Lipid-lowering therapy in patients with arterial hypertension with concomitant chronic obstructive pulmonary disease

Оbjective: in order to evaluate the effects (lipid-lowering, the effect on the endothelial function and oxidative stress) of pitavastatin at a dose of 4 mg in patients with dyslipidemia, arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD) at baseline, after 4 weeks and 12 months of treatment. Material and methods: the prospective study included 33 patients (mean age 60 [54;61] years) with AH, COPD and dyslipidemia. Laboratory examination consisted in determining the lipid spectrum, the level of lipid peroxidation products, creatinine, bilirubin, alanine aminotransferase, aspartate aminotransferase. The endothelium’s function was performed by the test with the endothelium-dependent vasodilation. We prescribed Pitavastatin (4 mg, Livazo, Recordati, Ireland) as a lipid-lowering therapy. After 12 months, the atherosclerotic plaques (AP) in the vessel was seen by the ultrasound duplex scanning of carotid arteries. Results: after 4 weeks of treatment with pitavastatin (4 mg), there was a decrease in total cholesterol — 26%, low-density lipoprotein (LDL) — 33%, triglycerides (TG) — 19%, high-density lipoprotein was increased by 18%. There was an improvement in endothelial dysfunction and oxidative stress. There were no side effects in patients. Conclusion: correction of lipid metabolism disorders in AH patients with COPD by prescribing pitavastatin (4 mg) can reduce total cholesterol, LDL and TG, can positively affect endothelial function and lipid peroxidation processes. Therapy with pitavastatin (4 mg) in patients with dyslipidemia, AH and COPD is safe. It is noted the regression of AP after 12 months of regular intake of pitavastatin at a dose of 4 mg. 

1. Chrysohoou C, Kollia N, Tousoulis D. The link between depression and atherosclerosis through the pathways of inflammation and endothelium dysfunction. Maturitas. 2018; 109:1-5. doi: 10.1016/j.maturitas.2017.12.001.

2. Cavaille`s A, Brinchault-Rabin G, Dixmier A. Comorbidities of COPD. Eur. Respir. J. 2013; 22(130):454-75. DOI: 10.1183/09059180.00008612.

3. Chazova I.E., Lazareva N.V., Oshchepkova E.V. Arterial hypertension and chronic obstructive pulmonary disease: clinicalcharacteristics and treatment efficasy (according to the national register of arterial hypertension). Therapeutic Archive. 2019; 91 (3): 4–10. DOI: 10.26442/00403660.2019.03.000110

4. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). European Heart Journal. 2018; 39(33):3021-3104. DOI:10.1093/eurheartj/ehy339.

5. Kobalava Z.D., Konradi A.O., Nedogoda S.V., Shlyakhto E.V., Arutyunov G.P., Baranova E.I., Barbarash O.L., Boitsov S.A., Vavilova T.V., Villevalde S.V., Galyavich A.S., Glezer M.G., Grineva E.N., Grinstein Yu.I., Drapkina O.M., Zhernakova Yu.V., Zvartau N.E., Kislyak O.A., Koziolova N.A., Kosmacheva E.D., Kotovskaya Yu.V., Libis R.A., Lopatin Yu.M., Nebiridze D.V., Nedoshivin A.O., Os-troumova O.D., Oschepkova E.V., Ratova L.G., Skibitsky V.V., Tkacheva O.N., Chazova I.E., Chesnikova A.I., Chumakova G.A., Shalnova S.A., Shestakova M.V., Yakushin S.S., Yanishevsky S.N. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):3786. DOI.10.15829/1560-4071-2020-3-3786

6. Global Initiative for Chronic Obstructive Lung Diseases (GOLD). Global strategy for diag-nosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO workshop report. Updated 2017. Accessed: February 5, 2020. https://goldcopd.org/wp-content/uploads/2017/02/wms-GOLD-2017-FINAL.pdf

7. Global Initiative for Chronic Obstructive Lung Diseases (GOLD). Global strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. NHLBI/WHO workshop report. Updated 2019 Accessed: February 6, 2020. https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf

8. Karoli N.A., Rebrov A.P. Chronic Obstructive Pulmonary Disease and Arterial Hypertension: Vascular Wall as the Target Organ in Comorbid Patients. Rational Pharmacotherapy in Cardiology. 2017;1 3(4):51 3-51 8. DOI: 10.20996/1819-6446-2017-13-4-513-518

9. Tomiyamа, H. Ishizu T., Kohro R. Longitudinal association among endothelial function, arterial stiffness and subclinical organ damage in hypertension. Int. J. Cardiol. 2018;253:161-166. DOI: 10.1016/j.ijcard.2017.11.022

10. Ambrosino, L. Clinical assessment of endothelial function in patients with chronic obstruc-tive pulmonary disease: a systematic review with meta-analysis. Internal and Emergency Medicine. 2017;5: 877-885. DOI:10.1007/ s11739-017-1690-0.

