Untersuchungen zur induzierbaren Expression des Adhäsionsmoleküls E-Selektin und dessen potentieller Bedeutung bei der Tumormetastasierung

In der vorliegenden Arbeit konnte gezeigt werden, dass sowohl die durch TNFalpha-, als auch durch Röntgenstrahlen vermittelte Expression des Adhäsionsmoleküls E-Selektin in Endothelzellen durch kleine GTPasen der Rho-Proteinfamilie reguliert ist. Hemmung dieser kleinen G-Proteine z.B. durch HMG-CoA Reduktase-Inhibitoren (Statine) oder clostridiale Toxine führt zu verminderter Expression von E-Selektin in humanen Endothelzellen (HUVEC; EA.hy-926). Aus den in der Arbeit erhaltenen Ergebnissen kann außerdem die Schlussfolgerung gezogen werden, dass die Regulation der zytokininduzierten E-Selektin-Genexpression von der gamma-Strahlen-vermittelten Expression des E-Selektingens differiert. Für die strahleninduzierte endotheliale E-Selektin-Expression scheint beispielsweise der Transkriptionsfaktor AP-1 als ein weiterer Kontrollfaktor neben NF-kappaB zu fungieren. Des Weiteren konnte in der vorliegenden Arbeit gezeigt werden, dass eine gesteigerte E-Selektin-Proteinexpression mit erhöhter Tumorzelladhäsion und -transmigration an bzw. durch humane Endothelzellen korreliert. Hemmung der TNFalpha- bzw. gamma-Strahlen-induzierten Expression von E-Selektin durch Statine oder Retinsäuren ist ausreichend, sowohl Tumorzelladhäsion als auch Tumorzelldiapedese zu reduzieren. Zusammenfassend lässt sich festhalten, dass das Adhäsionsmolekül E-Selektin eine vielversprechende Zielstruktur ist, über deren kontrollierte Beeinflussung es auch in vivo möglich sein sollte, das Risiko der Metastasierung zu reduzieren. Mit Statinen und Retinsäurederivaten wurden somit Pharmaka identifiziert, die durch Hemmung der Rho-regulierten E-Selektin-Expression der Tumorzellmetastasierung vorbeugen könnten. Um diese Hypothese in zukünftigen tierexperimentelle Studien zu bestätigen, wurde im Rahmen dieser Arbeit mit der Generierung transgener Tiermodelle begonnen.

Bedeutung von Rho-GTPasen bei der Regulation zellulärer Antworten auf genotoxischen Stress

SAPK/JNK regulieren nach genotoxischem Stress eine Vielzahl von Zielsubstraten, die bedeutsam für Reparatur und Überleben der Zelle sind, somit nehmen sie Einfluss auf das zelluläre Schicksal der Zelle. Ob DNA-Schäden eine Phosphorylierung von Stress-Kinasen nach sich ziehen ist bisher noch wenig untersucht. Mit reparaturdefizienten Zellen wurde der Einfluss von DNA-Schäden, durch Cisplatin/Transplatin/UV-C, auf die SAPK/JNK Aktivierung untersucht. Die Aktivierung der Stress-Kinasen erfolgte agenzspezifisch und abhängig von verschieden Reparaturfaktoren. Die Aktivierung korrelierte in reparaturdefizienten Zellen teilweise mit dem späten Auftreten von DNA-Strangbrüchen, war jedoch unabhängig von erhöhten initialen DNA-Schäden. Diese Befunde zeigten, dass die späte Aktivierung der SAPK/JNK DNA-schadensabhängig verläuft und das Cisplatin und Transplatin bei Verwendung von äquitoxischen Dosen zu einer vergleichbaren Aktivierung von SAPK/JNK führten. Die Hemmung der Rho-GTPasen sowohl durch Statine als auch mittels Clostridium difficile Toxin B zeigte weiterhin, dass Rho-GTPasen möglicherweise die späte DNA-schadensabhängige Aktivierung der Stress-Kinasen vermitteln. Die Hemmung von Rho-GTPasen durch physiologisch relevante Konzentrationen von Statinen führte in primären humanen Endothelzellen (HUVECs) zu einer Protektion vor IR-Strahlung und Doxorubicin. In beiden Fällen konnte eine Hemmung des pro-apoptotischen Transkriptionsfaktors p53 sowie der Chk1, welche einen Zellzyklusarrest reguliert, mit der Statin-Behandlung erreicht werden. Effektor-Caspasen wurden dabei durch den HMG-CoA-Reduktase Hemmer nicht beeinflusst. Ausschließlich bei dem Statin-vermittelten Schutz vor Doxorubicin kam es zu einer Reduktion von initialen DNA-Schäden, in Form von DNA-Strangbrüchen. Die IR-induzierten Strangbrüche in der DNA blieben von der Statin-Inkubation hingegen unbeeinflusst. Aufgrund ihrer protektiven Eigenschaften gegenüber IR- und Doxorubicin-induzierter Zytotoxizität in Endothelzellen und ihrer pro-apoptotischen Wirkung auf Tumorzellen könnten Statine möglicherweise die unerwünschten Nebenwirkungen von Zytostatika und einer Strahlentherapie günstig beeinflussen

