Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Statins, the most common drugs for reduction in lipid levels, are “strategic” medicinal products for the treatment and prevention of cardiovascular diseases caused by atherosclerosis. The milestones of lipid-lowering therapy history are presented as well as its contemporary aims and their implementation with focus on rosuvastatin. Data of recent metaanalysis regarding statins efficacy in primary and secondary prevention of cardiovascular complications, good safety and tolerability profile were presented. Treatment of patients with acute coronary syndrome with modern statins in high doses is discussed specially. Clinical case study of long-term treatment with rosuvastatin 20 mg/day is described. Frequency of statin prescriptions and achievements of target lipid levels in real medical practice among population of Russian patients is evaluated according to results of LIS study and PROFILE registry. Results of Russian studies of therapeutic equivalence of generic drug with original rosuvastatin are presented.

About the Author

L. N. Malay
The Far Eastern State Medical University
Russian Federation
Muravyeva-Amurskogo ul. 35, Khabarovsk, 680000 Russia


1. Mahmood SS, Levy D, Vasan RS, Wang TJ. The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. Lancet 2014;383(9921):999-1008.

2. Brown M.S. and Goldstein J.L. A receptor-mediated pathway for cholesterol homeostasis. Science 1986; 232:34-47.

3. Scandinavian Simvistatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvistatin Survival Study (4S). Lancet 1994; 344:1383-1389.

4. Gelsinger C, Steinhagen-Thiessen E, Kassner U. Therapeutic potential of mipomersen in the management of familial hypercholesterolaemia. Drugs 2012;72(11):1445-55.

5. Barter P.J., Caufield M., Eriksson M. et al. fort he ILLUMINATE Investigators. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med 2007;357:2109-22.

6. Rader D.J. Illuminating HDL – is it still a viable therapeutic targer? N Engl J Med 2007;357:2180-3.

7. Schwartz G.G., Olsson A.G., Abt M., et al. Effects of Dalcetrapib in Patients with a Recent Acute Coronary Syndrome. N Engl J Med 2012;367:2089-99.

8. ESC/EAS guidelines for the management of dyslipidemia. Eur Heart J 2011;32:1769-818.

9. Michael O’Riordan, New Cholesterol Guidelines Abandon LDL Targets. Available at: Accessed by 19.10.2014.

10. Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association. J Am Coll Cardiol 2014;63(25 Pt B):2889-934.

11. Eliashevich SO. Rejection of the target values of LDL in primary and secondary prevention of atherosclerosis: the new American recommendations. Available at: Accessed by 19/10/2014. Russian (Елиашевич С.О. Отказ от целевых значений уровня ЛПНП в первичной и вторичной профилактике атеросклероза: новые аме-риканские рекомендации. Доступно на: Проверено 19.10.2014).

12. Cheung B., Lauder I., Lau C., Kumana C. Meta-analysis of large randomized controlled trials to evaluate the impact of statins on cardiovascular outcomes. Br J Clin Pharmacol 2004;57:649-51.

13. Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of datafrom 170 000 participants in 26 randomised trials. Lancet 2010;376:1670-81.

14. Drapkina OM. Statins - the card cardiologist. Consilium Medicum 2012; (5): 28-31. Russian (Драп-кина О.М. Статины – визитная карточка кардиолога. Consilium Medicum 2012; (5): 28-31).

15. van Vark LC, Bertrand M, Akkerhuis KM et al. Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158,998 patients. Eur Heart J 2012; 33; 2088-97

16. Savarese G, Costanzo P, Cleland JG et al. A meta-analysis reporting effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients without heart failure. J Am Coll Cardiol 2013; 61: 131-42

17. Drapkina OM. On the question of safety of statins. Review of data. Ration Pharmacother Cardiol 2013; 9 (2): 143-8. Russian (Драпкина О.М. К вопросу о безопасности статинов. Обзор данных. Ра-циональная Фармакотерапия в Кардиологии 2013;9(2):143-8).

18. Spyridopoulos I. Is telomerase a potential target for vascular rejuvenation? Atherosclerosis 2011;216:19-20.

19. Jones P.H., Davidson M.H., Stein E.A. et al. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial). Am J Cardiol 2003;92: 152-60.

20. Ridker P.M., Danielson E., Fonseca F.A.H. et al. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. N Engl J Med 2008;359:2195-207.

21. Uholkina GB. Statins - past, present and future. Russkiy Meditsinskiy Zhurnal 2013; 4: 199-204. Russian (Ухолкина Г.Б. Статины – прошлое, настоящее, будущее. Русский Медицинский Жур-нал 2013;4:199-204).

22. National Guidelines for the efficacy and safety of drug therapy for primary and secondary prevention of cardiovascular disease. Available at: Accessed by 19/10/2014. Russian (Национальные рекомендации по эффективности и безопасности лекарственной терапии при первичной и вторичной профи-лактике сердечно-сосудистых заболеваний. Доступно на: Проверено 19.10.2014).

