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Do HMG-CoA reductase inhibitors affect fibrinogen?
Insights
Hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors impact fibrinogen levels differently. Pravastatin decreases fibrinogen, while atorvastatin and lovastatin increase it, and simvastatin has a neutral effect.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Clinical Chemistry
Background:
- Fibrinogen is a key protein in blood coagulation.
- Elevated fibrinogen levels are associated with an increased risk of coronary artery disease.
- Hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are widely used to lower cholesterol.
Purpose of the Study:
- To review fibrinogen assay methods.
- To examine the link between fibrinogen and coronary artery disease risk.
- To assess the impact of HMG-CoA reductase inhibitors on fibrinogen levels.
Main Methods:
- Literature review of primary and review articles from MEDLINE (1966-1999).
- Evaluation of all identified relevant articles.
- Analysis of studies investigating the effects of atorvastatin, lovastatin, simvastatin, and pravastatin on fibrinogen.
Main Results:
- The Clauss method is the preferred assay for fibrinogen due to accuracy and precision.
- Atorvastatin and lovastatin were associated with significant increases in fibrinogen (22% and 24.4%, respectively) using immunonephelometric methods.
- Simvastatin showed a neutral effect on fibrinogen, while pravastatin led to significant decreases (7-19%).
Conclusions:
- Different HMG-CoA reductase inhibitors have varying effects on fibrinogen concentrations.
- Further research using direct comparisons and clotting assays is recommended to clarify these effects.
Objective:
To review commonly used fibrinogen assay methods and the evidence demonstrating an association between fibrinogen and increased risk of coronary artery disease and to review the current literature to determine and assess the impact of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors on fibrinogen.
Data Sources:
Primary and review articles identified from a MEDLINE search (1966-December 1999); references obtained from these publications were subsequently reviewed for additional relevant articles.
Study Selection And Data Extraction:
All articles were evaluated, and all relevant information was included in this review.
Data Synthesis:
The Clauss method is currently the preferred method for determining plasma fibrinogen concentrations, due to its high degree of accuracy and precision. Furthermore, unlike immunologic methods, its reliability is unaffected by change in triglycerides. The effects of four HMG-CoA reductase inhibitors (atorvastatin, lovastatin, simvastatin, pravastatin) on fibrinogen have been evaluated. Atorvastatin has been shown to induce significant increases in fibrinogen (22% increase; p <0.05) by using the immunonephelometric method. This method also demonstrated that lovastatin use was associated with a 24.4% increase (p < 0.0001) in plasma fibrinogen concentration. Simvastatin has been shown in multiple studies using the Clauss method to have a neutral effect on fibrinogen. The majority of studies have revealed significant decreases (7-19%) in fibrinogen following treatment with pravastatin.
Conclusions:
Future studies need to be performed evaluating the effects of HMG-CoA reductase inhibitors on fibrinogen, but using direct comparisons and clotting assay methodology.