Regulation der Selenoproteinsynthese durch den Mevalonatweg

Im Rahmen dieser Arbeit sollte der Einfluss des Mevalonatpfads auf die Expression von Selenoproteinen untersucht werden. Im Mevalonatpfad, einem universellen Stoffwechselweg eukaryontischer Zellen, entstehen neben Cholesterol auch verschiedene Isoprenoide, die z.B. für die post-transkriptionelle Modifikation der Selenocystein-tRNA herangezogen werden. Selenocystein ist funktioneller Bestandteil von Selenoproteinen, welche häufig in den Abbau von oxidativem Stress involviert sind. rnDer Mevalonatpfad wird hauptsächlich durch die HMG-CoA-Reduktase (HMGCR) reguliert. Pharmaka vom „Statin“-Typ gelten als wirkungsvolle kompetitive Inhibitoren dieses Enzyms und finden ihren Einsatz bei Patienten zur Behandlung von Hypercholesterolämie, welche eine Grundlage für vaskuläre Krankheiten bildet. Trotz der allgemein guten Verträglichkeit der Statine treten jedoch auch unerwünschte Nebeneffekte, wie Erhöhung der Leberenzyme oder Myopathien auf, deren biochemischer Hintergrund bislang noch im Dunkeln liegt. rnDie in dieser Arbeit durchgeführten Experimente belegen, dass Atorvastatin, Cerivastatin und Lovastatin in klinisch relevanten Dosen die Synthese bestimmter Selenoproteine, wie der Glutathionperoxidase (GPx), in klonalen humanen Hepatocyten post-transkriptionell unterdrücken, wodurch die Zellen anfälliger für oxidativen Stress in Form von Peroxiden werden. Dieser Mechanismus könnte eine Erklärung für die häufig beobachteten abnormen Leberwerte von Statin-behandelten Patienten darstellen.rnEndogenes Cholesterol gilt ebenfalls als potenter Inhibitor der HMGCR. Die in dieser Arbeit erzielten Ergebnisse zeigen, dass Cholesterol in verschiedenen Formen, als Low-Density-Lipoprotein (LDL), als 25-Hydroxycholesterol, und als Methylcyclodextrin-Komplex in unterschiedlichen humanen Zelltypen die Selenoproteinsynthese ebenfalls unterdrücken. Der negative Zusammenhang zwischen Cholesterol und bestimmten Selenoproteinen konnte auch in vivo beobachtet werden. In juvenilen Mäusen konnte gezeigt werden, dass ein Knockout des LDL-Rezeptors sowie auch ein Knockout von Apolipoprotein E zu einer Senkung des Lebercholesterols führte, was in einer Zunahme der GPx in der Leber resultierte.rnDie vorliegenden Daten belegen erstmals einen direkten und funktionellen Zusammenhang zwischen dem Mevalonatpfad und der Selenoproteinsynthese. Unterdrückung dieses Pfades, entweder durch exogene Substanzen wie Statine, oder durch endogene Substanzen wie Cholesterol, hat offenbar zur Folge, dass essentielle Zwischenprodukte für die Modifizierung der Selenocystein-tRNA fehlen, was in einer post-transkriptionellen Verminderung der induzierbaren Selenoproteine resultiert. Dies könnte die biochemische Grundlage für einen Teil der vielfältigen gesundheitlich negativen Auswirkungen schon geringfügig erhöhter Cholesterolspiegel sein.