23. Ekstedt M, Franzen LE, Mathiesen UL et al. Statins in non-alcoholic fatty liver disease and chronically elevated liver enzymes: a histopathological follow-up study. J Hepatol 2007;47(1):135-41.

24. El-Serag HB, Johnson ML, Hachem C, Morgana RO. Statins are associated with a reduced risk of hepatocellular carcinoma in a large cohort of patients with diabetes. Gastroenterology 2009;136(5): 1601-8.

25. Drapkina OM, Ashikhmin YI, Ivashkin VT Statins and liver: friend or foe? A Critical Review. Serdtse 2011; 10 (1): 38-42. Russian (Драпкина О.М., Ашихмин Я.И., Ивашкин В.Т. Статины и печень: друзья или враги? Критический обзор. Сердце 2011; 10(1):38-42).

26. Norris W, Paredes AH, Lewis JH. Drug-induced liver injury in 2007. Curr Opin Gastroenterol. 2008;24(3):287-97.

27. Martsevich SYu, Kutishenko NP, Drozdova L.Yu. Study of the effect ursodeoxycholic acid on the efficacy and safety of statin therapy in patients with liver disease, gallbladder and / or biliary tract (theRAKURS study). Ration Pharmacother Cardiol 2014; 10 (2): 147-52. Russian (Марцевич С.Ю., Кутишенко Н.П., Дроздова Л.Ю.. Изучение влияния урсодезоксихолиевой кислоты на эф-фективность и безопасность терапии статинами у больных с заболеваниями печени, желчного пузыря и/или желчевыводящих путей (исследование РАКУРС). Рациональная Фармакотерапия в Кардиологии 2014; 10(2):147-52).

28. Poynter JN, Gruber SB, Higgins PD et all. Statins and the risk of colorectal cancer. N Engl J Med. 2005; 352(21): 2184-92.

29. Boudreau DM, Yu O, Buist DS, Miglioretti DL. Statin use and prostrate cancer risk in a large population-based setting. Cancer Causes Control 2008; 19(7):767-74.

30. Neil A, Cooper J, Betteridge J et al. Reductions in all-cause, cancer, and coronary mortality in statintreated patients with heterozygous familial hypercholesterolaemia: a prospective registry study. Eur Heart J 2008; 29(21):2625-33.

31. Undela K et al. Breast Cancer Res Treat 2012; 155:261-269.

32. Sattar N, Preiss D, Murray HM et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomized statin trials. Lancet 2010; 375:735-42.

33. Preiss D, Serbasai SR, Welsh P et val. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA 2011; 305:2556-64.

34. Abbas A, Milles J, Ramachadran S. Rosuvastatin and atorvastatin: comparative effects on glucose metabolism in non-diabetic patients with dyslipidaemia. Clin Medicine Insight Endocrinol Diab 2012; 5:13-30.

35. Chiang CE, Wang KL. Statin, risk of diabetes and impacts on mortality: insight from Taiwan national health insurance database. JACC 2012; 59(13): E1657.

36. Fonarow G. S., Right R. S., Spencer F. A. Et al. Effect of statin use within the first 24 hours of admission for acute myocardial infarction on early morbidity and mortality. Am J Cardiol 2005;96:611-6. .

37. Aronov AM, Bubnov MG. Pleiotropic effects of statins on the present stage of their study (focus on atorvastatin). Part I. Kardiosomatika 2012; 3 (3): 55-69. Russian (Аронов А.М., Бубнова М.Г. Плейо-тропные эффекты статинов на современном этапе их изучения (фокус на аторвастатин). Часть I. Кардиосоматика 2012; 3 (3): 55-69).

38. Lorenz H., Junger C., Seidl K et al. Do statin influence the prognostic impact of non-sustained ventricular tachucardia after ST-elevation myocardial infarction? Eur Heart J 2005; 26: 1078-85.

39. Gilyarevsky SR What is the selection of an optimal regimen of intensive statin therapy with evidencebased medicine? Russian Journal of Medicine 2013; 4: 220-4. Russian (Гиляревский С.Р. Что та-кое выбор оптимального режима интенсивной терапии статинами с позиций доказательной медицины? Русский Медицинский Журнал 2013; 4:220-4).

40. Pitt B., Loscalzo J., Monyak J. et al. Comparison of Lipid-Modifying Efficacy of Rosuvastatin Versus Atorvastatin in Patients With Acute Coronary Syndrome (from the Lunar Study). Am J Cardiol 2012; 109: 1239-46.

41. Nicholls S. J., Ballanyne C. M., Banter P. J. et al. Effect of two intensive statin regiments on progression of coronary disease. N Engl J Med 2011;365: 2078-87.

42. Grabowski DC, et al. The large social value resulting from use of statins warrants steps to improve adherence and broaden treatment.Health Affairs 2012; 31(10);2276-85.

43. Yusuf S., Islam S., Chow C.K. et al. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): A prospective epidemiological survey. Lancet 2011; 378(9798): 1231-43.

