1.Diosgenin alleviates NAFLD induced by a high-fat diet in rats via mTOR/SREBP-1c/HSP60/MCAD/SCAD signaling pathway.
Su-Wen CHEN ; Guo-Liang YIN ; Chao-Yuan SONG ; De-Cheng MENG ; Wen-Fei YU ; Xin ZHANG ; Ya-Nan FENG ; Peng-Peng LIANG ; Feng-Xia ZHANG
China Journal of Chinese Materia Medica 2023;48(19):5304-5314
This study aims to observe the effects of diosgenin on the expression of mammalian target of rapamycin(mTOR), sterol regulatory element-binding protein-1c(SREBP-1c), heat shock protein 60(HSP60), medium-chain acyl-CoA dehydrogenase(MCAD), and short-chain acyl-CoA dehydrogenase(SCAD) in the liver tissue of the rat model of non-alcoholic fatty liver disease(NAFLD) and explore the mechanism of diosgenin in alleviating NAFLD. Forty male SD rats were randomized into five groups: a control group, a model group, low-(150 mg·kg~(-1)·d~(-1)) and high-dose(300 mg·kg~(-1)·d~(-1)) diosgenin groups, and a simvastatin(4 mg·kg~(-1)·d~(-1)) group. The rats in the control group were fed with a normal diet, while those in the other four groups were fed with a high-fat diet. After feeding for 8 weeks, the body weight of rats in the high-fat diet groups increased significantly. After that, the rats were administrated with the corresponding dose of diosgenin or simvastatin by gavage every day for 8 weeks. The levels of triglyceride(TG), total cholesterol(TC), alanine transaminase(ALT), and aspartate transaminase(AST) in the serum were determined by the biochemical method. The levels of TG and TC in the liver were measured by the enzyme method. Oil-red O staining was employed to detect the lipid accumulation, and hematoxylin-eosin(HE) staining to detect the pathological changes in the liver tissue. The mRNA and protein levels of mTOR, SREBP-1c, HSP60, MCAD, and SCAD in the liver tissue of rats were determined by real-time fluorescence quantitative polymerase chain reaction(RT-qPCR) and Western blot, respectively. Compared with the control group, the model group showed increased body weight, food uptake, liver index, TG, TC, ALT, and AST levels in the serum, TG and TC levels in the liver, lipid deposition in the liver, obvious hepatic steatosis, up-regulated mRNA and protein expression levels of mTOR and SREBP-1c, and down-regulated mRNA and protein expression levels of HSP60, MCAD, and SCAD. Compared with the model group, the rats in each treatment group showed obviously decreased body weight, food uptake, liver index, TG, TC, ALT, and AST levels in the serum, TG and TC levels in the liver, lessened lipid deposition in the liver, ameliorated hepatic steatosis, down-regulated mRNA and protein le-vels of mTOR and SREBP-1c, and up-regulated mRNA and protein levels of HSP60, MCAD, and SCAD. The high-dose diosgenin outperformed the low-dose diosgenin and simvastatin. Diosgenin may prevent and treat NAFLD by inhibiting the expression of mTOR and SREBP-1c and promoting the expression of HSP60, MCAD, and SCAD to reduce lipid synthesis, improving mitochondrial function, and promoting fatty acid β oxidation in the liver.
Rats
;
Male
;
Animals
;
Non-alcoholic Fatty Liver Disease/genetics*
;
Sterol Regulatory Element Binding Protein 1/metabolism*
;
Diet, High-Fat/adverse effects*
;
Diosgenin/metabolism*
;
Chaperonin 60/therapeutic use*
;
Rats, Sprague-Dawley
;
Liver
;
Signal Transduction
;
TOR Serine-Threonine Kinases/metabolism*
;
Triglycerides
;
RNA, Messenger/metabolism*
;
Simvastatin/therapeutic use*
;
Body Weight
;
Lipid Metabolism
;
Mammals/metabolism*
2.Simvastatin Blocks Reinstatement of Cocaine-induced Conditioned Place Preference in Male Mice with Brain Lipidome Remodeling.