Pharmakologische Hemmung strahleninduzierter Tumorzell-Endothelzell-Interaktionen in vitro und Metastasierungsprozesse in vivo

Exposition von Endothelzellen mit ionisierender Strahlung (IR) oder Behandlung mit inflammatorischen Zytokinen (z. B. TNFa) induziert über eine Rho-GTPasen abhängige NF-kB-Aktivierung die Expression verschiedener Zelladhäsionsmoleküle, u. a. auch von E-Selektin. E-Selektin vermittelt die Adhäsion von Tumorzellen (TC) an Endothelzellen und ist daher vermutlich an der Extravasation von zirkulierenden Tumorzellen beteiligt. HMG-CoA-Reduktase-Inhibitoren (Statine), welche eine breite klinische Anwendung als Lipidsenker erfahren, sind in der Lage, Rho-GTPasen und die durch sie vermittelten Signalwege zu hemmen. Daher sollten Statine wie Lovastatin auch Zell-Zell-Adhäsionsvorgänge beeinflussen. Die vorliegende Arbeit widmet sich den Mechanismen, mit denen IR und TNF in Endothel- und/oder Tumorzellen pro-adhäsive Faktoren induzieren können und ob diese Effekte durch Lovastatin beeinflussbar sind. Zu diesem Zweck wurde mittels eines ELISA-basierenden Zelladhäsions-Assays die Auswirkung von IR und TNF auf Zell-Zell-Kontakte zwischen humanen Tumorzellen (u. a. Kolonkarzinomzellen (HT29)) und humanen, venösen Nabelschnurendothelzellen (HUVEC) analysiert. Zudem wurden die Effekte einer Lovastatinvorbehandlung von TC und/oder HUVEC auf TC-HUVEC-Adhäsion untersucht. Des Weiteren wurden die Wirkungen des sLex-Mimetikums Glycyrrhizin und des Rac1-spezifischen „small-molecule“ Inhibitors NSC23766 auf TC-HUVEC-Adhäsion überprüft. Zusätzlich wurde die strahleninduzierbare mRNA-Expression von diversen Zelladhäsionsmolekülen, Metastasierungsfaktoren und DNA-Reparatur-Genen mittels qRT-PCR (Real-Time Analysen) quantitativ erfasst. Um die erhaltenen in vitro Ergebnisse auch in vivo zu bestätigen, untersuchten wir den Effekt einer Ganzkörperbestrahlung (TBI) von BALB/c-Mäusen auf die Expression von pro-adhäsiven Faktoren. Zur Analyse der Tumorzell-Extravasation wurden Tumorzellen in die laterale Schwanzvene immundefizienter Mäuse injiziert und anschließend eine Ganzkörperbestrahlung durchgeführt (4 Gy). Nach einer Wartezeit von 4 Wochen wurde ein erhöhtes Auftreten von Lungenmetastasen beobachtet, welches durch Vorbehandlung der Tiere mit Statinen, NSC23766 oder Glycyrrhizin blockiert werden konnte. Zusammenfassend konnte somit ein Einfluss von IR auf die Expression verschiedener Zelladhäsionsmoleküle in vitro und auf die Extravasation zirkulierender Tumorzellen in vivo festgestellt werden. Diese pro-metastatischen Strahleneffekte konnten durch pharmakologische Hemmung Rho-regulierter Signalwege abgeschwächt werden.

