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Statins for Treatment of Pulmonary Hypertension

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Pulmonary Hypertension

Part of the book series: Contemporary Cardiology™ ((CONCARD))

Abstract

By virtue of their multiple actions, including anti-inflammatory, antiproliferative, and pro-apoptotic traits and the ability to restore endothelial vasoactive mediator production, statins have been proposed as potential therapies for pulmonary hypertension. In experimental studies in rats with pulmonary hypertension induced either by either monocrotaline or hypoxia, statins have blunted the severity of pulmonary hypertension, right ventricular hypertrophy, and pulmonary vascular remodeling, sometimes in association with the restoration of the endothelial cell production of nitric oxide. Pending trials that demonstrate the efficacy of statins in pulmonary arterial hypertension in humans, however, the clinical use of statins should be considered investigational.

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References

  1. Fenton JW, 2nd, Brezniak DV, Ofosu FA, Shen GX, Jacobson JR, Garcia JG. Statins and thrombin. Curr Drug Targets Cardiovasc Haematol Disord 2005; 5(2):115–20.

    Article  PubMed  Google Scholar 

  2. Chen Z, Fukutomi T, Zago AC, et al. Simvastatin reduces neointimal thickening in low-density lipoprotein receptor-deficient mice after experi\-mental angioplasty without changing plasma lipids. Circulation 2002; 106(1):20–3.

    Article  PubMed  CAS  Google Scholar 

  3. Bea F, Blessing E, Shelley MI, Shultz JM, Rosenfeld ME. Simvastatin inhibits expression of tissue factor in advanced atherosclerotic lesions of apolipoprotein E deficient mice independently of lipid lowering: Potential role of simvastatin-mediated inhibition of Egr-1 expression and activation. Atherosclerosis 2003; 167(2):187–94.

    Article  PubMed  CAS  Google Scholar 

  4. Zhu JH, Tao QM, Chen JZ, Wang XX, Shang YP. Statins contribute to enhancement of the number and the function of endothelial progenitor cells from peripheral blood. Sheng Li Xue Bao 2004; 56(3):357–64.

    PubMed  Google Scholar 

  5. Walter DH, Rittig K, Bahlmann FH, et al. Statin therapy accelerates reendothelialization: A novel effect involving mobilization and incorporation of bone marrow-derived endothelial progenitor cells. Circulation 2002; 105(25):3017–24.

    Article  PubMed  CAS  Google Scholar 

  6. Llevadot J, Murasawa S, Kureishi Y, et al. HMG-CoA reductase inhibitor mobilizes bone marrow-derived endothelial progenitor cells. J Clin Invest 2001; 108(3):399–405.

    PubMed  CAS  Google Scholar 

  7. Szczeklik A, Undas A, Musial J, Gajewski P, Swadzba J, Jankowski M. Antithrombotic actions of statins. Med Sci Monit 2001; 7(6):1381–5.

    PubMed  CAS  Google Scholar 

  8. Undas A, Brummel KE, Musial J, Mann KG, Szczeklik A. Simvastatin depresses blood clotting by inhibiting activation of prothrombin, factor V, and factor XIII and by enhancing factor Va inactivation. Circulation 2001; 103(18):2248–53.

    PubMed  CAS  Google Scholar 

  9. Gil-Nunez AC, Villanueva JA. Advantages of lipid-lowering therapy in cerebral ischemia: Role of HMG-CoA reductase inhibitors. Cerebrovasc Dis 2001; 11 (Suppl 1):85–95.

    PubMed  CAS  Google Scholar 

  10. Mutanen M, Freese R. Fats, lipids and blood coagulation. Curr Opin Lipidol 2001; 12(1):25–9.

    Article  PubMed  CAS  Google Scholar 

  11. Mason RP, Walter MF, Jacob RF. Effects of HMG-CoA reductase inhibitors on endothelial function: Role of microdomains and oxidative stress. Circulation 2004; 109(21 Suppl 1):1134–41.

    Google Scholar 

  12. Trochu JN, Mital S, Zhang X, et al. Preservation of NO production by statins in the treatment of heart failure. Cardiovasc Res 2003; 60(2):250–8.

    Article  PubMed  CAS  Google Scholar 

  13. Ongini E, Impagnatiello F, Bonazzi A, et al. Nitric oxide (NO)-releasing statin derivatives, a class of drugs showing enhanced antiproliferative and antiinflammatory properties. Proc Natl Acad Sci USA 2004; 101(22):8497–502.

