151. Can Statins Reduce the Inflammatory Response to Cardiopulmonary Bypass? A Clinical Study
- Author
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Catherine Pasquier, Ziad Mallat, Susanna Salvi, Emmanuelle Florens, Alix Nguyen, Alain Tedgui, Philippe Menasché, Alain Bel, Jacqueline Peynet, and Carole Elbim
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Neutrophils ,Atorvastatin ,Enzyme-Linked Immunosorbent Assay ,Preoperative care ,Gastroenterology ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,Preoperative Care ,medicine ,Cardiopulmonary bypass ,Humans ,Pyrroles ,Prospective Studies ,Prospective cohort study ,Aged ,Cardiopulmonary Bypass ,biology ,business.industry ,Lactoferrin ,NF-kappa B ,Interleukin ,Middle Aged ,Surgery ,Clinical trial ,Heptanoic Acids ,biology.protein ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Objective In addition to lowering lipid levels, statins might reduce leukocyte-endothelial cell interactions. Therefore, we assessed whether this effect could limit the inflammatory response to cardiopulmonary bypass (CPB) in cardiac surgical patients. Methods Twenty patients undergoing valve or coronary operations with tepid (34 degrees C) CPB were randomized to receive an oral dose of atorvastatin (40 mg the evening before and 40 mg the morning of surgery) or to serve as controls. Pre- and post-CPB blood samples were assayed for neutrophil CD11b surface adhesion molecule and oxidative burst. Plasma levels of interleukins 6 and 8, P-selectin, soluble intercellular adhesion molecule-1, and lactoferrin were measured by enzyme-linked immunosorbent assay (ELISA). In addition, right atrial biopsies were taken before and at the end of CPB, and processed for the expression of the transcription nuclear factor-kappa B (NF-kappaB). Results The two groups did not differ with regard to pre- and intraoperative data. Except for P-selectin, postbypass values of all markers significantly increased over baseline values, but atorvastatin therapy failed to attenuate the magnitude of this increase. In the two groups, the expression of NF-kappaB significantly (p = 0.004) increased over baseline without group effect. Postoperative clinical outcomes did not differ either between the two groups. Conclusion These data show that acute preoperative statin therapy fails to limit the inflammatory response to CPB; however, the data also document a major upregulation of NF-kappaB during cardiac operations, thereby providing a sound rationale for interventions targeted at inactivating this key component of the inflammatory cascade.
- Published
- 2001