Simvastatin Reduces Myocardial Injury Undergoing Noncoronary Artery Cardiac Surgery

Abstract

Objective— Myocardial injury during cardiac surgery is a major cause of perioperative morbidity and mortality. We determined whether perioperative statin therapy is cardioprotective in patients undergoing noncoronary artery cardiac surgery and the potential mechanisms. Methods and Results— One hundred fifty-one patients undergoing noncoronary artery cardiac surgery were randomly assigned to either a statin group (n=77) or a control group (n=74). Simvastatin (20 mg) was administered preoperatively and postoperatively. Plasma were analyzed for troponin T, isoenzyme of creatine kinase, C-reaction protein, interleukin-6, interleukin-8, creatinine, and blood urea nitrogen. Cardiac echocardiography was performed. Endothelial nitric oxide synthase (eNOS), Akt, p38, heat shock protein 90, caveolin-1, and nitric oxide (NO) in the heart were detected. Simvastatin significantly reduced plasma troponin T, isoenzyme of creatine kinase, C-reaction protein, blood urea nitrogen , creatinine, interleukin-6, interleukin-8, and the requirement of inotropic postoperatively. Simvastatin increased NO production, the expression of eNOS and phosphorylation at serine1177, phosphorylation of Akt, expression of heat shock protein 90, heat shock protein 90 association with eNOS and decreased eNOS phosphorylation at threonine 495, phosphorylation of p38, and expression of caveolin-1. Simvastatin also improved cardiac function postoperatively. Conclusion— Perioperative statin therapy can improve cardiac function and renal function by reducing myocardial injury and inflammatory response through activating Akt-eNOS and attenuating p38 signaling pathways in patients undergoing noncoronary artery cardiac surgery. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01178710.

Endothelial microparticles increase in mitral valve disease and impair mitral valve endothelial function

“…To stimulate NO release, VEGF (50 ng/ml) was added to all plates. And then the supernatant was used to determine NO generation by Griess assay (Nanjing Jiancheng Bioengineering Institute, Nanjing, China), and the cellular proteins were harvested for concentration determination by a bicinchoninic acid protein assay (Merck, Whitehouse Station, NJ), as described previously (2,26).…”

The statin therapy to prevent atrial fibrillation after cardiac surgery: Shakespearean dilemma

“…However, these recommendations are based on randomized trials that were small and had other important limitations. An updated meta-analysis of the results from previously published randomized trials of perioperative statin therapy (15)(16)(17)(18) showed an approximate halving of the incidence of postoperative AF with statins as compared with placebo. However, those trials involved small numbers of patients and had other important limitations.…”

“…Furthermore, a recent systematic Cochrane review of those trials showed evidence of selective reporting and publication bias (31). The suggestion that perioperative statin therapy might be associated with less severe myocardial damage derives from one randomized, placebocontrolled trial involving 200 patients undergoing CABG surgery (32) and from a non-blinded randomized trial involving 151 patients undergoing non-coronary cardiac surgery, which also reported improved left ventricular function (17).…”

“…The concentration of C-reactive protein after statin therapy, decrease in some studies (15)(16)(17). Perioperative statin therapy has been associated with a lower incidence of AF after cardiac surgery, as well as less severe myocardial injury preserved left ventricular and renal function, and shorter stays in the intensive care unit (ICU) and hospital (18).…”

Treatment of moyamoya disease by multipoint skull drilling for indirect revascularization combined with mobilization of autologous bone marrow stem cells

“…Statins can mobilize bone marrow endothelial stem cells and promote recovery from nerve injury. Mobilization of autologous BMSCs has improved treatment of ischemic cerebrovascular diseases to a certain extent (Almansob et al, 2012;Uhiara et al, 2012). Vasculogenesis and neurogenesis are two major pathophysiologic processes that occur in the brain after cerebral ischemia.…”