- About this Journal
- Abstracting and Indexing
- Aims and Scope
- Article Processing Charges
- Articles in Press
- Author Guidelines
- Bibliographic Information
- Citations to this Journal
- Contact Information
- Editorial Board
- Editorial Workflow
- Free eTOC Alerts
- Publication Ethics
- Submit a Manuscript
- Subscription Information
- Table of Contents
The Scientific World Journal
Volume 2012 (2012), Article ID 976519, 7 pages
Concomitant Administration of Different Doses of Simvastatin with Ivabradine Influence on PAI-1 and Heart Rate in Normo- and Hypercholesterolaemic Rats
Department of Biopharmacy, Medical University of Lodz, Muszynskiego 1, 90-151 Lodz, Poland
Received 16 December 2011; Accepted 2 February 2012
Academic Editors: C. Amarelli, C. L. Athanasuleas, C. Chen, K. Kamide, and Y. K. Lin
Copyright © 2012 Jacek Owczarek et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ivabradine is a novel heart rate lowering agent that inhibits If ionic current in the sinus node and demonstrates antiischaemic and antianginal activity. The aim of the paper was to investigate the effect its dose-dependent drug-drug interaction with simvastatin inhibitor HMGCo-A has on PAI-1 blood level, heart rate and blood pressure. The experiments were performed in hyper- and normocholesterolemic Wistar rats receiving simvastatin (1 and bw) with ivabradine ( bw) during a 4-week period. Ivabradine exacerbated the decrease of PAI-1 in normocholesterolemic animals receiving simvastatin at a dose of 1 mg/kg bw and was not observed to have any significant influence on the PAI-1 values in rats receiving bw simvastatin. Ivabradine, coadministered with simvastatin given at a dose of bw, significantly slowed the heart rate in normocholesterolaemic and hypercholesterolaemic groups as compared to the group receiving ivabradine alone. Conclusion. The administration of ivabradine to normocholesterolaemic and hypercholesterolaemic rats receiving simvastatin significantly exacerbated the slowing of heart rate with no effect on blood pressure. The administration of ivabradine has been shown to demonstrate different effects on PAI-1 values depending on lipid disorders.
The resting heart rate value acts as an independent factor of the risk associated with cardiovascular problems [1–3]. A significant advantage of the slowing of the heart rate is connected with reduced demand of the heart muscles for oxygen, as well as a beneficial influence on the function of the blood vessel endothelium [4, 5]. The novel selective for the current lowering heart rate agent, specifically slow cardiac frequency, by decreasing the rate of diastolic depolarization . Ivabradine seems to have an additional effect in patients with stabile coronary artery disease (CAD) without and with left ventricular systolic dysfunction (LVSD) [7–9]. Preclinical studies show that inhibition of the HCN channel slows the rhythm to varying degrees in the atria, ventricle, and outflow tract . Ivabradine reduces heart rate in the sinoatrial node without affecting blood pressure or myocardial contractility, intracardiac conduction, or ventricular repolarization . In ischaemic heart disease (IHD) patients, the role played by HMGCo-A inhibitors in the prevention of cardiovascular events is well established. Their beneficial activity is dependent on the limitation of cholesterol synthesis as well as cholesterol-independent “pleiotropic” effects . It has been shown in earlier clinical studies that simvastatin at a dose of 40 mg/day given for a period of 8 weeks significantly reduced the levels of inflammatory markers  as well as inhibited the activity of the circulating fibrinolysis inhibitor factor-plasminogen activator inhibitor 1(PAI-1) . Similar observations have been noted in laboratory studies . The influence on fibrinolysis processes were then observed depending on the “mechanism that involves geranylgeranyl-modified intermediates.”
The aim of this paper was to assess the impact of the administration of ivabradine alone and combined with various doses of simvastatin on PAI-1 and heart rate values in normocholesterolaemic and hypercholesterolaemic rats.
2. Materials and Methods
2.1. Study Protocol
The study was approved by the Ethics Committee of the Medical University of Lodz (Poland)–2/ŁB441/2009. The experiments were performed in 101, Wistar rats, outbred males, 200–240 g bw. An adaptation period lasting several days was scheduled prior to the beginning of the experiment. After the adaptation period, animals were divided into 2 groups: those receiving a normal diet (normocholesterolaemic rats) or those receiving a diet with 5% cholesterol and 2.5% cholic acid (hypercholesterolaemic rats). After a four-week period, each group was divided into 6 subgroups which, for 4 weeks, received intragastric (i.g.) doses of:(1)0.1% methylcellulose (control group);(2)ivabradine 10 mg × kg−1 bw;(3)simvastatin 1 mg × kg−1 bw;(4)simvastatin 20 mg × kg−1 bw;(5)simvastatin 1 mg × kg−1 bw + Ivabradine 10 mg × kg−1 bw;(6)simvastatin 20 mg × kg−1 bw + Ivabradine 10 mg × kg−1 bw.
