The Effects of Atorvastatin Treatment on the Fibrinolytic System in Dyslipidemic Patients

Abstract

SUMMARYStatins have pleiotrophic effects related to the pathogenesis of atherosclerosis and thrombogenicity of the vessel wall beyond lipid lowering. The aim of the present study was to examine the effect of atorvastatin treatment on the fibrinolytic system in patients with dyslipidemia.The investigation was carried out on 41 dyslipidemic patients (21 males and 20 females) with a mean age of 53.8 years (range, 30-76). The patients were divided into subgroups according to their cholesterol and triglyceride levels as hypercholesterolemic (n = 26) and mixed-type hyperlipidemic (n = 15) and their risk factors for coronary heart disease including age, sex, hypertension, obesity, smoking, and family history. The patients were started on atorvastatin 10 mg/day, and evaluated within 6-12 weeks to assess the changes in fibrinolytic parameters including global fibrinolytic capacity, plasminogen activator inhibitor type-1 and tissue plasminogen activator, and lipids.After successful lipid-lowering therapy, global fibrinolytic capacity (P = 0.003) and tissue plasminogen activator levels (P = 0.04) were found to be increased and plasminogen activator inhibitor type-1 levels (P = 0.02) decreased in dyslipidemic patients. Global fibrinolytic capacity levels increased (P < 0.001) and plasminogen activator inhibitor type-1 levels decreased (P = 0.01) in patients with hypercholesterolemia (n = 26). However, no significant changes were observed in fibrinolytic parameters in patients with mixed-type hyperlipidemia (n = 15). When the patients were separately evaluated according to risk factors, significant beneficial effects on the fibrinolytic system were observed, especially in patients without obesity and hypertension as well as in older patients and males.These findings suggest that atorvastatin treatment has a beneficial effect on the fibrinolytic system in patients with hypercholesterolemia, but not in patients with mixed-type hyperlipidemia. Further studies are needed to show whether higher doses and longer periods of lipid lowering treatment have beneficial effects in patients with mixed type hyperlipidemia and some risk factors. (Jpn Heart J 2004; 45: 977-987)

Does statin in the acute phase of ischemic stroke improve outcome after intravenous thrombolysis? A retrospective study

“…This result is consistent with most studies which showed a cholesterol-independent association between pre-treatment with statins and sICH in acute stroke nonthrombolysed patients, therefore suggesting pro-fibrinolytic and anti-thrombotic effects of statins [7,[16][17][18][19][20][21][22][23]29]. Only Meier et al found an independent association between prior statin use and sICH in patients treated with thrombolysis [16].…”

“…Several experimental studies demonstrated that statin use up-regulates tissue plasminogen activator (tPA) and reduces the activity of plasminogen activator inhibitor 1 (PAI)1 [16][17][18]. Moreover, there is evidence from experimental and clinical studies suggesting that statins act directly via anti-coagulant and antiplatelet mechanisms [7,[19][20][21][22][23].…”

The Japanese Aggrenox (Extended-Release Dipyridamole plus Aspirin) Stroke Prevention versus Aspirin Programme (JASAP) Study: A Randomized, Double-Blind, Controlled Trial

“…Statins were found to not only reduce blood lipids, but through their pleiotrophic effects also positively influence antithrombotic/anti-inflammatory properties of the blood vessel walls [28,29]. However, the benefit for these approaches has only been shown after a longer period of time, typically 2.5 years and more.…”

Effect of atorvastatin on endothelial function and inflammation in long‐duration type 1 diabetic patients without coronary heart disease and arterial hypertension

“…It seems likely that the impact of atorvastatin on PAI‐1 levels is dependent on the actual type of population under study. Both Goicoechea and Orem indicated, however, that this was actually not the case with regard to the population with chronic kidney disease or mixed‐type hyperlipidaemia, whereas Davidson et al reported that in his study population, atorvastatin treatment increased PAI‐1 by 36% within a 12‐month follow‐up [31–33]. It is hard to determine univocally the impact of other statins on the markers of fibrinolytic activity.…”