Statins and Renin-Angiotensin System Inhibitor Combination Treatment to Prevent Cardiovascular Disease

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  • Lee Hae-Young
    Division of Cardiology, Seoul National University College of Medicine
  • Sakuma Ichiro
    Cardiovascular Medicine, Hokko Memorial Clinic
  • Ihm Sang-Hyun
    Division of Cardiology, College of Medicine, The Catholic University of Korea
  • Goh Choong-Won
    Department of Cardiology, Sanggyepaik Hospital, Inje University
  • Koh Kwang Kon
    Division of Cardiology, Gachon University Gil Hospital Gachon Cardiovascular Research Institute

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Hypercholesterolemia and hypertension are common risk factors for cardiovascular disease (CVD). Updated guidelines emphasize target reductions of overall cardiovascular risks. Experimental studies have shown reciprocal relationships between insulin resistance (IR) and endothelial dysfunction. Hypercholesterolemia and hypertension have a synergistic deleterious effect on IR and endothelial dysfunction. Unregulated renin-angiotensin system (RAS) is important in the pathogenesis of atherosclerosis and hypertension. Various strategies with different classes of antihypertensive medications to reach target goals have failed to reduce residual CVD risk further. Of interest, treating moderate cholesterol elevations with low-dose statins in hypertensive patients reduced CVD risk by 35–40% further. Therefore, statins are important in reducing CVD risk. Unfortunately, statin therapy causes IR and increases the risk of type 2 diabetes mellitus. RAS inhibitors improve both endothelial dysfunction and IR. Further, cross-talk between hypercholesterolemia and RAS exists at multiple steps of IR and endothelial dysfunction. In this regard, combined therapy with statins and RAS inhibitors demonstrates additive/synergistic effects on endothelial dysfunction and IR in addition to lowering cholesterol levels and blood pressure when compared with either monotherapy in patients. This is mediated by both distinct and interrelated mechanisms. Therefore, combined therapy with statins and RAS inhibitors may be important in developing optimal management strategies in patients with hypertension, hypercholesterolemia, diabetes, metabolic syndrome, or obesity to prevent CVD.  (Circ J 2014; 78: 281–287)<br>

収録刊行物

  • Circulation Journal

    Circulation Journal 78 (2), 281-287, 2014

    一般社団法人 日本循環器学会

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