Key result
Dual statin and RAS inhibitor therapy reduces CV events and improves metabolic function over monotherapy.
Why the study?
Hypercholesterolemia and hypertension synergistically worsen insulin resistance and endothelial dysfunction, and combined statin and RAS inhibitor therapy may offer additive cardiovascular benefits beyond monotherapy.
Does combined therapy with statins and RAS inhibitors improve cardiovascular outcomes and metabolic parameters compared to monotherapy in patients with cardiovascular risk factors?
Does combined therapy with statins and RAS inhibitors improve cardiovascular outcomes and metabolic parameters compared to monotherapy in patients with cardiovascular risk factors?
Combined therapy with statins and RAS inhibitors offers synergistic benefits on endothelial dysfunction, insulin resistance, and cardiovascular event reduction compared to monotherapy.
Supports combined statin-RAS inhibitor therapy for endothelial and metabolic benefits; hypothesis-generating and requires prospective RCTs before practice change.
Hypercholesterolemia and hypertension are the most common risk factors for cardiovascular disease (CVD). Updated guidelines emphasize target reduction of overall cardiovascular risks. Hypercholesterolemia and hypertension have a synergistic deleterious effect on insulin resistance and endothelial dysfunction. Unregulated renin-angiotensin system (RAS) is important in the pathogenesis of atherosclerosis. Statins are the most important in patients with hypercholesterolemia to prevent CVD by lowering low-density lipoprotein-cholesterol, improving endothelial dysfunction, and other anti-atherosclerotic effects. Unfortunately, statin therapy dose-dependently causes insulin resistance and increases the risk of type 2 diabetes mellitus. RAS inhibitors improve both endothelial dysfunction and insulin resistance in addition to blood pressure lowering. Further, cross-talk between hypercholesterolemia and RAS exists at multiple steps of insulin resistance and endothelial dysfunction. In this regard, combined therapy with statins and RAS inhibitors demonstrates additive/synergistic beneficial effects on endothelial dysfunction and insulin resistance in addition to lowering both cholesterol levels and blood pressure and it did reduce cardiovascular events 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 or treat CVD.
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Koh et al. (2015) conducted a review in Cardiovascular disease, hypercholesterolemia, and hypertension. Combined therapy with statins and RAS inhibitors vs. Monotherapy was evaluated on Cardiovascular events. Combined therapy with statins and renin-angiotensin system inhibitors reduces cardiovascular events and improves endothelial dysfunction and insulin resistance compared with either monotherapy.
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