Wei XU ; Yuman HE ; Jiamei ZHANG ; Hongchun LI ; Xuemei WAN ; Menglu LI ; Yonghai WANG ; Rui XU ; Haoluo ZHANG ; Yanping DAI ; Haxiaoyu LIU ; Linhong JIANG ; Ying ZHAO ; Xiaobo CEN
Neuroscience Bulletin 2021;37(12):1683-1702
Drug-associated reward memories are conducive to intense craving and often trigger relapse. Simvastatin has been shown to regulate lipids that are involved in memory formation but its influence on other cognitive processes is elusive. Here, we used a mass spectrometry-based lipidomic method to evaluate the impact of simvastatin on the mouse brain in a cocaine-induced reinstatement paradigm. We found that simvastatin blocked the reinstatement of cocaine-induced conditioned place preference (CPP) without affecting CPP acquisition. Specifically, only simvastatin administered during extinction prevented cocaine-primed reinstatement. Global lipidome analysis showed that the nucleus accumbens was the region with the greatest degree of change caused by simvastatin. The metabolism of fatty-acids, phospholipids, and triacylglycerol was profoundly affected. Simvastatin reversed most of the effects on phospholipids induced by cocaine. The correlation matrix showed that cocaine and simvastatin significantly reshaped the lipid metabolic pathways in specific brain regions. Furthermore, simvastatin almost reversed all changes in the fatty acyl profile and unsaturation caused by cocaine. In summary, pre-extinction treatment with simvastatin facilitates cocaine extinction and prevents cocaine relapse with brain lipidome remodeling.
Animals
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Brain
;
Cocaine
;
Conditioning, Operant
;
Extinction, Psychological
;
Lipidomics
;
Male
;
Mice
;
Simvastatin/therapeutic use*
3.Ilexgenin A enhances the effects of simvastatin on non-alcoholic fatty liver disease without changes in simvastatin pharmacokinetics.
Ya-Wen LU ; Ying-Chao ZHU ; Li ZHANG ; Ping LI ; Jie YANG ; Xiao-Dong WEN
Chinese Journal of Natural Medicines (English Ed.) 2018;16(6):436-445
Cardiovascular disease (CVD) is the most common cause of death in patients with non-alcoholic fatty liver disease (NAFLD). New therapeutic strategies which have the potential for slowing down the evolution of NAFLD and reducing CVD-related mortality are urgently needed. Statins are well recognized in the treatment of dyslipidemia, but their use in the treatment of NAFLD is limited due to the safety concerns. Ilexgenin A (IA) is one of the main bioactive compounds in 'Shan-lv-cha', an herbal tea commonly used in China. In the present study, we investigated the possible synergistic therapeutic effects of IA and simvastatin (SV) on NAFLD. IA or SV showed beneficial effects on the rats with NAFLD by lowering the liver weight, liver index and plasma levels of alanine aminotransferase and aspartate aminotransferase, regulating abnormal metabolism of lipids and ameliorating steatosis in liver. IA significantly enhanced the hypolipidemic and anti-inflammation effects of SV. Furthermore, a sensitive, accurate, convenient and reproducible LC-MS method was developed to investigate the effects of IA on the pharmacokinetics of SV. No significant changes were observed in pharmacokinetic parameters of SV and simvastatin hydroxy acid in the IA plus SV co-treated group in comparison with those in the group treated with SV alone. The mRNA levels and activity of CYP3A1 were not altered by IA. In conclusion, the results obtained from the present study should be helpful for further clinical application of SV and IA alone or in combination.
Alanine Transaminase
;
metabolism
;
Animals
;
Aspartate Aminotransferases
;
metabolism
;
Cytochrome P-450 CYP3A
;
genetics
;
metabolism
;
Diet, High-Fat
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Disease Models, Animal
;
Drug Synergism
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Drug Therapy, Combination
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Lipids
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blood
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Liver
;
metabolism
;
pathology
;
physiopathology
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Male
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Molecular Structure
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Non-alcoholic Fatty Liver Disease
;
blood
;
drug therapy
;
Rats
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Rats, Sprague-Dawley
;
Simvastatin
;
analogs & derivatives
;
pharmacokinetics
;
therapeutic use
;
Transcription, Genetic
;
Triterpenes
;
chemistry
;
therapeutic use
4.Evalation of Jingzhi Xiaoban Tablet in Improving Heart Function of Coronary Heart Disease Pa- tients by Doppler Tissue Imaging and Speckle Tracking Imaging Technology.