11. Carter N.J. Rosuvastatin. A review of its use in the prevention of cardiovascular disease in apparently healthy women or men with normal LDL-C levels and elevated CRP levels. Am J Cardiovasc Drugs. 2010;10(6):383-400. DOI: 10.2165/11204600-000000000-00000..

12. Miyauchi K., Kimura T., Shimokawa H. et al. Rationale and design of Randomized Evalua-tion of Aggressive or Moderate Lipid Lowering Therapy with Pitavastatin in Coronary Ar-tery Disease (REAL-CAD) Trial. Int. Heart J. 2018; 59 (2): 315–320. DOI:10.1536/ihj.17-557

13. Ford I., Murray H., McCowan C., Packard C.J. Long-term safety and efficacy of lowering low-density lipoprotein cholesterol with statin therapy: 20-year follow-up of West of Scot-land Coronary Prevention Study. Circulation. 2016; 133(11):1073–1080. DOI: 10.1161/CIRCULATIONAHA.115.019014

14. De Backer G., Jankowski P., Kotseva K., et al. Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis. 2019; 285: 135-46. DOI:10.1016/j.atherosclerosis.2019.03.014

15. Thai M., Reeve E., Hilmer S.N., eds. Prevalence of statin-drug interactions in older people: A systematic review. Eur J Clin Pharmacol. 2016;72(5):513-21. DOI:10.1007/s00228-016-2011-7.

16. Brar A., Santana J.M., Salifu M.O., eds. Dyslipidemia in Special Populations, the Elderly, Women, HIV, Chronic Kidney Disease and ESRD, and Minority Groups. In: McFarlane SI ed. Dyslipidemia.1st ed. New York: IntechOpen., 2019;1-25. DOI:10.5772/intechopen.82831.

17. Berthold H.K., Gouni-Berthold I. Lipid-lowering Drug Therapy in Elderly Patients. Curr Pharm Des. 2011;17(9):877-93. doi:10.2174/138161211795428803.

18. Orimo H., Ito H., Suzuki T., et al. Reviewing the definition of “elderly”. Geriatr Gerontol Int. 2006;6(3):149-58. DOI:10.1111/j.1447- 0594.2006.00341.x.

19. Grundy S.M., Stone N.J., Bailey A.L., et al. 2018 AHA/ACC/AACVPR/ AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Asso-ciation Task Force on Clinical Practice Guidelines. J Am Coll Cardiol.2019;73(24):285- 350. DOI:10.1161/CIR.0000000000000625.

20. Fitilev SB, Dimitrova DA, Shkrebneva I.I., Vozzhaev A.V. Secondary prevention of cardiovascular diseases among patients of different age groups with a history of myocardial infarction by the example of outpatient cardiology institution. Ration Pharmacother Cardiol. 2017;13(3):317-322. DOI:10.20996/1819-6446-2017-13-3-317-322.

21. Fruchter, O., Yigla M., Kramer M. Lipid profile and statin use: the paradox of survival after acute exacerbation of chronic obstructive pulmonary disease. The American Journal of the Medical Sciences. 2015; 349(4):338–343. DOI: 10.1097/MAJ.0000000000000435

22. Citgez E., Palen van der J., Koehorst-Ter Huurne K. [et. al]. Statins and morbidity and mor-tality in COPD in the COMIC study: a prospective COPD cohort study. BMJ Open Resp Res. 2016; 17;3(1). DOI: 10.1136/bmjresp-2016-000142

23. Lahousse L., Loth D. W., Joos G. F. [et al.] Statins, systemic inflammation and risk of death in COPD: the Rotterdam study. Pulm. Pharmacol. Ther. 2013 ;26(2):212-217. DOI: 10.1016/j.pupt.2012.10.008

24. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to re-duce cardiovascular risk. European Heart Journal. 2020; 41: 111-188. DOI:10.1093/eurheartj/ehz455.

25. Ezhov M.V., Sergienko I.V., Alekseev I.A. Pitavastatin (Livazo) in the treatment of dyslipidemia in routine clinical practice in Rus-sia. Russian programme "LEADER". The Journal of Atherosclerosis and Dyslipidemias. 2020; 3(40): 5–14 . DOI: 10.34687/2219-8202.JAD.2020.03.0001