EFFECTS OF SIMVASTAIN COMBINED WITH OMEGA-3 FATTY ACIDS ON HIGH SENSITIVE C-REACTIVE PROTEIN, LIPIDEMIA, ANDFIBRINOLYSIS IN PATIENTS WITH MIXED DYSLIPIDEMIA

Objective To evaluate the effects of simvastatin combined with omega-3 fatty acids on high sensitive C-reactive protein(HsCRP), lipidemia, and fibrinolysis in coronary heart disease (CHD) and CHD risk equivalent patients with mixed dyslipi-demia. Methods A randomized, double-blind placebo controlled and parallel group trial was conducted. Patients with CHD and CHD risk equivalents with mixed dyslipidemia were treated with 10 or 20 mg simvastatin for 6-12 weeks. Following with the treatment of patients whose low-density lipoprotein cholesterol (LDL-ch) reaching goal level (< 100 mg/dL) or close to the goal (< 130 mg/dL), while triglyceride (TG) ≥200 mg/dL and < 500 mg/dL, was combined with omega-3 fatty acids (3 g/d) or a placebo for 2 months. The effects of the treatment on HsCRP, total cholesterol (TC), LDL-ch, high-density lipoprotein cholesterol (HDL-ch), TG, lipoprotein (a) [LP (a)], apolipoprotein A1 (apoA1), apolipoprotein B (apoB), plasminogen activator inhibitor-1 (PAI-1), and tissue plasminogen activator (tPA) were investigated. Forty patients finished the study with each group consisting of twenty patients. Results (1) There were significant reductions of HsCRP, TG, TC, and TC/HDL-ch, which decreased by 2.16 ±2.77 mg/L (38.5%), 94.0 ±65.4 mg/dL (31.1%), 13.3 ±22.3 mg/dL (6.3%), 0.78 ±1.60 respectively in the omega-3 fatty acids group (P< 0.01, < 0.001, < 0.05, < 0.05) compared to the baseline. HsCRP and triglyceride reduction were more significant in omega-3 fatty acids group compared to the placebo group (P=0.021 and 0.011 respectively). (2) In the omega-3 fatty acids group, the values and percentage of TG reduction had a significantly positive relation with HsCRP reduction (r=0.51 and 0.45, P=0.021 and 0.047 respectively). Conclusion In CHD and CHD risk equivalent patients with mixed dyslipidemia, dyslipidemia’s therapeutic effect using simvastatin and omega-3 fatty acids may result from not only the combination of lipid adjustment, but also enhancement of their own nonlipid influences.

Long-term effects of simvastatin on protection against atrial fibrillation in patients with acute myocardial infarction

Objective To investigate the impact of simvastatin on blood lipid and the incidence of atrial fibrillation and ischemic-related events in patients with acute myocardial infarction accompanied by paroxysmal atrial fibrillation. Methods One hundred and three patients with acute myocardial infarction and paroxysmal atrial fibrillation were selected as subjects,and were divided into a simvastatin group and a control group. Forty-five patients were in the simvastatin group,who took simvastatin 20mg/d orally for 18 months;fifty-eight patients were in the control group,and received conventional therapy except for statins. All patients were followed up for 18 months. The level of blood lipid,recurrence rate of paroxysmal atrial fibrillation,incidence rate of persistent or permanent atrial fibrillation,and the ischemic-related events were investigated and compared between the two groups. Results ① The levels of blood lipids did not change significantly in the control group(P>0.05) ;concentrations of total cholesterol(TC) and low density lipoprotein cholesterol(LDL-C) decreased significantly after treatment of simvastatin(P<0.05) . ② Recurrence of atrial fibrillation was observed in five patients during 18 months follow-up in the simvastatin group(11.1%) ,whereas it occurred in 14 patients of the control group(24. 1%,P<0.05) ;the occurrence rate of persistent or permanent atrial fibrillation in the simvastatin group was 4.4%,which was lower than that of control(12.1%,P<0.05) . ③ Nine patients had ischemic-related events in the simvastatin group(20.0%) ,with three heart failures(6.6%) ,two rehospitalizations for deterioration of coronary heart diseases(4.4%) ,three cardiac deaths(6.6%) ,and one cerebral stroke(2.2%) ,which was lower evidently than in the control group(41.4%,P<0.05) . Conclusions Simvastatin can not only decrease the levels of serum TC and LDL-C but also prevent the occurrence of atrial fibrillation and ischemic-related events.

Intraoperative Bleeding Associated with Preoperative Use of <i>Ganoderma lucidum</i>Supplements

Reishi mushroom, also known as Ganoderma lucidum, is a type of edible medicinal fungi that is found throughout Asia. Recent research has shown that it may also have antiplatelet activity that is similar to aspirin. Likewise simvastatin has been shown to inhibit platelet aggregation. In addition, montelukast has anecdotally related to one case of acquired thrombopathia and may interfere with platelet aggregation. We report a case of intraoperative hemorrhage with laparoscopic trocar placement and dissection in a patient concomitantly taking Ganoderma lucidum supplements, simvastatin and montelukast. The hemorrhage only responded to a transfusion of platelets. We believe this is the first report associating Ganoderma lucidum products with an intraoperative hemorrhage. We recommend that patients who are on simvastatin, montelukast or an anticoagulant should refrain from taking Ganoderma lucidum products for seven days prior to surgery.