1. By MD., FAC.C Zagazig University

3. 1.Improve endothelial function 2.Stimulate angiogenesis 3.Mobilize bone-marrow derived stem cells 4.Reduce systemic inflammation and control it (Zaca et al., JACC, 2007) Statins

5. Statins may slow lung function decline : To less than half as much annual decline over 10 years.To less than half as much annual decline over 10 years. Alexeeff. SE et al., Am. J. Respir. Crit. Care. Med. October 12/2007

10. Cardiovascular mortality is increased in CHF patients with CRP>3 mg/L especially in ischemic cardiomyopathy. The impact of CRP is independent of usual prognostic parameters. (Lamblin N. Monguet et al., EHJ, 2005) CRP and CHF

11. Copyright ©2001 American College of Cardiology Foundation. Restrictions may apply. Tsutamoto, T. et al. J Am Coll Cardiol 2001;37:2086-2092 Plasma oxidized low density lipoprotein (oxLDL) concentrations in the aortic root (AO), coronary sinus (CS) and femoral vein (FV) in 8 control subjects and in 22 patients with dilated cardiomyopathy

12. Copyright ©2001 American College of Cardiology Foundation. Restrictions may apply. Tsutamoto, T. et al. J Am Coll Cardiol 2001;37:2086-2092 Correlation between the transcardiac gradient of plasma tumor necrosis factor-alpha (TNF-alpha) and the transcardiac gradient of plasma oxidized low density lipoprotein (oxLDL) in patients with dilated cardiomyopathy

16. Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. Zaca, V. et al. J Am Coll Cardiol 2007;50:551-557 TNF-{alpha} and MMP-2

17. Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. Zaca, V. et al. J Am Coll Cardiol 2007;50:551-557 Magnitude of Circulating BMSCs

18. Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. Zaca, V. et al. J Am Coll Cardiol 2007;50:551-557 Ventriculographic Measures of LV Function and Size

25. Copyright ©2007 American Heart Association Khush, K. K. et al. Circulation 2007;115:576-583 Proportion of patients in the 10- and 80-mg arms of TNT hospitalized with HF during follow-up

26. Copyright ©2007 American Heart Association Khush, K. K. et al. Circulation 2007;115:576-583 Proportion of patients with and without a history of HF in the 10- and 80-mg arms of TNT experiencing hospitalization for HF during follow-up

27. Ongoing trials 1.UNIVERSE (Rousvastatin impact on ventricular remodeling lipids and cytokines) Echo and biomarkers study. 2.GISSI-HF : Rousvastatin and fish oil on CHF of any etiology. 3.CORONA (10 mg Rousvastatin for 5 years in ischemic cardiomyopthy).

28. Conclusion 1.Statins :  Oxidative stress,  CRP,  IL-6,  TNF- , mobilize bone marrow derived stem cells, and improve CHF. 2.Reverse remodeling occurs in ischemic and non- ischemic cardiomyopathy. 3.Statins benefit is additive to ACE-I and ARB’s in CHF. 4.Higher doses seems to be more effective.

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