Statins complications

Unless contraindicated, lipid lowering with HMGCoA reductase inhibitors (statins) should be used to treat hyperlipidemia for prevention of cardiovascular complications and are effective and well tolerated in those at least up to 80 years with coronary disease. 

Nephrotic hyperlipidemia is accompanied with increased risk of cardiovascular complications and should be treated in all patients with persistent nephrotic syndrome. The putative positive effect of hypolipidemic drugs (namely statins) on the cardiovascular risk and potentially also on the rate of progression of chronic renal failure remains to be demonstrated in prospective controlled studies. 

As yet there are no completed megatrials with the newer statins. A study that compared atorvastatin versus angioplasty in 341 patients with stable CHD over 18 months was recently reported (Pitt et al., 1999). There were fewer ischemic events in the atorvastatin group, but the difference did not quite reach statistical significance. Furthermore, a previous study had shown a significantly lower incidence of such events in a group treated with conventional medical therapy, because angioplasty can be complicated by myocardial infarction and other acute coronary events (RITA-2 trial participants, 1997). 

For subarachnoid hemorrhage surgical clipping of the causative aneurysm or resection of the arteriovenous malformation is the mainstay of treatment. Endovascular coiling of the aneurysm can also be performed. Post-operative infection (either brain or respiratory) is an uncommon complication and not believed to be any more common than after other invasive surgical procedures. Hypervolemic-hemodilution and hypertensive (HHH) therapy is used to prevent spasm. There may be a role for anti-inflammatory measures for the prevention of vasospasm and delayed cerebral ischemia, as shown in a recent pilot study of patients treated with statins (Lynch et al., 2005). 

A 53-year-old male patient with elevated levels of low-density lipoprotein (LDL) cholesterol, signs of premature cholesterol gallstone disease and substantially elevated triglycerides visited his physician for a follow-up to check his current status. The patient had received various statin, HMG-CoA-reductase inhibitors therapies for the past 2 years. However, after blood work done at this follow-up visit, complications had still not subsided. This patient has similar problems as two of his siblings. Which of the following best explains this patients dyslipidemia ... 

The evidence suggests that all the azole antifungals can raise ciclosporin levels to a greater or lesser degree. Ketoconazole may cause five- to tenfold rises, while itraconazole, fluconazole and voriconazole may cause two- to threefold rises. A case report suggests that intravenous miconazole interacts similarly and in theory, miconazole oral gel may also interact. Posaconazole may also modestly raise ciclosporin levels. Rhabdomyolysis has been reported with the combination of ciclosporin and itraconazole, but four of these cases were complicated by the presence of statins. 

In preventing incidence of cardiovascular complications in patients with CKD, no report has been made on the effectiveness of a single-modality therapy such as hypertensive therapy or monotherapy with statins. 

A 74-year-old-woman whose preoperative medications consisted of a statin, an angiotensin-converting enzyme inhibitor and flecainide for atrial fibrillation presented with generalised myoclonic movements after an ultrasound-guided brachial plexus block in which a total of 380 mg of lidocaine was used. She was treated with 200 mL of lipid emulsion 20°/o and surgery proceeded after 30 min without any further complications. A venous sample taken at the time yielded nontoxic concentration of 4.2 ng/L lidocaine and flecainide plasma levels of 180 rg/mL (toxic level range 700-1000 rg/mL). 

A randomised, open-label, controlled trial of daptomycin to treat osteomyelitis associated with prosthetic devices revealed increases in CPK levels in 16% of those treated with 6mg/kg, and 21.7% of those treated with 8mg/kg. Daptomycin was given for between 6 and 8 weeks [148 ]. Similarly, a retrospective analysis of the use of daptomycin (4-6mg/kg) for complicated skin and soft-tissue infections with or without associated bacteraemia revealed a favourable safety profile. The most common adverse event reported was elevation of blood CPK [149 ]. A similar retrospective analysis investigating the safety of prolonged (>14days) daptomycin in 2263 patients reported increased blood CPK, nausea, diarrhoea, vomiting, thrombocytopenia, rash, pyrexia and increased blood creatinine at a rate of between 0.1% and 2.2% [150 ]. In contrast to this, a retrospective study assessed the safety of co-administration of daptomycin with statins. There was no significant increase in rhabdomyolysis with the combination [ISl ]. 

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