All rats had free access to food and water throughout the study. After an eight-week period of diet and drug administration, heart rate, and hemodynamic parameters were measured. The surgery was performed 24 h after administration of the last drug dose and 10 h after the last feed supply. For the further surgical procedures, anesthesia was initiated by an intraperitoneal (i.p.) dose of pentobarbital sodium at 60 mg × kg−1 bw. The anesthesia was maintained by intraperitoneal bolus injections of pentobarbital sodium at 10 mg × kg−1 bw as needed. For the measurements of heart rate, and blood pressure, catheters were implanted into the right carotid artery. The signals were provided by an Isotec pressure transducer connected to a direct current bridge amplifier (both Hugo Sachs Elektronik) for 20 minutes after the hemodynamic parameter stabilization period. For the further PAI-1 assessment and lipid profile examination, blood samples were taken. Surgical procedures, heart rate and blood pressure recording were provided as described previously [16, 17]. Plasma PAI-1 levels were determined using ELISA kits from American Diagnostica following the manufacturer’s instructions.
All data were presented as means ± SD (standard deviation). Statistical comparisons between the groups were performed using ANOVA, and post hoc comparisons were performed using the LSD test. The normal distribution of parameters was checked by means of the Shapiro-Wilks test. If the data was not normally distributed or the values of variance were different, ANOVA with Kruscal-Wallis and Mann-Whitney’s U test were used. All parameters were considered significantly different if . The statistical analysis of heart rate and hemodynamic parameters was performed using Statgraphics 5.0 plus software.
3.1. Lipid Profile
3.2. Blood Pressure
Ivabradine and simvastatin given alone or in combination was found to have an insignificant influence on the mean, systolic, and diastolic blood pressure in normocholesterolaemic and hypercholesterolaemic rats (Tables 3 and 4).
3.3. Heart Rate
In normocholesterolaemic and hypercholesterolaemic rats receiving simvastatin at doses of 1 and 20 mg × kg−1 bw alone, no significant differences were seen in the heart rate disturbances compared to control groups. Ivabradine administration to normocholesterolaemic rats resulted in significant deceleration of heart rate compared to the control group (350.2 ± 16.2 versus 434.8 ± 17.2 min−1). Similar results were also observed in the hypercholesterolaemic group (363 ± 21.7 versus 435.3 ± 20.3 min−1). The heart rate values after concomitant administration of ivabradine and simvastatin at a dose of 1 mg × kg−1 bw to normocholesterolaemic rats were significantly decreased compared to the control group (342.3 ± 28.6 versus 434.8 ± 17.2 min−1) and compared to the group receiving simvastatin alone. Similar observations were made in hypercholesterolaemic rats. There were no statistical differences in heart rate concerning concomitant administration of ivabradine and simvastatin at dose 1 mg × kg−1 bw between hyper- and normocholesterolaemic rats. Administration of ivabradine with simvastatin at a dose of bw to hypercholesterolaemic rats significantly reduced heart rate compared to the control group (319.6 ± 30.6 versus 435.3 ± 20.3 min−1) and compared to the groups receiving simvastatin at a dose of 1 or bw alone.
In the normocholesterolaemic group, the slowing of the heart rate was statistically similar to hypercholesterolaemic rats. Administration of ivabradine with simvastatin at a dose of bw to hypercholesterolaemic and normocholesterolaemic rats similarly decreased heart rate. The concomitant administration of ivabradine with simvastatin at a dose of bw to hypercholesterolaemic and normocholesterolaemic was shown to significantly decrease the heart rate compared to rats receiving ivabradine alone (Figures 3 and 4).
3.4. PAI-1 Blood Level
In normocholesterolaemic rats, the administration of ivabradine was seen to have no statistically significant influence on PAI-1 values compared to the control group or the group receiving 1 mg/kg bw of simvastatin alone. The administration of simvastatin at dose of 20 mg/kg significantly () reduced the levels of PAI-1 compared to the control group. After a combined dose of ivabradine with 1 or 20 mg × kg−1 bw simvastatin, a significant reduction of the level of PAI-1 was seen compared to the group which only received ivabradine () (Figure 1).