Atorvastatin attenuates hepatic fibrosis in rats after bile duct ligation via decreased turnover of hepatic stellate cells

Activation of hepatic stellate cells (HSC) and transdifferentiation to myofibroblasts following liver injury is the main culprit for hepatic fibrosis. Myofibroblasts show increased proliferation, migration, contraction, and production of extracellular matrix (ECM). In vitro, HMG-CoA reductase inhibitors (statins) inhibit proliferation and induce apoptosis of myofibroblastic HSC. To investigate the antifibrotic effects of atorvastatin in vivo we used bile duct ligated rats (BDL).

Statins for cardiovascular prevention according to different strategies: a cost analysis

Several studies have shown that treatment with HMG-CoA reductase inhibitors (statins) can reduce coronary heart disease (CHD) rates. However, the cost effectiveness of statin treatment in the primary prevention of CHD has not been fully established.

Cholesteryl ester accumulation and accelerated cholesterol absorption in intestine-specific hormone sensitive lipase-null mice

Hormone sensitive lipase (HSL) regulates the hydrolysis of acylglycerols and cholesteryl esters (CE) in various cells and organs, including enterocytes of the small intestine. The physiological role of this enzyme in enterocytes, however, stayed elusive. In the present study we generated mice lacking HSL exclusively in the small intestine (HSLiKO) to investigate the impact of HSL deficiency on intestinal lipid metabolism and the consequences on whole body lipid homeostasis. Chow diet-fed HSLiKO mice showed unchanged plasma lipid concentrations. In addition, feeding with high fat/high cholesterol (HF/HC) diet led to unaltered triglyceride but increased plasma cholesterol concentrations and CE accumulation in the small intestine. The same effect was observed after an acute cholesterol load. Gavaging of radioactively labeled cholesterol resulted in increased abundance of radioactivity in plasma, liver and small intestine of HSLiKO mice 4h post-gavaging. However, cholesterol absorption determined by the fecal dual-isotope ratio method revealed no significant difference, suggesting that HSLiKO mice take up the same amount of cholesterol but in an accelerated manner. mRNA expression levels of genes involved in intestinal cholesterol transport and esterification were unchanged but we observed downregulation of HMG-CoA reductase and synthase and consequently less intestinal cholesterol biosynthesis. Taken together our study demonstrates that the lack of intestinal HSL leads to CE accumulation in the small intestine, accelerated cholesterol absorption and decreased cholesterol biosynthesis, indicating that HSL plays an important role in intestinal cholesterol homeostasis.

Statin therapy induces ultrastructural damage in skeletal muscle in patients without myalgia

Muscle pain and weakness are frequent complaints in patients receiving 3-hydroxymethylglutaryl coenzymeA (HMG CoA) reductase inhibitors (statins). Many patients with myalgia have creatine kinase levels that are either normal or only marginally elevated, and no obvious structural defects have been reported in patients with myalgia only. To investigate further the mechanism that mediates statin-induced skeletal muscle damage, skeletal muscle biopsies from statin-treated and non-statin-treated patients were examined using both electron microscopy and biochemical approaches. The present paper reports clear evidence of skeletal muscle damage in statin-treated patients, despite their being asymptomatic. Though the degree of overall damage is slight, it has a characteristic pattern that includes breakdown of the T-tubular system and subsarcolemmal rupture. These characteristic structural abnormalities observed in the statin-treated patients were reproduced by extraction of cholesterol from skeletal muscle fibres in vitro. These findings support the hypothesis that statin-induced cholesterol lowering per se contributes to myocyte damage and suggest further that it is the specific lipid/protein organization of the skeletal muscle cell itself that renders it particularly vulnerable.