Yue-ai WANG ; Xi-jiao YU ; Chou-fu CHENG ; Li YANG ; Fang LIU ; Meng-hong ZHOU ; Yun TAN
Chinese Journal of Integrated Traditional and Western Medicine 2016;36(4):399-402
OBJECTIVETo evaluate the role of Jiangzhi Xiaoban Tablet (JXT) in improving heartfunction of coronary heart disease (CHD) patients by tissue Doppler imaging (TDI) and speckle trackingimaging (STI) technology.
METHODSRecruited were 60 inpatients with confirmed CHD by coronary angiography at First Affiliated Hospital, Hunan University of Traditional Chinese Medicine from October 2013to November 2014. They were assigned to the treatment group (group A) and the control group (groupB) according to random digit table, 30 cases in each group. Patients in group A took JXT, 0.45 g/tablet,4 tablets each time, 3 times per day, while those in group B took Simvastatin Tablet, 20 mg/tablet, 1 tablet each time, once per evening. The therapeutic course for all was 8 weeks. The long axis view of theheart of 18 segments STI Peak strain LS and TDI peak systolic Sa parameters were performed in all patients before and after treatment.
RESULTSBefore treatment segments of STI strain LS and TDI longitudinal peak systolic peak Sa were not statistically different between the two groups (P > 0.05). Each segment of STI peak longitudinal strain LS and TDI peak systolic Sa in the two groups were higher after treatment than before treatment (P < 0.05). After treatment each segment of STI parameters of LS and eachTDI segment parameters of Sa were significantly lower in group B than in group A (P < 0.01).
CONCLUSIONJXT could improve heart function of CHD patients to different degrees, and its curative effect was betterthan that of routine Western medicine (Simvastatin Tablets) treatment.
Coronary Artery Disease ; drug therapy ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Echocardiography, Doppler ; Heart ; drug effects ; Humans ; Simvastatin ; therapeutic use ; Tablets
5.Effect of Buyang Huanwu Decoction on mRNA Expressions of Aorta Rho Kinase and NF-κB p65 in Atherosclerosis Model Rats.
Hong-zhen ZHANG ; Li LI ; Rui JIAO ; Ying ZHANG ; Yan QIAN
Chinese Journal of Integrated Traditional and Western Medicine 2015;35(12):1495-1500
OBJECTIVETo observe the effect of Buyang Huanwu Decoction (BYHWD), a representative formula of qi benefiting blood activating method on aorta Rho associated coiled-coil forming protein serine/threonine kinase (Rhokinase, ROCK) and nuclear transcription factor kappa B (NF-κB) p65 mRNA expressions and levels of blood lipids in atherosclerosis (AS) model rats.
METHODSThe AS rat model was prepared by vitamin D3 and high fat diet. Totally 60 rats were randomly divided into 6 groups, i.e., the normal control group, the model group, the low dose BYHWD group (10 g/kg), the high dose BYHWD group (20 g/kg), the Simvastatin control group (0.6 mg/kg), and the BYHWD prevention group (10 g/kg), 10 in each group. After successful modeling all medication was intervened for 28 days. Expression levels oxidized low density lipoprotein (ox-LDL) were detected by ELISA. Levels of TG, TC, LDL-C, HDL-C were determined by enzyme method. Pathological changes of aortic tissue were observed under light microscope. mRNA expressions of Rho kinase and NF-κB p65 in aorta were detected by real time (RT) PCR.
RESULTSHigh fat diet and peritoneal injection of vitamin D3 could induce AS rat model. Typical atheromatous plaque formed in aorta of AS model rats. Compared with the normal control group, levels of TC, TG, LDL-C, and ox-LDL significantly increased in the model group, but the HDL-C level decreased (P < 0.01). Compared with the model group, levels of TC, TG, LDL-C, and ox-LDL all decreased, but HDL-C increased in low and high dose BYHWD groups, the Simvastatin control group, and the BYHWD prevention group (P < 0.05, P < 0.01). Compared with the low dose BYHWD group, above-mentioned indices were more obviously lowered in the high dose BYHWD group, the Simvastatin control group, and the BYHWD prevention group (P < 0.05). Compared with the normal control group, mRNA expression levels of Rho kinase and NF-κB p65 significantly increased in the model group (P < 0.01). Compared with the model group, mRNA expressions of Rho kinase and NF-κB p65 obviously decreased in low and high dose BYHWD groups, the Simvastatin control group, and the BYHWD prevention group (P < 0.01). Compared with the low dose BYHWD group, the two indicators were more obviously lowered in the high dose BYHWD group, the Simvastatin control group, and the BYHWD prevention group (P < 0.05). But there was no statistical difference in blood lipids levels, mRNA expression levels of Rho kinase or NF-κB p65 among the high dose BYHWD group, the Simvastatin control group, and the BYHWD prevention group (P >0. 05).