    Article  PubMed  CAS  Google Scholar 

  14. Bellosta S, Arnaboldi L, Gerosa L, et al. Statins effect on smooth muscle cell proliferation. Sem Vasc Med 2004; 4(4):347–56.

    Article  Google Scholar 

  15. Porter KE, Naik J, Turner NA, Dickinson T, Thompson MM, London NJ. Simvastatin inhibits human saphenous vein neointima formation via inhibition of smooth muscle cell proliferation and migration. J Vasc Surg 2002; 36(1):150–7.

    Article  PubMed  Google Scholar 

  16. Jeffery TK, Morrell NW. Molecular and cellular basis of pulmonary vascular remodeling in pulmonary hypertension. Prog Cardiovasc Dis 2002; 45(3):173–202.

    Article  PubMed  CAS  Google Scholar 

  17. Sakao S, Taraseviciene-Stewart L, Lee JD, Wood K, Cool CD, Voelkel NF. Initial apoptosis is followed by increased proliferation of apoptosis-resistant endothelial cells. FASEB J 2005; 19(9):1178–80.

    PubMed  Google Scholar 

  18. Dorfmuller P, Humbert M, Capron F, Muller KM. Pathology and aspects of pathogenesis in pulmonary arterial hypertension. Sarcoidosis Vasc Diffuse Lung Dis 2003; 20(1):9–19.

    PubMed  Google Scholar 

  19. Deng Z, Morse JH, Slager SL, et al. Familial primary pulmonary hypertension (gene PPH1) is caused by mutations in the bone morphogenetic protein receptor-II gene. Am J Hum Genet 2000; 67(3):737–44.

    Article  PubMed  CAS  Google Scholar 

  20. Newman JH, Wheeler L, Lane KB, et al. Mutation in the gene for bone morphogenetic protein receptor II as a cause of primary pulmonary hypertension in a large kindred. N Engl J Med 2001; 345(5):319–24.

    Article  PubMed  CAS  Google Scholar 

  21. Trembath RC, Harrison R. Insights into the genetic and molecular basis of primary pulmonary hypertension. Pediatr Res 2003; 53(6):883–8.

    Article  PubMed  Google Scholar 

  22. Machado RD, Pauciulo MW, Thomson JR, et al. BMPR2 haploinsufficiency as the inherited molecular mechanism for primary pulmonary hypertension. Am J Hum Genet 2001; 68(1):92–102.

    Article  PubMed  CAS  Google Scholar 

  23. Atkinson C, Stewart S, Upton PD, et al. Primary pulmonary hypertension is associated with reduced pulmonary vascular expression of type II bone morphogenetic protein receptor. Circulation 2002; 105(14):1672–8.

    Article  PubMed  CAS  Google Scholar 

  24. Atkinson C, Stewart S, Imamura T, Trembath RC, Morrell NW. Immunolocalisation of BMPR-II and TGF-ss type I and II receptors in primary plexogenic pulmonary hypertension. J Heart Lung Transplant 2001; 20(2):149.

    Article  PubMed  Google Scholar 

  25. Langenfeld EM, Langenfeld J. Bone morphogenetic protein-2 stimulates angiogenesis in developing tumors. Mol Cancer Res 2004; 2(3):141–9.

    PubMed  CAS  Google Scholar 

  26. Goumans MJ, Valdimarsdottir G, Itoh S, Rosendahl A, Sideras P, ten Dijke P. Balancing the activation state of the endothelium via two distinct TGF-beta type I receptors. EMBO J 2002; 21(7):1743–53.

    Article  PubMed  CAS  Google Scholar 

  27. Pammer J, Reinisch C, Kaun C, Tschachler E, Wojta J. Inhibitors of differentiation/DNA binding proteins Id1 and Id3 are regulated by statins in endothelial cells. Endothelium 2004; 11(3–4):175–80.

    Article  PubMed  CAS  Google Scholar 

  28. Fishman AP. Primary pulmonary arterial hypertension: A look back. J Am Coll Cardiol 2004; 43(12 Suppl S):2S–4S.

    Article  PubMed  Google Scholar 

  29. Thompson PD, Moyna NM, White CM, Weber KM, Giri S, Waters DD. The effects of hydroxy-methyl-glutaryl co-enzyme A reductase inhibitors on platelet thrombus formation. Atherosclerosis 2002; 161(2):301–6.