JTT-130, a Microsomal Triglyceride Transfer Protein (MTP) Inhibitor Lowers Plasma Triglycerides and LDL Cholesterol Concentrations without Increasing Hepatic Triglycerides in Guinea Pigs

BACKGROUND: Microsomal transfer protein inhibitors (MTPi) have the potential to be used as a drug to lower plasma lipids, mainly plasma triglycerides (TG). However, studies with animal models have indicated that MTPi treatment results in the accumulation of hepatic TG. The purpose of this study was to evaluate whether JTT-130, a unique MTPi, targeted to the intestine, would effectively reduce plasma lipids without inducing a fatty liver. METHODS: Male guinea pigs (n = 10 per group) were used for this experiment. Initially all guinea pigs were fed a hypercholesterolemic diet containing 0.08 g/100 g dietary cholesterol for 3 wk. After this period, animals were randomly assigned to diets containing 0 (control), 0.0005 or 0.0015 g/100 g of MTPi for 4 wk. A diet containing 0.05 g/100 g of atorvastatin, an HMG-CoA reductase inhibitor was used as the positive control. At the end of the 7th week, guinea pigs were sacrificed to assess drug effects on plasma and hepatic lipids, composition of LDL and VLDL, hepatic cholesterol and lipoprotein metabolism. RESULTS: Plasma LDL cholesterol and TG were 25 and 30% lower in guinea pigs treated with MTPi compared to controls (P < 0.05). Atorvastatin had the most pronounced hypolipidemic effects with a 35% reduction in LDL cholesterol and 40% reduction in TG. JTT-130 did not induce hepatic lipid accumulation compared to controls. Cholesteryl ester transfer protein (CETP) activity was reduced in a dose dependent manner by increasing doses of MTPi and guinea pigs treated with atorvastatin had the lowest CETP activity (P < 0.01). In addition the number of molecules of cholesteryl ester in LDL and LDL diameter were lower in guinea pigs treated with atorvastatin. In contrast, hepatic enzymes involved in maintaining cholesterol homeostasis were not affected by drug treatment. CONCLUSION: These results suggest that JTT-130 could have potential clinical applications due to its plasma lipid lowering effects with no alterations in hepatic lipid concentrations.

The combined effect of pravastatin and aspirin on clinical cardiovascular events

The 3-hydroxy-3methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins, can achieve significant reductions in plasma low-density lipoprotein (LDL)-cholesterol levels. Experimental and clinical evidence now shows that some statins interfere with formation of atherosclerotic lesions independent of their hypolipidemic properties. Vulnerable plaque rupture can result in thrombus formation and artery occlusion; this plaque deterioration is responsible for most acute coronary syndromes, including myocardial infarction (MI), unstable angina, and coronary death, as well as coronary heart diseaseequivalent non-hemorrhagic stroke. Inhibition of HMG-CoA reductase has potential pleiotropic effects other than lipid-lowering, as statins block mevalonic acid production, a precursor to cholesterol and numerous other metabolites. Statins' beneficial effects on clinical events may also thus involve nonlipid-related mechanisms that modify endothelial function, inflammatory responses, plaque stability, and thrombus formation. Aspirin, routinely prescribed to post-MI patients as adjunct therapy, may potentiate statins beneficial effects, as aspirin does not compete metabolically with statins but acts similarly on atherosclerotic lesions. Common functions of both medications include inhibition of platelet activity and aggregation, reduction in atherosclerotic plaque macrophage cell count, and prevention of atherosclerotic vessel endothelial dysfunction. The Cholesterol and Recurrent Events (CARE) trial provides an ideal population in which to examine the combined effects of pravastatin and aspirin. Lipid levels, intermediate outcomes, are examined by pravastatin and aspirin status, and differences between the two pravastatin groups are found. A modified Cox proportional-hazards model with aspirin as a time-dependent covariate was used to determine the effect of aspirin and pravastatin on the clinical cardiovascular composite endpoint of coronary heart disease death, recurrent MI or stroke. Among those assigned to pravastatin, use of aspirin reduced the composite primary endpoint by 35%; this result was similar by gender, race, and diabetic status. Older patients demonstrated a nonsignificant 21% reduction in the primary outcome, whereas the younger had a significant reduction of 43% in the composite primary outcome. Secondary outcomes examined include coronary artery bypass graft (38% reduction), nonsurgical bypass, peripheral vascular disease, and unstable angina. Pravastatin and aspirin in a post-MI population was found to be a beneficial combination that seems to work through lipid and nonlipid, anti-inflammatory mechanisms. ^

