF-alpha) and the transcardiac
gradient of plasma oxidized low density lipoprotein (oxLDL) in
patients with dilated cardiomyopathy
Tsutamoto, T. et al. J Am Coll Cardiol 2001;37:2086-2092
Copyright ©2001 American College of Cardiology Foundation. Restrictions may apply.
TNF-{alpha} and MMP-2
Zaca, V. et al. J Am Coll Cardiol 2007;50:551-557
Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply.
Magnitude of Circulating BMSCs
Zaca, V. et al. J Am Coll Cardiol 2007;50:551-557
Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply.
Ventriculographic Measures of
LV Function and Size
Zaca, V. et al. J Am Coll Cardiol 2007;50:551-557
Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply.
Proportion of patients in the 10- and 80-mg arms of
TNT hospitalized with HF during follow-up
Khush, K. K. et al. Circulation 2007;115:576-583
Copyright ©2007 American Heart Association
Proportion of patients with and without a history of
HF in the 10- and 80-mg arms of TNT experiencing
hospitalization for HF during follow-up
Khush, K. K. et al. Circulation 2007;115:576-583
Copyright ©2007 American Heart Association
Ongoing trials
1. UNIVERSE
(Rousvastatin
impact
on
ventricular remodeling lipids and cytokines)
Echo and biomarkers study.
2. GISSI-HF : Rousvastatin and fish oil on
CHF of any etiology.
3. CORONA (10 mg Rousvastatin for 5 years
in ischemic cardiomyopthy).
Conclusion
1. Statins :  Oxidative stress,  CRP,  IL-6, 
TNF-, mobilize bone marrow derived stem cells,
and improve CHF.
2. Reverse remodeling occurs in ischemic and nonischemic cardiomyopathy.
3. Statins benefit is additive to ACE-I and ARB’s in
CHF.
4. Higher doses seems to be more effective.
Graphic@Show