Effect of cholesterol lowering treatment on positive exercise tests in patients with hypercholesterolaemia and normal coronary angiograms

Aim-To assess the impact of cholesterol lowering on positive exercise stres s tests in hypercholesterolaemic patients with normal coronary angiograms. Methods-43 non-diabetic patients aged 43-61 years, with total serum cholest erol concentrations of more than 7.75 mmol/l, positive exercise tests, and normal coronary angiograms, were started on the American Heart Association step 1 diet. After 12 weeks these patients were randomly assigned to treatm ent for another 16 weeks with the diet alone (diet,group, n = 20) or with t he diet plus lovastatin or simvastatin (statin group, n = 23). After this 2 8 week run in period, statins were withdrawn and lipid profile tests and ex ercise tests were done and repeated 20 weeks later. Results-At week 28, the statin group but not the diet group had significant reductions from baseline (week 12) in plasma total cholesterol (p < 0.0001 ), low density lipoprotein (p < 0.0001), and triglyceride (p < 0.0001). The number of patients with positive exercise tests decreased from 23 to three in the statin group and from 20 to 15 in the diet group (p = 0.01). After the final 20 weeks without statins, Lipid profiles returned to baseline lev els in all 17 patients remaining in the statin group, and exercise tests we re again positive in 15 of these patients. Conclusions-In hypercholesterolaemic patients with normal coronary arteries , cholesterol lowering treatment reduces myocardial ischaemia, as shown by the beneficial effects on exercise testing.