In hypercholesterolaemic rats, the levels of PAI-1 in the control group as well as the group receiving bw simvastatin were comparable. The administration of ivabradine or bw simvastatin to hypercholesterolaemic rats significantly lowered PAI-1 values () compared to the control group. Concomitant administration of ivabradine with 1 or bw simvastatin, to hypercholesterolaemic rats, did not exacerbate the fall in PAI-1 levels compared to the group receiving only ivabradine (Figure 2).
PAI-1(serpin E1) is an inhibitor of t-Pa (tissue plasminogen activator) and u-Pa (urokinase-type plasminogen activator) and plays an important role in the regulation of activity of plasminogen. Raised levels of serum PAI-1 occur in many pathological conditions and are associated with an increased risk of cardiovascular complications [18, 19]. In an earlier study on cell cultures (HMEC and HUVEC), it was demonstrated that simvastatin significantly lowers the level of PAI-1. The observed effect was dose dependent, and the mechanism of action most probably involved the pleiotropic statin pathway . The influence of simvastatin on PAI-1 values has been confirmed by clinical trials. It has been shown that administration of 40 mg × kg−1 bw simvastatin for 8 weeks in patients with metabolic syndrome significantly reduced the activity of PAI-1 . The reduction of PAI-1 expression after “statin” administration has been evidenced in many preclinical and clinical trials [20–22]. The mechanisms surrounding the influence of HMG-CoA on the expression PAI-1 can be diverse. They include an influence on the inflammatory process, through mitogen-activated protein (MAP), nuclease factor kappa-B(NF-kB), phosphatidylinositol 3-kinase (PI3), JNK(c-jun-N-terminal kinases), and ERK (extracellular signal-regulated kinases), as well as on the small Rho proteins [23–26]. The influence of the small Rho protein family on the regulation of PAI-1 is, however, very complex and requires further studies . To the best of our knowledge, this is the first study to evaluate the influence of ivabradine on PAI-1 values. Ivabradine may influence PAI-1 values by means of reducing factors associated with the inflammation process. It has been shown in E−/− mice that ivabradine modulates the inflammation process by reducing the expression of interleukin–6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) cytokine mRNA, which is not observed in wild-type mice . The beneficial effect of reducing the inflammation process might also be a result of the slowing of the heart rate. In fact, accelerating the heart rate is associated with raised C-reactive protein (CRP) [29, 30]. The administration of ivabradine to animals receiving high dose of simvastatin has no effect on PAI-1 values compared to the groups receiving only simvastatin. However, it has been observed that ivabradine causes the reduction of PAI-1 in animals receiving small doses of simvastatin.
The mechanism of interaction on heart rate between simvastatin and ivabradine might involve a metabolic pathway. Previous pharmacokinetic studies have revealed that simvastatin might increase ivabradine plasma concentration, and, in this way, it might influence the pharmacological activity of ivabradine . Although simvastatin is reported to be the substrate for P450 CYP3A4, it was seen to demonstrate inhibitory activity, as well . The inhibitory activity of simvastatin is significant especially for the lactone forms rather than its acid forms . Rats do not possess the CYP3A4 isoenzyme, but its activity might be adopted by others, for example, CYP 2C11, CYP3A, and CYP2D3 [34, 35]. In our study, a dose-dependent influence of simvastatin on heart rate after concomitant administration with ivabradine was observed. After concomitant administration of a small dose of simvastatin (1 mg × kg−1 bw) with ivabradine, the heart rates of normo- and hypercholesterolaemic rats were compared to group receiving ivabradine alone. The administration of ivabradine with simvastatin given at a higher dose (20 mg × kg−1 bw) caused important drug-drug interaction and significant slowing of the heart rate as compared to ivabradine alone.
The slowing of heart rate might also be a result of beta-blockers therapy, however the mechanistic background is different. Only several reports indicate the possible interaction between statins and beta-blockers. Statins reduce the isoprenoid cholesterol intermediates and as well as dolichols, geranylgeranoic acid and farnesyl-farnesoic acid and it was shown that statin influences the beta-adrenergic stimulation which is connected with their impact on isoprenylation of G-protein beta-subunits. . Additionally, it was shown that simvastatin in rats restored the sympathetic/parasympathetic balance . Gentlesk et al. suggested that the impact of statins on the autonomic nervous system is most probably the effect of extralipid action of simvastatin .