Der3p/Hrd1p Is Required for Endoplasmic Reticulum-associated Degradation of Misfolded Lumenal and Integral Membrane Proteins

We have studied components of the endoplasmic reticulum (ER) proofreading and degradation system in the yeast Saccharomyces cerevisiae. Using a der3–1 mutant defective in the degradation of a mutated lumenal protein, carboxypeptidase yscY (CPY*), a gene was cloned which encodes a 64-kDa protein of the ER membrane. Der3p was found to be identical with Hrd1p, a protein identified to be necessary for degradation of HMG-CoA reductase. Der3p contains five putative transmembrane domains and a long hydrophilic C-terminal tail containing a RING-H2 finger domain which is oriented to the ER lumen. Deletion of DER3 leads to an accumulation of CPY* inside the ER due to a complete block of its degradation. In addition, a DER3 null mutant allele suppresses the temperature-dependent growth phenotype of a mutant carrying the sec61–2 allele. This is accompanied by the stabilization of the Sec61–2 mutant protein. In contrast, overproduction of Der3p is lethal in a sec61–2 strain at the permissive temperature of 25°C. A mutant Der3p lacking 114 amino acids of the lumenal tail including the RING-H2 finger domain is unable to mediate degradation of CPY* and Sec61–2p. We propose that Der3p acts prior to retrograde transport of ER membrane and lumenal proteins to the cytoplasm where they are subject to degradation via the ubiquitin-proteasome system. Interestingly, in ubc6-ubc7 double mutants, CPY* accumulates in the ER, indicating the necessity of an intact cytoplasmic proteolysis machinery for retrograde transport of CPY*. Der3p might serve as a component programming the translocon for retrograde transport of ER proteins, or it might be involved in recognition through its lumenal RING-H2 motif of proteins of the ER that are destined for degradation.

The Role of the 3-Hydroxy 3-Methylglutaryl Coenzyme A Reductase Cytosolic Domain in Karmellae Biogenesis

In all cells examined, specific endoplasmic reticulum (ER) membrane arrays are induced in response to increased levels of the ER membrane protein 3-hydroxy 3-methylglutaryl coenzyme A (HMG-CoA) reductase. In yeast, expression of Hmg1p, one of two yeast HMG-CoA reductase isozymes, induces assembly of nuclear-associated ER stacks called karmellae. Understanding the features of HMG-CoA reductase that signal karmellae biogenesis would provide useful insights into the regulation of membrane biogenesis. The HMG-CoA reductase protein consists of two domains, a multitopic membrane domain and a cytosolic catalytic domain. Previous studies had indicated that the HMG-CoA reductase membrane domain was exclusively responsible for generation of ER membrane proliferations. Surprisingly, we discovered that this conclusion was incorrect: sequences at the carboxyl terminus of HMG-CoA reductase can profoundly affect karmellae biogenesis. Specifically, truncations of Hmg1p that removed or shortened the carboxyl terminus were unable to induce karmellae assembly. This result indicated that the membrane domain of Hmg1p was not sufficient to signal for karmellae assembly. Using β-galactosidase fusions, we demonstrated that the carboxyl terminus was unlikely to simply serve as an oligomerization domain. Our working hypothesis is that a truncated or misfolded cytosolic domain prevents proper signaling for karmellae by interfering with the required tertiary structure of the membrane domain.

Expression of sterol regulatory element-binding protein 1c (SREBP-1c) mRNA in rat hepatoma cells requires endogenous LXR ligands

The current paper describes a line of cultured rat hepatoma cells (McA-RH7777 cells) that mimics the behavior of rat liver by producing an excess of mRNA for sterol regulatory element-binding protein 1c (SREBP-1c) as opposed to SREBP-1a. These two transcripts are derived from a single gene by use of alternative promoters that are separated by many kilobases in the genome. The high level of SREBP-1c mRNA is abolished when cholesterol synthesis is blocked by compactin, an inhibitor of 3-hydroxy-3-methylglutaryl CoA (HMG CoA) reductase that inhibits cholesterol synthesis. Levels of SREBP-1c mRNA are restored by mevalonate, the product of the HMG CoA reductase reaction, and by ligands for the nuclear hormone receptor LXR, including 22(R)-hydroxycholesterol and T0901317. These data suggest that transcription of the SREBP-1c gene in hepatocytes requires tonic activation of LXR by an oxysterol intermediate in the cholesterol biosynthetic pathway. Reduction of this intermediate lowers SREBP-1c levels, and this in turn is predicted to lower the rates of fatty acid biosynthesis in liver.

