Low-Dose Rosuvastatin for Hypercholesterolemic Patients With

RESEARCH HIGHLIGHTS

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Non-narcotic analgesics management of combined hyperlipidemia, the associated with increased risk efficacy of statin therapy, and a comparison of of hypertension the effects of different statins, have not been investigated in patients with the metabolic Women who take high daily doses of acetamin- syndrome. ophen and some nonsteroidal anti- inflammatory This post hoc analysis of the randomized drugs (NSAIDs) have an elevated risk of devel- MERCURY I trial compared the effects of four oping incident hypertension, a prospective statin drugs on the lipid profiles of 3,140 indi- study carried out in the US has shown. viduals with and without the metabolic syn- Forman and colleagues investigated a pos- drome. Only patients with coronary or other sible association between the dose of analgesic atherosclerotic disease, or type 2 diabetes, drugs used and incidence of hypertension were eligible for the study, and were assigned among 1,903 women aged 51–77 years who one of five daily treatment regimens: 10 mg participated in the Nurses’ Health Study I and rosuvastatin, 10 mg or 20 mg atorvastatin, 3,200 women aged 34–53 years from the Nurses’ 20 mg simvastatin or 40 mg pravastatin. Health Study II. Women included in the study LDL cholesterol, total cholesterol and non- had no history of hypertension at baseline. They HDL cholesterol levels were significantly lower completed detailed questionnaires about their in patients who received 10 mg rosuvastatin use of acetaminophen, aspirin or other NSAIDs, than in patients treated with other statin thera- including average daily doses and indications for pies, except 20 mg atorvastatin. Triglyceride their use. Information was also gathered about levels were also significantly reduced and HDL relevant confounders such as alcohol intake and cholesterol levels raised in the 10 mg rosuva- history of smoking. Study participants were then statin group, regardless of the presence of followed up prospectively to find out whether the metabolic syndrome. Importantly, more they developed hypertension. patients reached the ideal LDL cholesterol Women in both age-groups who took at least level with low-dose rosuvastatin than other 500 mg of acetaminophen daily were almost treatment regimens. twice as likely to develop hypertension as those Stender et al. conclude that statins who did not use acetaminophen. Among women improve the lipid profile of high-risk hyper- aged 51–77 years who used at least 400 mg cholesterolemic patients with and without NSAIDs daily, the risk of hypertension increased the metabolic syndrome and that low-dose by almost 80%, whereas for younger women rosuvastatin was the most effective treatment (aged 34–53 years) the risk of hypertension was regimen. 60% higher compared with individuals who did Hannah Camm not use NSAIDs. Interestingly, high doses of aspi- Original article Stender S et al. (2005) Comparison of rin were not associated with an increased risk of rosuvastatin with atorvastatin, simvastatin and pravastatin developing hypertension in either age-group. in achieving cholesterol goals and improving plasma lipids in hypercholesterolaemic patients with or without the According to the researchers, these results metabolic syndrome in the MERCURY I trial. Diabetes Obes have significant public health implications Metab 7: 430–438 and suggest that acetaminophen and NSAIDs should be used with greater caution. Claire Braybrook

Original article Forman JP et al. (2005) Non-narcotic Risks and benefits of warfarin analgesic dose and risk of incident hypertension in US plus aspirin therapy for patients women. Hypertension 46: 500–507 with acute coronary syndromes

A recent meta-analysis indicates that warfarin plus aspirin therapy has a beneficial effect Low-dose rosuvastatin for on cardiovascular outcome for some patients hypercholesterolemic patients with acute coronary syndromes, despite an with the metabolic syndrome increased risk of bleeding. Although there is some evidence that While statin therapy is an obvious part of the addition of warfarin to standard aspi- combined drug treatment for the optimum rin therapy can reduce the incidence of

NOVEMBER 2005 VOL 2 NO 11 NATURE CLINICAL PRACTICE CARDIOVASCULAR MEDICINE 555