CONCLUSIONSBYHWD could down-regulate mRNA expression levels of Rho kinase and NF-κB p65, lower levels of blood lipids, and fight against AS. Suppressing Rho kinase pathway might be one of its mechanisms.
Animals ; Aorta ; Atherosclerosis ; genetics ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Gene Expression ; drug effects ; Lipids ; Lipoproteins, LDL ; NF-kappa B ; metabolism ; RNA, Messenger ; metabolism ; Rats ; Simvastatin ; Transcription Factor RelA ; metabolism ; rho-Associated Kinases ; metabolism
6.Attenuation of airway inflammation by simvastatin and the implications for asthma treatment: is the jury still out?.
Jing Nan LIU ; Dong Hyeon SUH ; Eun Mi YANG ; Seung Ihm LEE ; Hae Sim PARK ; Yoo Seob SHIN
Experimental & Molecular Medicine 2014;46(9):e113-
Although some studies have explained the immunomodulatory effects of statins, the exact mechanisms and the therapeutic significance of these molecules remain to be elucidated. This study not only evaluated the therapeutic potential and inhibitory mechanism of simvastatin in an ovalbumin (OVA)-specific asthma model in mice but also sought to clarify the future directions indicated by previous studies through a thorough review of the literature. BALB/c mice were sensitized to OVA and then administered three OVA challenges. On each challenge day, 40 mg kg-1 simvastatin was injected before the challenge. The airway responsiveness, inflammatory cell composition, and cytokine levels in bronchoalveolar lavage (BAL) fluid were assessed after the final challenge, and the T cell composition and adhesion molecule expression in lung homogenates were determined. The administration of simvastatin decreased the airway responsiveness, the number of airway inflammatory cells, and the interleukin (IL)-4, IL-5 and IL-13 concentrations in BAL fluid compared with vehicle-treated mice (P<0.05). Histologically, the number of inflammatory cells and mucus-containing goblet cells in lung tissues also decreased in the simvastatin-treated mice. Flow cytometry showed that simvastatin treatment significantly reduced the percentage of pulmonary CD4+ cells and the CD4+/CD8+ T-cell ratio (P<0.05). Simvastatin treatment also decreased the expression of the vascular cell adhesion molecule 1 and intercellular adhesion molecule 1 proteins, as measured in homogenized lung tissues (P<0.05) and human epithelial cells. The reduction in the T cell influx as a result of the decreased expression of cell adhesion molecules is one of the mechanisms by which simvastatin attenuates airway responsiveness and allergic inflammation. Rigorous review of the literature together with our findings suggested that simvastatin should be further developed as a potential therapeutic strategy for allergic asthma.
Animals
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Anti-Inflammatory Agents/*therapeutic use
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Asthma/*drug therapy/immunology
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Bronchoalveolar Lavage Fluid/immunology
;
CD4-Positive T-Lymphocytes/drug effects/immunology
;
CD8-Positive T-Lymphocytes/drug effects/immunology
;
Female
;
Humans
;
Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use
;
Inflammation/*drug therapy/immunology
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Interleukins/analysis/immunology
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Lung/*drug effects/immunology
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Mice, Inbred BALB C
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Simvastatin/*therapeutic use
7.Effect of simvastatin on the expression of farnesoid X receptor in diabetic animal models of altered glucose homeostasis.
Lulu WANG ; Xianping HUANG ; Su HU ; Xiaoli MA ; Shaolian WANG ; Shuguang PANG
Chinese Medical Journal 2014;127(2):218-224
BACKGROUNDStatin therapy has affected glucose homoeostasis of type 2 diabetes patients, which could be related with bile acids metabolism. Whether bile acid metabolism and the expression of farnesoid X receptor (FXR), liver X receptor-α (LXR-α) and sterol regulatory element-binding protein (Srebp)-1c is regulated by hyperglycemia, or whether simvastatin therapy led to higher glucose is related with down-regulated expression of FXR in diabetic rats remained unclear.
