Rational Pharmacotherapy in Cardiology

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Review of large of trials that prove the positive impact of high-dose lipid-lowering therapy on the prognosis in patients with ischemic heart disease (IHD) are presented. The data on the efficacy of the lipid profile correction by lipid apheresis in patients with hypercholesterolemia that is refractory to optimal medical therapy are showed. The results of the large trials (LIPS, ARMYDA, NAPLES II, ARMYDA-RECAPTURE, Post-CABG, TNT) and meta-analyzes on the role of statins, prescribed before and after coronary artery bypass surgery and stenting, in reducing the risk of early and late cardiac events and the need for repeat myocardial revascularization are analyzed. The issue of therapeutic apheresis should be considered in cases of refractory hypercholesterolemia according to ESC/EAS Guidelines for the management of dyslipidaemias (2011). The tendency to reduction in the risk of stent restenosis and vein graft lesions after lipid apheresis is found in very high risk patients with IHD and refractory hypercholesterolemia that underwent coronary stenting or bypass surgery.

About the Authors

R. N. Adzhiev
Russian Cardiology Research and Production Complex, Moscow
Russian Federation

M. S. Safarova
Russian Cardiology Research and Production Complex, Moscow
Russian Federation

M. V. Ezhov
Russian Cardiology Research and Production Complex, Moscow
Russian Federation


1. Boden WE, O'Rourke RA, Teo KK, et al. COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007; 356: 1503-16.

2. Wijns W, Kolh P, Danchin N, et al. Guidelines on myocardial revascularization. Eur Heart J 2010;31: 2501-55.

3. Jeremias A, Kaul S, Rosengart TK, et al. The impact of revascularization on mortality in patients with nonacute coronary artery disease. Am J Med 2009;122:152-61.

4. Fernandez SF, Boden WE. Strategies in stable ischemic heart disease: lessons from the COURAGE and BARI-2D trials. Curr Atheroscler Rep 2010;12:423-31.

5. Shah SJ, Waters DD, Barter P, et al. Intensive lipid-lowering with atorvastatin for secondary prevention in patients after coronary artery bypass surgery. J Am Coll Cardiol 2008; 51: 1938-43.

6. Motwani J, Topol E. Aortocoronary saphenous vein graft disease. Pathogenesis, predisposition, and prevention. Circulation 1998; 97:916-31.

7. Szczepiorkowski ZM, Winters JL, Bandarenko N, et al. Apheresis Applications Committee of the American Society for Apheresis. Guidelines on the use of therapeutic apheresis in clinical practice-evidencebased approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 2010;25:83-177.

8. Mabuchi H, Koizumi J, Shimizu M, et al. Long-term efficacy of low-density lipoprotein apheresis on coronary heart disease in familial hypercholesterolemia. Hokuriku-FH-LDL-Apheresis Study Group. Am J Car- diol 1998; 82:1489-95.

9. Masaki N, Tatami R, Kumamoto T, et al. Ten-year follow-up of familial hypercholesterolemia patients after intensive cholesterol-lowering therapy. Int Heart J 2005;46:833-43.

10. Serruys PW, de Feyter P, Macaya C, et al.; Lescol Intervention Prevention Study (LIPS) Investigators. Fluvastatin for prevention of cardiac events following successful first percutaneous coronary intervention: a randomized controlled trial. JAMA 2002;287:3215-22.

11. Zhang ZJ, Marroquin OC, Weissfeld JL, et al. Beneficial effects of statins after percutaneous coronary intervention. Eur J Cardiovasc Prev Rehabil 2009; 16:445-50.

12. Mood GR, Bavry AA, Roukoz H, Bhatt DL. Meta-analysis of the role of statin therapy in reducing myocardial infarction following elective percutaneous coronary intervention. Am J Cardiol 2007; 100: 919-23.

13. Brener SJ, Ellis SG, Schneider J, Topol EJ. Frequency and long-term impact of myonecrosis after coronary stenting. Eur Heart J 2002; 23: 869-76.

14. Briguori C, Colombo A, Airoldi F, et al. Statin administration before percutaneous coronary intervention: impact on peri-procedural myocardial infarction. Eur Heart J 2004; 25: 1822-8.

15. Pasceri V, Patti G, Nusca A, et al., ARMYDA Investigators. Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: results from the ARMYDA (Atorvastatin for Reduction of Myocardial Damage during Angioplasty) study. Circulation 2004; 110: 674-67.

16. Patti G, Chello M, Pasceri V, et al. Protection from procedural myocardial injury by atorvastatin is associated with lower levels of adhesion molecules after percutaneous coronary intervention: results from the ARMYDA-CAMs (Atorvastatin for Reduction of MYocardial Damage during Angioplasty-Cell Adhesion Molecules) substudy. J Am Coll Cardiol 2006; 48:1560-6.

17. Bartok A, Steiner S, Seidinger D, et al. Atorvastatin reduces thrombin generation after percutaneous coronary intervention independent of soluble tissue factor. Thromb Res 2005; 115:469-74.

18. Briguori C, Visconti G, Focaccio A, et al. Novel approaches for preventing or limiting events (Naples) II trial: impact of a single high loading dose of atorvastatin on periprocedural myocardial infarction. J Am Coll Cardiol 2009; 54: 2157-63.

19. Di Sciascio G, Patti G, Pasceri V, et al. Efficacy of atorvastatin reload in patients on chronic statin therapy undergoing percutaneous coronary intervention: results of the ARMYDA-RECAPTURE (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) Randomized Trial. J Am Coll Cardiol 2009; 54: 558-65.

