Document Detail

Statins in the treatment of chronic heart failure: biological and clinical considerations.
MedLine Citation:
PMID:  16730683     Owner:  NLM     Status:  MEDLINE    
Patients with increased cholesterol levels are at increased risk to experience cardiovascular events and to die from vascular disease. Statins have been proven to effectively reduce cholesterol levels and subsequently reduce cardiovascular events in patients with coronary artery disease or at increased risk to develop coronary artery disease. However, in patients with chronic heart failure (CHF), not high, but low levels of cholesterol are related to increased mortality. This phenomenon of reverse epidemiology is not unique to CHF, but also exists in other critical diseases and in the elderly in general as well. An important rationale has been provided by the endotoxin hypothesis, which suggests that cholesterol has an important scavenger function regarding harmful endotoxins. Indeed, these lines of evidence predict a harmful effect of statin treatment in patients with CHF. However, statins not only lower cholesterol, but also have been reported to exhibit a plethora of pleiotropic effects, including reduction of inflammation and improvement of endothelial function. In order to reconcile these contradictory lines of evidence, it is necessary to examine the pharmacological mechanisms of effects of statin treatment. Understanding the pharmacology of statin intervention in CHF models and patients may facilitate the development of therapeutic strategies. In this review, we provide an overview of the known associations between serum cholesterol and CHF in human subjects. In addition, we review the available lines of evidence in animal models and humans predicting both harmful and beneficial effects of statin treatment in CHF. We emphasize the importance of additional research specifically in CHF models and patients.
Pim van der Harst; Adriaan A Voors; Wiek H van Gilst; Michael Böhm; Dirk J van Veldhuisen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2006-04-27
Journal Detail:
Title:  Cardiovascular research     Volume:  71     ISSN:  0008-6363     ISO Abbreviation:  Cardiovasc. Res.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-07-31     Completed Date:  2006-10-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0077427     Medline TA:  Cardiovasc Res     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  443-54     Citation Subset:  IM    
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands.
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MeSH Terms
Cholesterol / blood
Heart Failure / blood,  drug therapy*
Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects,  therapeutic use*
Reg. No./Substance:
0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 57-88-5/Cholesterol

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