44. Martsevich SYu, Ginsburg ML, Kutishenko NP, et al. The LIS study (Lubertsy study mortality in patients with acute myocardial infarction). Evaluation of drug therapy. Part 1: How patients are treated prior myocardial infarction, and how this affects mortality in the hospital. Ration Pharmacother Cardiol 2012, 8 (5): 681-4. Russian (Марцевич С.Ю., Гинзбург М.Л., Кутишенко Н.П., и др. Ис-следование ЛИС (Люберецкое исследование смертности больных, перенесших острый ин-фаркт миокарда). Оценка лекарственной терапии. Часть 1. Как лечатся больные перед инфарктом миокарда, и как это влияет на смертность в стационаре. Рациональная Фармакотерапия в Кар-диологии 2012;8(5): 681-4).

45. Martsevich SYu, Gaisenok OV, Tripkosh SG, et al. Observation in a specialized medical center and the quality of lipid-lowering therapy in patients with cardiovascular disease (according to the PROFIL register). Ration Pharmacother Cardiol 2013; 9 (2): 133-7. Russian (Марцевич С.Ю., Гайсенок О.В., Трипкош С.Г., и др. Наблюдение в специализированном медицинском центре и качество ги-полипидемической терапии у пациентов с сердечно-сосудистыми заболеваниями (по данным регистра ПРОФИЛЬ). Рациональная Фармакотерапия в Кардиологии 2013;9(2):133-7).

46. Martsevich SYu, Gaisenok OV Tripkosh SG, et al. Actual practice of prescribing statins and its dependence on the observation in a specialized medical center for patients with high risk of cardiovascular events (according to the PROFIL register). Ration Pharmacother Cardiol 2013; 9 (4): 362-7. Russian (Мар-цевич С.Ю., Гайсенок О.В., Трипкош С.Г., и др. Реальная практика назначения статинов и ее за-висимость от наблюдения в специализированном медицинском центре у больных с высоким риском сердечно-сосудистых осложнений (по данным регистра ПРОФИЛЬ). Рациональная Фармакотерапия в Кардиологии 2013;9(4):362-7).

47. Drapkina OM, Palatkin L, Zyatenkova E. Pleiotropic effects of statins. Effect on vascular stiffness. Vrach 2012; 9: 5-8. Russian (Драпкина О.М., Палаткина Л., Зятенкова Е. Плейотропные эффекты ста-тинов. Влияние на жесткость сосудов. Врач 2012; 9: 5-8).

48. Gilyarevsky SR, Orlov VA, Kuzmina IM, Baturina OV. Lipid-lowering effects of the use of intensive statin regimens in the treatment of patients with acute coronary syndrome: approaches to the choice of the drug and its dose. Kardiologiya i serdechno-sosudistaya khirurgiya 2012; 5 (4): 36-41. Russian (Гиляревский С.Р., Орлов В.А., Кузьмина И.М., Батурина О.В. Гиполипидемические эффекты применения интенсивных режимов приема статинов при лечении больных с острым коронарным синдромом: подходы к выбору препарата и его дозы. Кардиология и сердечно-сосудистая хи-рургия 2012; 5(4): 36-41).

49. Zadionchenko VS, Shehyan GG, Shahray NB, et al. Effect of rosuvastatin on lipid metabolism, microcirculation and central hemodynamics in patients with acute coronary syndrome. Consilium Medicum 2011; 13 (5): 3-10. Russian (Задионченко В.С., Шехян Г.Г., Шахрай Н.Б., и др. Влияние розу-вастатина на липидный обмен, микроциркуляцию и показатели центральной гемодинами-ки у больных с острым коронарным синдромом. Consilium Medicum 2011; 13(5): 3-10).

50. Zubareva MY, Rozhkova TA, Amelyushkina VA, et al. Efficacy, safety and tolerability of rosuvastatin 40 mg daily in patients with very high cardiovascular risk with primary hypercholesterolemia. The results of the 24-week study, "40*40". Farmateka 2013;7 (260): 63-6. Russian (Зубарева М.Ю., Рожкова Т.А., Амелюшкина В.А., и др. Эффективность, безопасность и переносимость тера-пии розувастатином 40 мг/сут у больных очень высокого сердечно-сосудистого риска с пер-вичной гиперхолестеринемией. Результаты 24-недельного исследования «40*40». Фарма-тека 2013;7(260):63-6).

51. Pristrom AM, Samokhodkina SV, Crater ML, Gumenuk AG. Comparative effectiveness and safety Mertenil®(rosuvastatin) in patients with hyperlipidemia. Meditsinskie Novosti 2013; 3: 51-6. Russian (При-стром А.М., Самоходкина С.В., Крейтер М.Л., Гуменюк А.Г. Сравнительная эффективность и безопасность Мертенила®(розувастатина) у пациентов с гиперлипидемией. Медицинские новости 2013;3:51-6). Поступила: 17.09.2014

For citation:


Views: 616

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)