Statins and Renin-Angiotensin System Inhibitor Combination Treatment to Prevent Cardiovascular Disease

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概要

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• Hypercholesterolemia and hypertension are common risk factors for cardiovascular disease (CVD). Updated guidelines emphasize target reductions of overall cardiovascular risks. Experimental studies have shown reciprocal relationships between insulin resistance (IR) and endothelial dysfunction. Hypercholesterolemia and hypertension have a synergistic deleterious effect on IR and endothelial dysfunction. Unregulated renin-angiotensin system (RAS) is important in the pathogenesis of atherosclerosis and hypertension. Various strategies with different classes of antihypertensive medications to reach target goals have failed to reduce residual CVD risk further. Of interest, treating moderate cholesterol elevations with low-dose statins in hypertensive patients reduced CVD risk by 35–40% further. Therefore, statins are important in reducing CVD risk. Unfortunately, statin therapy causes IR and increases the risk of type 2 diabetes mellitus. RAS inhibitors improve both endothelial dysfunction and IR. Further, cross-talk between hypercholesterolemia and RAS exists at multiple steps of IR and endothelial dysfunction. In this regard, combined therapy with statins and RAS inhibitors demonstrates additive/synergistic effects on endothelial dysfunction and IR in addition to lowering cholesterol levels and blood pressure when compared with either monotherapy in patients. This is mediated by both distinct and interrelated mechanisms. Therefore, combined therapy with statins and RAS inhibitors may be important in developing optimal management strategies in patients with hypertension, hypercholesterolemia, diabetes, metabolic syndrome, or obesity to prevent CVD.

著者

• Sakuma Ichiro

  Cardiology Hokkaido University

• Koh Kwang

  Division Of Cardiology Gachon University Gil Medical Center

• Ihm Sang-hyun

  Division Of Cardiology Department Of Internal Medicine College Of Medicine The Catholic University Of Korea St Paul's Hospital

• SAKUMA Ichiro

  Cardiovascular Medicine, Hokko Memorial Clinic

• Lee Hae-Young

  Division of Cardiology, Seoul National University College of Medicine

• Lee Hae-Young

  Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital

• Goh Choong-Won

  Department of Cardiology, Sanggyepaik Hospital, Inje University

• Ihm Sang-Hyun

  Division of Cardiology, College of Medicine, The Catholic University of Korea

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