20. Patti G, Cannon CP, Murphy SA, et al. Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention: a collaborative patient-level meta-analysis of 13 randomized studies. Circulation 2011;123:1622-32.

21. Daida H, Lee YJ, Yokoi H, et al. Prevention of restenosis after percutaneous transluminal coronary angioplasty by reducing lipoprotein (a) levels with low-density lipoprotein apheresis. Low-Density Lipoprotein Apheresis Angioplasty Restenosis Trial (L-ART) Group. Am J Cardiol 1994;73:1037-40.

22. Yamaguchi H, Lee YJ, Daida H, et al. Effectiveness of LDL-apheresis in preventing restenosis after percutaneous transluminal coronary angioplasty (PTCA): LDL-apheresis angioplasty restenosis trial (LART). Chem Phys Lipids 1994;67-68:399-403.

23. Kanemitsu S, Takekoshi N, Matsui S, et al. Short-term and long-term effects of low-density lipoprotein (LDL) apheresis on restenosis after percutaneous transluminal coronary angioplasty (PTCA): is lowering Lp(a) by LDL apheresis effective on restenosis after PTCA? Ther Apher 1998;2:65-70.

24. Yamashita K, Tasaki H, Tsuda Y, et al. Can aggressive lipid lowering using low-density lipoprotein apheresis prevent restenosis after percutaneous transluminal coronary angioplasty in patients with normocholesterolemia? Ther Apher 1998;2:210-7.

25. van Buuren F, Kreickmann S, Horstkotte D, et al. HELP apheresis in hypercholesterolemia and cardiovascular disease: efficacy and adverse events after 8,500 procedures. Clin Res Cardiol Suppl 2012; 7:24-30.

26. The Post Coronary Artery Bypass Graft Trial Investigators. The effect of aggressive lowering of lowdensity lipoprotein and low-dose anticoagulation on obstructive changes in saphenous-vein coronaryartery bypass grafts. N Engl J Med 1997; 336: 153-62.

27. Waters DD, Azar RR. Postscripts from the Post-Coronary Artery Bypass Graft trial: the sustained benefit of more aggressive cholesterol lowering and the enigma of low-dose anticoagulation. Circulation 2000; 102: 144-6.

28. Kulik A, Ruel M. Statins and coronary artery bypass graft surgery: preoperative and postoperative efficacy and safety. Expert Opin Drug Saf 2009; 8:559-71.

29. Magovern JA, Moraca RJ, Bailey SH, et al. Preoperative statin is associated with decreased operative mortality in high risk coronary artery bypass patients. J Cardiothorac Surg. 2010;24:5-8.

30. Ouattara A, Benhaoua H, Le Manach Y, et al. Perioperative statin therapy is associated with a significant and dose-dependent reduction of adverse cardiovascular outcomes after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2009; 23: 633-8.

31. Pascual DA, Arribas JM, Tornel PL, et al. Preoperative statin therapy and troponin T predict early complications of coronary artery surgery. Ann Thorac Surg 2006; 81: 78-83.

32. Pires LA, Wagshal AB, Lancey R, Huang SK. Arrhythmias and conduction disturbances after coronary artery bypass graft surgery: epidemiology, management, and prognosis. Am Heart J 1995; 129: 799-808.

33. Anselmi A, Possati G, Gaudino M. Postoperative inflammatory reaction and atrial fibrillation: simple correlation or causation? Ann Thorac Surg 2009; 88: 326-33.

34. Kjekshus J, Dunselman P, Blideskog M, et al. A statin in the treatment of heart failure? Controlled Rosuvastatin Multinational Study in Heart Failure (CORONA): study design and baseline characteristics. Eur J Heart Fail 2005; 7:1059-69.

35. Fauchier L, Pierre B, de Labriolle A, et al. Antiarrhythmic effect of statin therapy and atrial fibrillation a meta-analysis of randomized controlled trials. J Am Coll Cardiol 2008; 26; 51:828-35.

36. Kourliouros A, De Souza A, Roberts N, et al. Dose-related effect of statins on atrial fibrillation after cardiac surgery. Ann Thorac Surg 2008; 85: 1515-20.

37. Sun Y, Ji Q, Mei Y, et al. Role of preoperative atorvastatin administration in protection against postoperative atrial fibrillation following conventional coronary artery bypass grafting. Int Heart J 2011;52:7-11.

38. Marín F, Pascual DA, Roldán V, et al. Statins and postoperative risk of atrial fibrillation following coronary artery bypass grafting. Am J Cardiol 2006; 97: 55-60.

39. Chello M, Patti G, Candura D, et al. Effects of atorvastatin on systemic inflammatory response after coronary bypass surgery. Crit Care Med 2006; 34: 660-7.

40. Chopra V, Wesorick DH, Sussman JB, et al. Effect of perioperative statins on death, myocardial infarction, atrial fibrillation, and length of stay: a systematic review and meta-analysis. Arch Surg 2012;147: 181-9.

41. Kito Y, Takahashi J, Endo M, et al. The effect of LDL-apheresis on the long-term prognosis of hypercholesterolemic patients with coronary artery bypass grafts: a multicenter study. Kyobu Geka 1993;46:399-404.

42. Blessing F, Jaeger BR, Oberhoffer M, et al. Prevention of early graft occlusion after coronary bypass grafting by post-operative reduction of plasma fibrinogen by H.E.L.P. apheresis. First evaluation of 12 patients treated during our study (44 bypasses). Z Kardiol 2003;92(Suppl 3):III42-7.

43. Ezhov MV, Il'ina LN, Safarova MS, et al. Cascade plasma filtration during the first year after CABG in patients with hyperlipidemia refractory to statins. Atheroscler Suppl 2013;14:101-5.

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