    Article  PubMed  CAS  Google Scholar 

  30. Puccetti L, Bruni F, Bova G, et al. Effect of diet and treatment with statins on platelet-dependent thrombin generation in hypercholesterolemic subjects. Nutr Metab Cardiovasc Dis 2001; 11(6):378–87.

    PubMed  CAS  Google Scholar 

  31. Notarbartolo A, Davi G, Averna M, et al. Inhibition of thromboxane biosynthesis and platelet function by simvastatin in type IIa hypercholesterolemia. Arterioscler Thromb Vasc Biol 1995; 15(2):247–51.

    PubMed  CAS  Google Scholar 

  32. Mraiche F, Cena J, Das D, Vollrath B. Effects of statins on vascular function of endothelin-1. Br J Pharmacol 2005; 144(5):715–26.

    Article  PubMed  Google Scholar 

  33. Hernandez-Perera O, Perez-Sala D, Soria E, Lamas S. Involvement of Rho GTPases in the transcriptional inhibition of preproendothelin-1 gene expression by simvastatin in vascular endothelial cells. Circ Res 2000; 87(7):616–22.

    PubMed  CAS  Google Scholar 

  34. Kureishi Y, Luo Z, Shiojima I, et al. The HMG-CoA reductase inhibitor simvastatin activates the protein kinase Akt and promotes angiogenesis in normocholesterolemic animals. Nat Med 2000; 6(9):1004–10.

    Article  PubMed  CAS  Google Scholar 

  35. Inoue I, Goto S, Mizotani K, et al. Lipophilic HMG-CoA reductase inhibitor has an anti-inflammatory effect: Reduction of MRNA levels for interleukin-1beta, interleukin-6, cyclooxygenase-2, and p22phox by regulation of peroxisome proliferator-activated receptor alpha (PPARalpha) in primary endothelial cells. Life Sci 2000; 67(8):863–76.

    Article  PubMed  CAS  Google Scholar 

  36. Faul JL, Nishimura T, Berry GJ, Benson GV, Pearl RG, Kao PN. Triptolide attenuates pulmonary arterial hypertension and neointimal formation in rats. Am J Respir Crit Care Med 2000; 162(6):2252–8.

    PubMed  CAS  Google Scholar 

  37. Nishimura T, Faul JL, Berry GJ, Veve I, Pearl RG, Kao PN. 40-O-(2-hydroxyethyl)-rapamycin attenuates pulmonary arterial hypertension and neointimal formation in rats. Am J Respir Crit Care Med 2001; 163(2):498–502.

    PubMed  CAS  Google Scholar 

  38. Nishimura T, Faul JL, Berry GJ, et al. Simvastatin attenuates smooth muscle neointimal proliferation and pulmonary hypertension in rats. Am J Respir Crit Care Med 2002; 166(10):1403–8.

    Article  PubMed  Google Scholar 

  39. Okada K, Bernstein ML, Zhang W, Schuster DP, Botney MD. Angiotensin-converting enzyme inhibition delays pulmonary vascular neointimal formation. Am J Respir Crit Care Med 1998; 158(3):939–50.

    PubMed  CAS  Google Scholar 

  40. Nishimura T, Vaszar LT, Faul JL, et al. Simvastatin rescues rats from fatal pulmonary hypertension by inducing apoptosis of neointimal smooth muscle cells. Circulation 2003; 108(13):1640–5.

    Article  PubMed  CAS  Google Scholar 

  41. Vaszar LT, Nishimura T, Storey JD, et al. Longitudinal transcriptional analysis of developing neointimal vascular occlusion and pulmonary hypertension in rats. Physiol Genom 2004; 17(2):150–6.

    Article  CAS  Google Scholar 

  42. Girgis RE, Li D, Zhan X, et al. Attenuation of chronic hypoxic pulmonary hypertension by simvastatin. Am J Physiol Heart Circ Physiol 2003; 285:H938–45.

    PubMed  CAS  Google Scholar 

  43. Girgis RE, Ma SF, Ye S, et al. Differential gene expression in chronic hypoxic pulmonary hypertension: Effect of simvastatin treatment. Chest 2005 Dec; 128(6 Suppl):579S.

    Google Scholar 

  44. Davidson MH, McGarry T, Bettis R, et al. Ezetimibe coadministered with simvastatin in patients with primary hypercholesterolemia. J Am Coll Cardiol 2002; 40(12):2125–34.

    Google Scholar 

  45. Boccuzzi SJ, Bocanegra TS, Walker JF, Shapiro DR, Keegan ME. Long-term safety and efficacy profile of simvastatin. Am J Cardiol 1991; 68(11):1127–31.