Previous studies being performed in humans [39, 40] did not reveal apparent antiadrenergic effects of statins such as a reduction of heart rate, however. Also in our previous studies simvastatin administration during two  and four-week (article in press) period did not influence the heart rate and blood pressure after metoprolol injection in normo- and hypercholesterolemic rats, however. In other words, any significant statin intensification of heart rate deceleration after metoprolol administration was not observed.
Another point is if the augmentation of heart rate reduction by simvastatin might be related to influence of statin on vasodilatation with enhancement the endothelium-derived nitric oxide and elevation the cGMP levels. The impact of statins on blood pressure and possible statin vasodilatory properties have been discussed widely . Among suggested pathways leading to possible vasodilatory efficacy of statins, the restoration of endothelial dysfunction, increased nitric oxide synthesis with enhancement of eNOS mRNA stabilization or decreased synthesis of endothelin-1 (ET-1) are mentioned. The described effects are cholesterol-independent or “pleiotropic” ones and are the result of, at least partially, the inhibition of Rho isoprenylation [41, 42].
The administration of ivabradine to normocholesterolaemic and hypercholesterolaemic rats receiving simvastatin significantly exacerbated the slowing of heart rate with no effect on blood pressure. The administration of ivabradine has been shown to demonstrate different effects on PAI-1 values depending on lipid disorders. Concomitant administration of ivabradine and simvastatin in different doses, decrease PAI-1 blood levels in normo- and hypercholesterolaemic rats.
Conflict of Interests
The authors have no actual or potential conflict of interests including any financial, personal, or other relationships with other people or organizations that could inappropriately influence, or be perceived to influence, this paper.
|AUC:||Area under plasma concentration time curve|
|CAD:||Coronary artery disease|
|ERK:||Extracellular signal-regulated kinases|
|HDL:||High density lipoprotein cholesterol|
|HMGCo-A reductase:||3-hydroxy-3-methyl-glutaryl-CoA reductase|
|IHD:||Ischemic heart disease|
|LDL:||low density lipoprotein cholesterol|
|LVSD:||Left ventricular systolic dysfunction|
|NF-kB:||Nuclease factor kappa-B|
The study was supported by Medical University of Lodz; Grant: 503/3-011-02/503-01.
- W. B. Kannel, C. Kannel, R. S. Paffenbarger, and A. Cupples, “Heart rate and cardiovascular mortality: the Framingham study,” American Heart Journal, vol. 113, no. 6, pp. 1489–1494, 1987.
- X. Jouven, J. P. Empana, P. J. Schwartz, M. Desnos, D. Courbon, and P. Ducimetière, “Heart-rate profile during exercise as a predictor of sudden death,” New England Journal of Medicine, vol. 352, no. 19, pp. 1951–1958, 2005.
- A. Hjalmarson, E. A. Gilpin, J. Kjekshus et al., “Influence of heart rate on mortality after acute myocardial infarction,” American Journal of Cardiology, vol. 65, no. 9, pp. 547–553, 1990.
- F. Custodis, S. H. Schirmer, M. Baumhkel, G. Heusch, M. Bhm, and U. Laufs, “Vascular pathophysiology in response to increased heart rate,” Journal of the American College of Cardiology, vol. 56, no. 24, pp. 1973–1983, 2010.
- R. Ferrari, A. Cargnoni, and C. Ceconi, “Anti-ischaemic effect of ivabradine,” Pharmacological Research, vol. 53, no. 5, pp. 435–439, 2006.
- D. DiFrancesco, “Funny channels in the control of cardiac rhythm and mode of action of selective blockers,” Pharmacological Research, vol. 53, no. 5, pp. 399–406, 2006.
- K. Fox, I. Ford, P. G. Steg, M. Tendera, M. Robertson, and R. Ferrari, “Relationship between ivabradine treatment and cardiovascular outcomes in patients with stable coronary artery disease and left ventricular systolic dysfunction with limiting angina: a subgroup analysis of the randomized, controlled BEAUTIFUL trial,” European Heart Journal, vol. 30, no. 19, pp. 2337–2345, 2009.
- K. Swedberg, M. Komajda, M. Böhm et al., “Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study,” The Lancet, vol. 376, no. 9744, pp. 875–885, 2010.
- K. Fox, I. Ford, P. G. Steg, M. Tendera, M. Robertson, and R. Ferrari, “Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial,” The Lancet, vol. 372, no. 9641, pp. 817–821, 2008.
- A. Sarre, S. Pedretti, S. Gardier, and E. Raddatz, “Specific inhibition of HCN channels slows rhythm differently in atria, ventricle and outflow tract and stabilizes conduction in the anoxic-reoxygenated embryonic heart model,” Pharmacological Research, vol. 61, no. 1, pp. 85–91, 2010.