METHODSForty male Wistar rats were randomly divided into four groups: normal control rats, insulin resistance rats, diabetic model rats, and the late simvastatin induced diabetic rats. Normal control rats were fed with standard diet, others were fed with high-fat diet. Diabetic model rats were induced by a single intraperitoneal injection of streptozotocin (STZ). The late simvastatin induced diabetic rats started simvastatin administration after STZ induced diabetic model rats. Characteristics of fasting blood glucose (FPG), lipid files and total bile acids (TBAs) were measured and the oral glucose tolerance test (OGTT) was performed after overnight fasting at the eighth weekend. RNA and protein levels of FXR, LXR-α and Srebp-1c were tested by Western blotting and reverse transcription polymerase chain reaction (RT-PCR).
RESULTSThe insulin resistance rats showed higher glucose, lipid files and lower expression of FXR compared with normal control rats (P > 0.05). The diabetic model rats showed significantly higher glucose, lipid files, TBA and lower expression of FXR compared with insulin resistance rats (P < 0.05). The late simvastatin induced diabetic rats displayed higher glucose and TBA and lower expression of FXR compared with diabetic model rats (P < 0.05).
CONCLUSIONSChanges in bile acid homeostasis, including the alterations of bile acid levels and bile acid receptors, are either a cause or a consequence of the metabolic disturbances observed during diabetic models. Statin therapy induced hyperglycemia may be related with FXR, SHP, LXR-α and Srebp-1 pathways.
Animals ; Blood Glucose ; drug effects ; metabolism ; Diabetes Mellitus, Experimental ; drug therapy ; metabolism ; Glucose Tolerance Test ; Homeostasis ; drug effects ; Insulin Resistance ; physiology ; Liver X Receptors ; Male ; Orphan Nuclear Receptors ; metabolism ; Rats ; Rats, Wistar ; Receptors, Cytoplasmic and Nuclear ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Simvastatin ; therapeutic use ; Sterol Regulatory Element Binding Protein 1 ; metabolism
8.Anti-hypercholesterolemic effect of Pistacia lentiscus fatty oil in egg yolk-fed rabbits: a comparative study with simvastatin.
Chinese Journal of Natural Medicines (English Ed.) 2014;12(8):561-566
AIM:
The current study was undertaken to assess anti-hyperlipidemic activity of Pistacia lentiscus fatty oil (PLFO) in rabbits following a hyperlipidemic diet.
METHOD:
Twenty healthy female (WNZ) rabbits were divided into four groups of five animals each: (a) normal control (NC group) receiving standard diet, (b) hyperlipidemic control (EY) group receiving standard diet and gavaged daily with egg yolk (10 mL), (c) hyperlipidemic + PLFO (EY + PLFO) group receiving as the EY group and treated daily with PLFO (2 mL/kg BW, (d) hyperlipidemic + simvastatin (EY + SVS) group receiving as the EY group and treated once daily with 2.5 mg/kg BW of simvastatin. At the end of the six-week experimental period, the lipidemic profiles of the different groups were investigated.
RESULTS:
In the EY group, the egg yolk resulted in a significant increase of total cholesterol (TC), triglycerides (TG), HDL-C, LDL-C, and the LDL-C/HDL-C ratio. Both the EY + PLFO and EY + SVS groups, when compared to the EY group, showed a significant decrease of TC, TG, LDL-C, and the LDL-C/HDL-C ratio. However, with respect to HDL-C the differences were not significant. The TGs were significantly lower (P < 0.001) in the simvastatin-treated group when compared to rabbits treated in the PLFO group.
CONCLUSION
The study concludes that P. lentiscus fatty oil (PLFO) possesses anti-hyperlipidemic properties at least in reducing total cholesterol, LDL-cholesterol and triglycerides.
Animals
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Anticholesteremic Agents
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pharmacology
;
therapeutic use
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Cholesterol
;
blood
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Cholesterol, HDL
;
blood
;
Cholesterol, LDL
;
blood
;
Diet
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Egg Yolk
;
Female
;
Fruit
;
Hyperlipidemias
;
blood
;
drug therapy
;
etiology
;
Lipids
;
blood
;
Phytotherapy
;
Pistacia
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Plant Oils
;
pharmacology
;
therapeutic use
;
Rabbits
;
Simvastatin
;
pharmacology
;
therapeutic use
;
Triglycerides
;
blood
9.Doctor, my dentist wants your opinion.
