Combination of Fosinopril and Pravastatin Decreases Platelet Response to Thrombin Receptor Agonist in Monkeys

From the Department of Medicine, Wake Forest University School of Medicine (L.P.H., K.T.C.), and the Department of Pathology, Wake Forest University Baptist Medical Center (A.M.B.), Winston-Salem, NC; Clinical Pathology Consultants, Conway, SC (M.V.S.); and the Departments of Public Health Sciences (L.D.C.) and Medicine (J.O.), Wake Forest University School of Medicine, Winston-Salem, NC.

Correspondence to L. Paulette Hale, MD, Hematology/Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, First Floor, Watlington Hall, Winston-Salem, NC 27157. E-mail phaleobi{at}earthlink.net

Abstract—Both angiotensin-converting enzyme (ACE) inhibitors and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors have been shown to decrease cardiovascular morbidity and mortality. Results from clinical trials have suggested that HMG-CoA reductase inhibition might exert a beneficial effect independent of its lipid-lowering effect, and ACE inhibition may exert a benefit independent of blood-pressure lowering. To test the hypothesis that such an effect might be mediated by alteration in platelet reactivity, we studied 55 monkeys receiving both, 1, or neither of the ACE inhibitor fosinopril and the HMG-CoA reductase inhibitor pravastatin. Platelet responsiveness to collagen and to the thrombin receptor agonist (TRA) SFLRRN-NH₂ was determined by aggregometry. For each agonist, the maximum rate and extent of aggregation were measured for each dose, and the concentration required for half-maximal response (C₅₀) was determined. Each drug, when given alone, slightly decreased the dose of agonist required to produce 50% response in the rate and extent of platelet aggregation relative to control. The combination of the 2 drugs, however, produced a significant increase in the dose of TRA required to produce 50% response in the rate and extent of aggregation relative to either drug alone or the control group. This was not true for collagen. The magnitude of the change relative to the control group, 47% for rate and 30% for extent of aggregation, could confer considerable protection by changing the threshold for thrombin-induced platelet aggregation and, thus, decrease thrombosis.

Key Words: angiotensin-converting enzyme inhibitors • platelet aggregation • 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors

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