Myasoedova Veronika A, Rega Sara, Valerio Vincenza, Moschetta Donato, Massaiu Ilaria, Bonalumi Giorgia, Esposito Giampiero, Rusconi Valentina, Bertolini Francesca, Perrucci Gianluca Lorenzo, Poggio Paolo
Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.
Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
Front Pharmacol. 2024 Aug 1;15:1426982. doi: 10.3389/fphar.2024.1426982. eCollection 2024.
Thoracic aortic aneurysm (TAA) that progress to acute aortic dissection is often fatal and there is no pharmacological treatment that can reduce TAA progression. We aim to evaluate statins' effects on TAA growth rate and outcomes using a meta-analysis approach.
A detailed search related to the effects of statins on TAA was conducted according to PRISMA guidelines. The analyses of statins' effects on TAA growth rate were performed on 4 studies (n = 1850), while the impact on outcomes was evaluated on 3 studies (n = 2,867). Patients under statin treatment showed a reduced TAA growth rate (difference in means = -0.36 cm/year; 95%CI: -0.64, -0.08; = 0.013) when compared to controls, patients not taking statins. Regarding the outcomes (death, dissection, or rupture of the aorta, and the need for operative repair), statins exhibited a protective effect reducing the number of events (log odds ratio = -0.56; 95%CI: -1.06, -0.05; = 0.030). , the anti-fibrotic effect of atorvastatin was tested on vascular smooth muscle cells (VMSC) isolated from patients with TAA. Our results highlighted that, in transforming growth factor beta 1 (TGF-β1) pro-fibrotic condition, VSMC expressed a significant lower amount of collagen type I alpha 1 chain (COL1A1) when treated with atorvastatin (untreated = +2.66 ± 0.23 fold-change vs. treated = +1.63 ± 0.09 fold-change; = 0.014).
Statins show a protective effect on TAA growth rate and adverse outcomes in patients with TAA, possibly via their anti-fibrotic properties on VSMC. Given the current lack of effective drug treatments for TAA, we believe our findings highlight the need for more in-depth research to explore the potential benefits of statins in this context.
进展为急性主动脉夹层的胸主动脉瘤（TAA）通常是致命的，且尚无能够降低TAA进展的药物治疗方法。我们旨在采用荟萃分析方法评估他汀类药物对TAA生长速率和预后的影响。
根据PRISMA指南，对与他汀类药物对TAA的影响相关的研究进行了详细检索。对4项研究（n = 1850）进行了他汀类药物对TAA生长速率影响的分析，而对3项研究（n = 2867）评估了其对预后的影响。与未服用他汀类药物的对照组患者相比，接受他汀类药物治疗的患者TAA生长速率降低（平均差异=-0.36厘米/年；95%置信区间：-0.64，-0.08；P = 0.013）。关于预后（死亡、主动脉夹层或破裂以及手术修复的必要性），他汀类药物表现出保护作用，减少了事件数量（对数比值比=-0.56；95%置信区间：-1.06，-0.05；P = 0.030）。此外，在从TAA患者分离的血管平滑肌细胞（VMSC）上测试了阿托伐他汀的抗纤维化作用。我们的结果突出显示，在转化生长因子β1（TGF-β1）促纤维化条件下，用阿托伐他汀处理时，VSMC表达的I型胶原α1链（COL1A1）量显著降低（未处理=+2.66±0.23倍变化 vs. 处理后=+1.63±0.09倍变化；P = 0.014）。
他汀类药物对TAA患者的TAA生长速率和不良预后显示出保护作用，可能是通过其对VSMC的抗纤维化特性。鉴于目前缺乏针对TAA的有效药物治疗，我们认为我们的研究结果凸显了在此背景下进行更深入研究以探索他汀类药物潜在益处的必要性。
