title: Prophylactic statins as a possible method to decrease bubble formation in diving.
abstract: BACKGROUND
  Nitric oxide (NO) may decrease bubble formation in diving. Statin medications are attractive potential options to increase NO. Statins exhibit a proven safety profile, and possess a myriad of pleiotropic properties improving vascular endothelial function. Additionally, statin-mediated lipid reduction may reduce bubble generation via alterations in plasma surface tension. We investigated the efficacy of atorvastatin as a pharmacological intervention to reduce the risk of bubble formation after diving, a surrogate for decompression sickness (DCS).
  
  
  METHODS
  There were 16 trained military divers who completed a provacative hyperbaric chamber dive protocol after taking either 80-mg of atorvastatin or placebo for 4 d. Subjects completed the alternate medication regimen no sooner than 2 wk. After each dive, subjects were subjected to precordial trans-thoracic echocardiographic exams via standardized protocols. Bubbles were graded via a non-parametric, ordinal grading system and statistically analyzed via Wilcoxon signed-rank tests.
  
  
  RESULTS
  We found no within subject differences for the maximum bubble grade scores (z = 0.00, p = 1.00, n=16). Low-density lipoprotein (LDL), and total cholesterol (TC) levels decreased significantly (107.6 +/- 26.2 to 79.3 +/- 21.9 mg x dl(-1) and 175 +/- 20.9 to 147 +/- 22.4 mg x dl(-1), respectively) 1-2 wk post statin administration. Age, bioelectrical impedance (BEI), TC, LDL, potassium, and calcium demonstrated positive correlations to placebo bubble grades.
  
  
  CONCLUSIONS
  Prophylactic 80-mg atorvastatin administration for 4 d failed to reduce the number of intravascular bubbles observed following a 60-ft, 80-min dry chamber dive despite significant acute reductions in lipid levels. Several hypotheses may explain why statins failed to decrease bubble volume: (1) differential influence of statins on the venous vs. arterial vasculature; (2) failure to elicit an improvement in endothelial function and, therefore, the hypothesized endothelial conditioning in younger patients possessing normal baseline; and (3) the ordinal grading system encompassing a substantial variation in bubble volume (bubbles Scm(-2)).
authors.affiliation: Naval Submarine Medical Research Laboratory, Groton, CT 06349-5900, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Duplessis
authors.forename: David
authors.initials: D
authors.lastname: Fothergill
authors.forename: Derek
authors.initials: D
authors.lastname: Schwaller
authors.forename: Linda
authors.initials: L
authors.lastname: Hughes
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gertner
mesh_terms: D000328:Adult; D000069059:Atorvastatin; D018890:Chemoprevention; D003665:Decompression Sickness / Q000517:prevention & control*; D004242:Diving / Q000009:adverse effects*; D006538:Heptanoic Acids / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000096:biosynthesis*; D011758:Pyrroles / Q000494:pharmacology / Q000627:therapeutic use*; D013501:Surface-Active Agents
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D013501:Surface-Active Agents; D009569:Nitric Oxide; D000069059:Atorvastatin