Singapore medical journal 2013;54(1):11-quiz p.14
Dental surgery is very common, and it is important for our dental colleagues to understand the medical history and chronic medications of our co-managed patients. Antibiotic prophylaxis is currently recommended only for patients at high risk for infective endocarditis when undergoing high-risk dental procedures. Good dental hygiene can prevent more infective endocarditis than prophylactic antibiotic therapy, as transient bacteraemia is common in daily activities such as the brushing and flossing of teeth. Most dental surgeries can generally be performed on patients taking a daily dose of aspirin, but the dentist must be able to assess the risk-benefit ratio of employing local measures of haemostasis versus stopping the antiplatelet therapy. Patients on antiplatelet with recent coronary artery stenting should be referred to their primary cardiologist regarding the cessation of these agents before any surgery.
Angioplasty
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Antibiotic Prophylaxis
;
methods
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Aspirin
;
therapeutic use
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Dental Care for Chronically Ill
;
methods
;
Dentists
;
Drug Interactions
;
Endocarditis
;
prevention & control
;
Humans
;
Hyperlipidemias
;
complications
;
Macrolides
;
adverse effects
;
Male
;
Mitral Valve Prolapse
;
complications
;
Myocardial Ischemia
;
complications
;
Platelet Aggregation Inhibitors
;
adverse effects
;
Simvastatin
;
adverse effects
;
Streptococcal Infections
;
prevention & control
;
Tooth Extraction
;
methods
;
Viridans Streptococci
;
metabolism
10.Use of secondary preventive medications in patients with atherosclerotic disease in urban China: a cross-sectional study of 16, 860 patients.
Jing LI ; Yi-ping CHEN ; Xi LI ; Jane ARMITAGE ; Fang FENG ; Jia-min LIU ; Yan GAO ; Hai-bo ZHANG ; Dan ZHANG ; Wuhan-bilige HUNDEI ; Zheng-ming CHEN ; Fang CHEN ; Jemma C HOPEWELL ; Elsa VALDES-MARQUEZ ; Martin LANDRAY ; Li-xin JIANG ; null
Chinese Medical Journal 2012;125(24):4361-4367
BACKGROUNDDespite considerable improvements in the care of patients with cardiovascular disease in various populations over the last few decades, there are still limited data about long-term treatment patterns among patients with various atherosclerotic vascular conditions in China, especially the use of statin therapy.
METHODSBetween June 2007 and October 2009, 16 860 patients aged 50 - 80 years with established history of atherosclerotic vascular disease (coronary heart disease (CHD), atherosclerotic cerebrovascular disease (CVD), or peripheral arterial disease (PAD)) from 51 hospitals in 14 cities of China were screened for a large randomized trial. Detailed information about current use of statins and various other treatments was recorded and analyzed by prior disease history, adjusting for various baseline characteristics.
RESULTSAmong the 16 860 patients, the mean age was 63 years and 74% were male. Overall, 78% of the patients had documented CHD, 40% had CVD, 5% had PAD and 21% reported more than one condition. The median time from initial diagnosis of vascular disease to screening was 18 months. At screening, the proportions who took various treatments were 83% for antiplatelet agents, 49% for beta-blockers, 47% for statins and 28% for angiotensin-converting enzyme inhibitors. The proportion treated with statin was much higher in CHD than in CVD or PAD patients (61% vs. 10% vs. 22% respectively) and decreased significantly with time from initial diagnosis. Simvastatin (mainly 20 mg) and atorvastatin (mainly 10 mg) each accounted for about 40% of total statin use.
CONCLUSIONSIn urban China, there is still significant underuse of various proven secondary preventive therapies, with particularly low use of statins in patients with ischaemic stroke.
Aged ; Aged, 80 and over ; Atherosclerosis ; drug therapy ; Atorvastatin Calcium ; Cerebrovascular Disorders ; drug therapy ; Coronary Artery Disease ; drug therapy ; Cross-Sectional Studies ; Female ; Heptanoic Acids ; therapeutic use ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; therapeutic use ; Male ; Middle Aged ; Peripheral Vascular Diseases ; drug therapy ; Pyrroles ; therapeutic use ; Secondary Prevention ; methods ; Simvastatin ; therapeutic use

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