Effect of pravastatin on cardiovascular events in people with chronic kidney disease

Background - Limited data describe the cardiovascular benefit of HMG-CoA reductase inhibitors (statins) in people with moderate chronic kidney disease (CKD). The objective of this analysis was to determine whether pravastatin reduced the incidence of cardiovascular events in people with or at high risk for coronary disease and with concomitant moderate CKD. Methods and Results - We analyzed data from the Pravastatin Pooling Project (PPP), a subject-level database combining results from 3 randomized trials of pravastatin ( 40 mg daily) versus placebo. Of 19 700 subjects, 4491 ( 22.8%) had moderate CKD, defined by an estimated glomerular filtration rate of 30 to 59.99 mL/min per 1.73 m(2) body surface area. The primary outcome was time to myocardial infarction, coronary death, or percutaneous/surgical coronary revascularization. Moderate CKD was independently associated with an increased risk of the primary outcome ( adjusted HR 1.26, 95% CI 1.07 to 1.49) compared with those with normal renal function. Among the 4491 subjects with moderate CKD, pravastatin significantly reduced the incidence of the primary outcome ( HR 0.77, 95% CI 0.68 to 0.86), similar to the effect of pravastatin on the primary outcome in subjects with normal kidney function ( HR 0.78, 95% CI 0.65 to 0.94). Pravastatin also appeared to reduce the total mortality rate in those with moderate CKD ( adjusted HR 0.86, 95% CI 0.74 to 1.00, P = 0.045). Conclusions - Pravastatin reduces cardiovascular event rates in people with or at risk for coronary disease and concomitant moderate CKD, many of whom have serum creatinine levels within the normal range. Given the high risk associated with CKD, the absolute benefit that resulted from use of pravastatin was greater than in those with normal renal function.

Effects of pravastatin on coronary events in 2073 patients with low levels of both low-density lipoprotein cholesterol and high-density lipoprotein cholesterol: results from the LIPID study

Aims Fibrates or nicotinic acid are usually recommended for secondary prevention of coronary heart disease in patients with low plasma levels of both low-density tipoprotein cholesterol (LDL-C) less than or equal to140 mg/dL (less than or equal to3.6 mmol/L) and high-density lipoprotein cholesterol (HDL-C) less than or equal to40 mg/dL (less than or equal to1.03 mmol/L). The LIPID trial, a randomised, placebo-controlled trial in 9014 patients at 87 centres in Australia and New Zealand, provided an opportunity to investigate the effects of an HMG-CoA reductase inhibitor in patients with tow LDL-C and tow HDL-C. Methods and results Participants in this post hoc substudy were 2073 patients aged 31-75 years with baseline LDL-C less than or equal to140 mg/dL (less than or equal to3.6 mmoL/L), HDL-C less than or equal to40 mg/dL (less than or equal to1.03 mmol/L), and triglyceride less than or equal to300 mg/dL (less than or equal to3.4 mmol/L). The relative risk reduction with pravastatin treatment was 27% for major coronary events (95% Cl 8-42%), 27% for coronary heart disease mortality (95% CI 0-47%), 21% for all-cause mortality (95% Cl 0-38%), and 51% for stroke (95% CI 24-69%). The number needed to treat to prevent a major coronary event over 6 years was 22. Conclusions Treatment with pravastatin in patients with both low LDL-C and low HDL-C significantly reduced major coronary events, stroke, and all-cause mortality. The level of HDL-C is crucial to the risk of recurrent CHD events and, consequently, the benefit of lowering LDL-C. (C) 2004 Published by Elsevier Ltd on behalf of The European Society of Cardiology.