Arun H. S. Kumar
Editor in Chief, Journal of Natural Science, Biology and Medicine, University College Dublin, Dublin, Ireland.
Earlier this year the results from Heart Outcomes Prevention Evaluation (HOPE-3) trial were published, which strongly supported the potential use of rosuvastatin for the primary prevention of cardiovascular events. Considering the global socioeconomic burden of cardiovascular diseases, which span from acute to chronic events, the outcomes of HOPE-3 are promising. Statins inhibit 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase enzyme, which has a key role in the production of cholesterol. Hence, statins by blocking HMG-CoA reductase enzyme are useful as lipid lowering therapeutics and have specifically been beneficial in patients with high cholesterol levels and as secondary prevention measures in patients suffering from cardiovascular events. Currently, the following seven statins are approved for clinical use, i.e. lovastatin, simvastatin, pravastatin, fluvastatin, atorvastatin, rosuvastatin, and pitavastatin. While lovastatin and simvastatin are naturally derived the other four are chemically synthesized. Despite the structural similarities between the synthetic statins, pharmacologically they are unique and probably different. For instance, pitavastatin is reported to enhance high-density-lipoprotein-cholesterol levels while rosuvastatin is reported to increase nitric oxide (NO) bioavailability and due to its sulfur content may potentially exhibit antioxidant effects. Other members of the statin group do not share these pharmacological properties of pitavastatin and rosuvastatin. The increase in NO bioavailability by rosuvastatin is specifically of interest as this can independently have cardiovascular benefits. Since the authors of HOPE-3 trial did not control for NO bioavailability in their placebo group, generalizing the benefits observed in rosuvastatin group to other members of the statin family is not appropriate. This necessitates the need to understand the detailed mechanisms involved in the benefits observed with low-dose rosuvastatin use, until which extending rosuvastatin for primary prevention for cardiovascular events is unjustified, specifically concerning the potential side effects associated with statins use impacting patients quality of life. Based on the HOPE-3 trial outcome, probably over 50% of the global population may qualify for using at least rosuvastatin statin for primary prevention of cardiovascular events, such a pandemic approach to statinizing the global population should be rationalized with robust evidence-based medical need rather than commercial greed. A collateral topic associated with this is the need for effective and optimal control groups in any scientific research as a means to derive reliable and valid conclusions. Hence, scientific study designs must emphasize on selecting the right control groups, without which the reliability and validity of any study will always be questioned. Read more….