- J. P. Vilaine, “The discovery of the selective If current inhibitor ivabradine. A new therapeutic approach to ischemic heart disease,” Pharmacological Research, vol. 53, no. 5, pp. 424–434, 2006.
- M. Jasińska, J. Owczarek, and D. Orszulak-Michalak, “Statins: a new insight into their mechanisms of action and consequent pleiotropic effects,” Pharmacological Reports, vol. 59, no. 5, pp. 483–499, 2007.
- S. Devaraj, E. Chan, and I. Jialal, “Direct demonstration of an antiinflammatory effect of simvastatin in subjects with the metabolic syndrome,” Journal of Clinical Endocrinology and Metabolism, vol. 91, no. 11, pp. 4489–4496, 2006.
- L. Wang, J. Rockwood, D. Zak, S. Devaraj, and I. Jialal, “Simvastatin reduces circulating plasminogen activator inhibitor 1 activity in volunteers with the metabolic syndrome,” Metabolic Syndrome and Related Disorders, vol. 6, no. 2, pp. 149–152, 2008.
- B. Haslinger, M. F. Goedde, K. H. Toet, and T. Kooistra, “Simvastatin increases fibrinolytic activity in human peritoneal mesothelial cells independent of cholesterol lowering,” Kidney International, vol. 62, no. 5, pp. 1611–1619, 2002.
- J. Owczarek, M. Jasińska, and D. Orszulak-Michalak, “Dose-dependent influence of two-week administration of simvastatin and metoprolol injection on the blood pressure in normocholesterolemic rats,” Acta Poloniae Pharmaceutica - Drug Research, vol. 65, no. 1, pp. 147–151, 2008.
- J. Owczarek, M. Jasińska, and D. Orszulak-Michalak, “Interaction between different doses of simvastatin after two-week administration and metoprolol injection on the heart rate in normocholesterolemic rats,” Acta Poloniae Pharmaceutica - Drug Research, vol. 65, no. 1, pp. 141–145, 2008.
- A. Smith, C. Patterson, J. Yarnell, A. Rumley, Y. Ben-Shlomo, and G. Lowe, “Which hemostatic markers add to the predictive value of conventional risk factors for coronary heart disease and ischemic stroke? The Caerphilly study,” Circulation, vol. 112, no. 20, pp. 3080–3087, 2005.
- K. Takazoe, H. Ogawa, H. Yasue et al., “Increased plasminogen activator inhibitor activity and diabetes predict subsequent coronary events in patients with angina pectoris,” Annals of Medicine, vol. 33, no. 3, pp. 206–212, 2001.
- F. Wiesbauer, C. Kaun, G. Zorn, G. Maurer, K. Huber, and J. Wojta, “HMG CoA reductase inhibitors affect the fibrinolytic system of human vascular cells in vitro: a comparative study using different statins,” British Journal of Pharmacology, vol. 135, no. 1, pp. 284–292, 2002.
- S. Demyanets, C. Kaun, G. Maurer, K. Huber, and J. Wojta, “Statins modulate expression of components of the plasminogen activator/plasmin system in human cardiac myocytes in vitro ,” Journal of Thrombosis and Haemostasis, vol. 4, no. 2, pp. 476–479, 2006.
- J. Q. Li, S. P. Zhao, Q. Z. Li et al., “Atorvastatin reduces plasminogen activator inhibitor-1 expression in adipose tissue of atherosclerotic rabbits,” Clinica Chimica Acta, vol. 370, no. 1-2, pp. 57–62, 2006.
- J. F. Schindler, J. B. Monahan, and W. G. Smith, “P38 pathway kinases as anti-inflammatory drug targets,” Journal of Dental Research, vol. 86, no. 9, pp. 800–811, 2007.
- S. F. Liu and A. B. Malik, “NF-κB activation as a pathological mechanism of septic shock and inflammation,” American Journal of Physiology, vol. 290, no. 4, pp. L622–L645, 2006.
- J. Dong, S. Fujii, S. Imagawa et al., “IL-1 and IL-6 induce hepatocyte plasminogen activator inhibitor-1 expression through independent signaling pathways converging on C/EBPδ,” American Journal of Physiology, vol. 292, no. 1, pp. C209–C215, 2007.
- E. K. O. Kruithof, “Regulation of plasminogen activator inhibitor type 1 gene expression by inflammatory mediators and statins,” Thrombosis and Haemostasis, vol. 100, no. 6, pp. 969–975, 2008.
