Statin intervention

New substances of this family are in development, and we cannot exclude the possibility that oriented modifications of the molecules of SERMs, statins, or prostaglandin inhibitors will be able to enhance their effect on the breast or bone, maintaining equivalent power in their genuine indication. Knowing that a perfect multitasking molecule is unlikely, we can expect to obtain the maximal benefit from a single pharmacological intervention with substances with relevant added positive effects. 

In two cases, rhabdomyolysis was caused by itraconazole in heart transplant recipients taking long-term ciclosporin and simvastatin (48,49). To avoid severe myopathy, ciclosporin concentrations should be monitored frequently and statins should be withdrawn or the dosage should be reduced, as long as azoles need to be prescribed in transplant recipients. Patients need to be educated about signs and symptoms that require immediate physician intervention. 

Chan AW, Bhatt DL, Chew DP et al, Early and sustained survival benefit associated with statin therapy at the time of percutaneous coronary intervention, Circulation 2002 ... 

Briguori C, Colombo A, Airoldi p et al, Statin administration before percutaneous coronary intervention impact on periprocedural myocardial infarction, Eur Heart J 2004 25 1822-1828. 

Khanal S, Attallah N, Smith DE, et al, Statin therapy reduces contrast-induced nephropathy an analysis of contemporary percutaneous interventions, The potential role of statins in contrast nephropathy, Am J Med 2005 I I 8 843-849. 

I Chan AW, Bhatt DL, Chew DR et al. Relation of inflammation and benefit of statins after percutaneous coronary interventions. Circulation 2003 107 1750-1756,... 

Chang SM, Yazbek N, Lakkis NM. Use of statins prior to percutaneous coronary intervention reduces myonecrosis and improves clinical outcome. Catheter Cardiovasc Interv 2004 62(2)4 93-197. 

Today HMG-CoA reductase inhibitors (statins) account for the large majority of prescriptions for lipid-lowering drugs in most countries. As discussed in a subsequent section of this chapter, the widespread acceptance of this drug class is due not only to excellent efficacy and tolerability but also to the publication of several very large intervention trials, which have unequivocally demonstrated the effectiveness of the first three members of the class—lovastatin, simvastatin, and pravastatin—in reducing coronary morbidity and mortality. 

If the patient with coronary artery disease also develops cardiac dysfunction, the same medications would be expected to apply, but for additional reasons. The re-instation of preconditioning mechanisms by ACEI administration has already been described. (I-blockers have additional mechanisms, such as an antiapoptotic and antioxidant action.276 In this situation oxidative stress is also predominant and may further exacerbate apoptotic mechanisms.277 The only drugs predictably diminishing oxidative stress in clinical usage are carvedilol and statins. The latter drug family is also used in heart failure. Exercise is also a standard preventive and therapeutic intervention in both the above categories. 

---