REDUCTION IN SERUM-CHOLESTEROL WITH PRAVASTATIN IMPROVES ENDOTHELIUM-DEPENDENT CORONARY VASOMOTION IN PATIENTS WITH HYPERCHOLESTEROLEMIA

Background This study aimed to determine if cholesterol-lowering thera py improves endothelium-dependent coronary vasomotion in patients with hypercholesterolemia. Methods and Results Nine patients with hypercho lesterolemia were studied before and after cholesterol-lowering therap y with pravastatin (an inhibitor of HMG-CoA reductase) for 6+/-3 month s, which lowered serum cholesterol from 272+/-8 to 187+/-16 mg/dL (P<. 01). Control patients with serum cholesterol of 218+/-23 mg/dL also we re studied twice in a similar interval (8+/-2 months) with no choleste rol-lowering drugs. Acetylcholine (the endothelium-dependent vasodilat or) and papaverine and nitrate (endothelium-independent vasodilators) were infused into the study coronary artery. Changes in the diameter o f the epicardial coronary artery and coronary blood flow were assessed by quantitative coronary arteriography and an intracoronary Doppler c atheter. In patients with hypercholesterolemia, acetylcholine-induced vasoconstriction of the epicardial artery was less (P<.05) and the ace tylcholine-induced increases in coronary blood flow were greater (P<.0 01) after than before pravastatin. In control patients, responses of t he epicardial coronary artery and coronary blood flow to acetylcholine did not change over the follow-up period. The vasomotor responses to papaverine or nitrate were similar between the two groups, and no inte rval changes in their responses were noted in either group. Conclusion s These results suggest that cholesterol-lowering therapy with pravast atin may improve endothelium-dependent coronary vasomotion, which may possibly contribute to the improvement of myocardial perfusion as well as the regression of coronary atherosclerosis.