    Article  PubMed  CAS  Google Scholar 

  46. Pedersen TR, Berg K, Cook TJ, et al. Safety and tolerability of cholesterol lowering with simvastatin during 5 years in the Scandinavian Simvastatin Survival Study. Arch Intern Med 1996; 156(18):2085–92.

    Article  PubMed  CAS  Google Scholar 

  47. Thibault A, Samid D, Tompkins AC, et al. Phase I study of lovastatin, an inhibitor of the mevalonate pathway, in patients with cancer. Clin Cancer Res 1996; 2(3):483–91.

    PubMed  CAS  Google Scholar 

  48. Kim WS, Kim MM, Choi HJ, et al. Phase II study of high-dose lovastatin in patients with advanced gastric adenocarcinoma. Invest New Drugs 2001; 19(1):81–3.

    Article  PubMed  CAS  Google Scholar 

  49. Larner J, Allan G, Kessler C, Reamer P, Gunn R, Huang LC. Phosphoinositol glycan derived mediators and insulin resistance. Prospects for diagnosis and therapy. J Basic Clin Physiol Pharmacol 1998; 9(2–4):127–37.

    PubMed  CAS  Google Scholar 

  50. Kao PN. Simvastatin treatment of pulmonary hypertension: An observational case series. Chest 2005; 127(4):1446–52.

    Article  PubMed  Google Scholar 

  51. Kaye JA, Meier CR, Walker AM, Jick H. Statin use, hyperlipidaemia, and the risk of breast cancer. Br J Cancer 2002; 86(9):1436–9.

    Article  PubMed  CAS  Google Scholar 

  52. Hebert PR, Gaziano JM, Chan KS, Hennekens CH. Cholesterol lowering with statin drugs, risk of stroke, and total mortality. An overview of randomized trials. JAMA 1997; 278(4):313–21.

    CAS  Google Scholar 

  53. Li HY, Appelbaum FR, Willman CL, Zager RA, Banker DE. Cholesterol-modulating agents kill acute myeloid leukemia cells and sensitize them to therapeutics by blocking adaptive cholesterol responses. Blood 2003; 101(9):3628–34.

    Article  PubMed  CAS  Google Scholar 

  54. Wong WW, Dimitroulakos J, Minden MD, Penn LZ. HMG-CoA reductase inhibitors and the malignant cell: The statin family of drugs as triggers of tumor-specific apoptosis. Leukemia 2002; 16(4):508–19.

    Article  PubMed  CAS  Google Scholar 

  55. Ardati A, Stolley P, Knapp DE, Wolfe SM, Lurie P. Statin-associated rhabdomyolysis. Pharmacoepidemiol Drug Saf 2005; 14(4):287.

    Article  PubMed  Google Scholar 

  56. Ratz Bravo AE, Tchambaz L, Krahenbuhl-Melcher A, Hess L, Schlienger RG, Krahenbuhl S. Prevalence of potentially severe drug-drug interactions in ambulatory patients with dyslipidaemia receiving HMG-CoA reductase inhibitor therapy. Drug Saf 2005; 28(3):263–75.

    Article  PubMed  Google Scholar 

  57. Sochman J, Podzimkova M. Not all statins are alike: Induced rhabdomyolysis on changing from one statin to another one. Int J Cardiol 2005; 99(1):145–6.

    Article  PubMed  Google Scholar 

  58. Baker SK. Molecular clues into the pathogenesis of statin-mediated muscle toxicity. Muscle Nerve 2005; 31(5):572–80.

    Article  PubMed  Google Scholar 

  59. Chu JW, Kao PN, Faul JL, Doyle RL. High prevalence of autoimmune thyroid disease in pulmonary arterial hypertension. Chest 2002; 122(5):1668–73.

    Article  PubMed  Google Scholar 

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© 2008 Humana Press, Totowa, NJ

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Faul, J.L., Kao, P.N., Nishimura, T., Sung, A., Hu, H., Pearl, R.G. (2008). Statins for Treatment of Pulmonary Hypertension. In: Hill, N.S., Farber, H.W. (eds) Pulmonary Hypertension. Contemporary Cardiology™. Humana Press. https://doi.org/10.1007/978-1-60327-075-5_15

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  • DOI: https://doi.org/10.1007/978-1-60327-075-5_15

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-661-0

  • Online ISBN: 978-1-60327-075-5

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