- M. Essig, G. Nguyen, D. Prié, B. Escoubet, J. D. Sraer, and G. Friedlander, “3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors increase fibrinolytic activity in rat aortic endothelial cells: role of geranylgeranylation and Rho proteins,” Circulation Research, vol. 83, no. 7, pp. 683–690, 1998.
- S. H. Schirmer, A. Degen, M. Baumhakel, et al., “Heart-rate reduction by If-channel inhibition with ivabradine restores collateral artery growth in hypercholesterolemic atherosclerosis,” European Heart Journal. In press.
- O. Rogowski, I. Shapira, A. Shirom, S. Melamed, S. Toker, and S. Berliner, “Heart rate and microinflammation in men: a relevant atherothrombotic link,” Heart, vol. 93, no. 8, pp. 940–944, 2007.
- A. Sajadieha, O. W. Nielsen, V. Rasmussen, H. O. Hein, S. Abedini, and J. F. Hansen, “Increased heart rate and reduced heart-rate variability are associated with subclinical inflammation in middle-aged and elderly subjects with no apparent heart disease,” European Heart Journal, vol. 25, no. 5, pp. 363–370, 2004.
- I. Savelieva and A. J. Camm, “If inhibition with ivabradine: electrophysiological effects and safety,” Drug Safety, vol. 31, no. 2, pp. 95–107, 2008.
- C. Transon, T. Leemann, and P. Dayer, “In vitro comparative inhibition profiles of major human drug metabolising cytochrome P450 isozymes (CYP2C9, CYP2D6 and CYP3A4) by HMG-CoA reductase inhibitors,” European Journal of Clinical Pharmacology, vol. 50, no. 3, pp. 209–215, 1996.
- M. Ishigami, T. Honda, W. Takasaki et al., “A comparison of the effects of 3-hydroxy-3-methylglutaryl-coenzyme a (HMG-CoA) reductase inhibitors on the CYP3A4-dependent oxidation of mexazolam in vitro,” Drug Metabolism and Disposition, vol. 29, no. 3, pp. 282–288, 2001.
- M. Ishigami, W. Takasaki, T. Ikeda, T. Komai, K. Ito, and Y. Sugiyama, “Sex difference in inhibition of in vitro mexazolam metabolism by various 3-hydroxy-3-methylglutaryl-coenzyme a reductase inhibitors in rat liver microsomes,” Drug Metabolism and Disposition, vol. 30, no. 8, pp. 904–910, 2002.
- T. Aiba, Y. Takehara, M. Okuno, and Y. Hashimoto, “Poor correlation between intestinal and hepatic metabolic rates of CYP3A4 substrates in rats,” Pharmaceutical Research, vol. 20, no. 5, pp. 745–748, 2003.
- A. S. Wierzbicki, R. Poston, and A. Ferro, “The lipid and non-lipid effects of statins,” Pharmacology and Therapeutics, vol. 99, no. 1, pp. 95–112, 2003.
- R. U. Pliquett, K. G. Cornish, and I. H. Zucker, “Statin therapy restores sympathovagal balance in experimental heart failure,” Journal of Applied Physiology, vol. 95, no. 2, pp. 700–704, 2003.
- P. J. Gentlesk, T. Wiley, and A. J. Taylor, “A prospective evaluation of the effect of simvastatin on heart rate variability in non-ischemic cardiomyopathy,” American Heart Journal, vol. 150, no. 3, pp. 478–483, 2005.
- K. Node, M. Fujita, M. Kitakaze, M. Hori, and J. K. Liao, “Short-term statin therapy improves cardiac function and symptoms in patients with idiopathic dilated cardiomyopathy,” Circulation, vol. 108, no. 7, pp. 839–843, 2003.
- M. Bountioukos, V. Rizzello, B. J. Krenning et al., “Effect of atorvastatin on myocardial contractile reserve assessed by tissue doppler imaging in moderately hypercholesterolemic patients without heart disease,” American Journal of Cardiology, vol. 92, no. 5, pp. 613–616, 2003.
- M. Ii and D. W. Losordo, “Statins and the endothelium,” Vascular Pharmacology, vol. 46, no. 1, pp. 1–9, 2007.
- H. J. Milionis, E. N. Liberopoulos, A. Achimastos, M. S. Elisaf, and D. P. Mikhailidis, “Statins: another class of antihypertensive agents?” Journal of Human Hypertension, vol. 20, no. 5, pp. 320–335, 2006.