Potent anti-ischaemic effects of statins in chronic stable angina: incremental benefit beyond lipid lowering?

Abstract

AimsThe DoUble-blind Atorvastatin AmLodipine (DUAAL) trial investigated whether atorvastatin decreases ischaemia by a vascular benefit, independent of low-density lipoprotein cholesterol lowering, in patients with coronary artery disease (CAD), both alone and in combination with the traditional anti-anginal therapy, amlodipine.Methods and resultsRandomized, double-blind, parallel-group, multicountry trial (2 weeks run-in and 24 weeks active therapy) comparing three treatments: amlodipine, atorvastatin, and amlodipine + atorvastatin; in 311 patients (78% male; mean age 62 years) with stable angina (≥2 attacks/week), CAD history, ≥3 transient myocardial ischaemia (TMI) episodes, and/or ≥15 min ischaemia on 48 h ambulatory electrocardiographic (AECG) monitoring. Efficacy variables were change in TMI by AECG, exercise ischaemia, angina diary data, and inflammatory biomarkers at Week 26. There was a comparable, highly significant decrease in TMI with amlodipine and atorvastatin, but no additional benefit for the combination. More than 50% of patients became TMI-free in all three groups and this was accompanied by a comparable, marked reduction in angina and nitroglycerin consumption. High-sensitivity C-reactive protein fell by 40% in patients receiving atorvastatin but there was no change with amlodipine. Adverse events were comparable among groups.ConclusionAtorvastatin was as potent an anti-ischaemic agent as amlodipine. Future studies of combination therapies will be instructive.Clinical trial registration information: National clinical trial number: NCT00159718, protocol number A0531031 listed on .

Performance of Diagnostic Tests for Intermediate Probabilities of Coronary Heart Disease: A Decision Making Analysis

“…15 The submission to an invasive test in patients whose high probability of CAD would justify the start of treatment may add an unnecessary risk to the propaedeutic of these patients. Emblematic works, such as that carried out by Patel et al 17 in 2010, point to a rate of 39.2% of negative tests for obstructive coronary disease (lesions lower than 20% of luminal obstruction) in 398,978 patients referred to coronary angiography in 663 hospitals, reinforcing the need for a better diagnostic stratification prior to the indication of invasive examination. 18 Hence, it would be more appropriate to relocate the indication of the procedure to those in whom an intervention is planned, may be it angioplasty or surgery.…”

Hypertension and stable coronary artery disease

“…10 Similarly, verapamil, a phenylalkylamine CCB derivative, combined with trandolapril, an ACEI, did not differ from an atenolol along with hydrochlorothiazidebased regimen in hypertensive patients with stable CAD. 7 Different from both drugs, amlodipine, a DHP with potent antianginal properties 51 and well tolerated in severe congestive heart failure, 52 decreased cardiovascular events as compared with both placebo and enalapril, an ACEI 8 (Fig. 2, left panel).…”

How to Suitablely Manage the Mucormycosis---Recommended Dose of Liposomal Amphotericin B and Other Management of Risk Factors?

“…Besides, it has been suggested that statins decrease the ability of R. oryzae to damage endothelial cells [52]. Statins are known to improve vascular endothelial health [55], reduce inflammation, and eliminate prothrombotic [56,57]. Mucormycosis has an affinity for invading blood vessels and cause thrombosis and tissue necrosis [6].…”