Effect of fluvastatin on endothelium-dependent brachial artery vasodilation in patients after renal transplantation

Background Hypercholesterolemia may affect both endothelial function and ar terial distensibility (DC). Renal transplant recipients (NTX) exhibit advan ced structural and functional alterations of arterial vessel walls. The aim of this double-blind, randomized trial was to evaluate the effects of fluv astatin (FLU) on brachial artery flow-mediated vasodilation (FMD) and DC in hypercholesterolemic NTX. Methods. Eighteen NTX received FLU 40 mg/day and 18 NTX placebo (PLA). Befo re and after six months of treatment, the brachial artery diameter and DC a t rest were measured by a Doppler frequency analysis in the M mode, and the n changes in diameter during reactive hyperemia (to assess endothelial-depe ndent FMD) and after 400 mug sublingual nitroglycerin (to assess endotheliu m-independent vasodilation-NMD). Results. FLU, but not PLA, treatment resulted in significant decreases in t otal (from 288 +/- 10 to 239 +/- 8 mg/dL, P < 0.05) and low-density lipopro tein cholesterol (from 182 <plus/minus> 779 to 138 +/- 8 mg/dL, P < 0.05). Blood pressure did not differ between FLU- and PLA-treated patients and was not affected by either treatment. Also, the brachial artery baseline diame ter was not different between groups and was not affected by FLU or PLA. Br achial artery how at rest and during reactive hyperemia as measured by puls ed Doppler did not differ between groups. Brachial artery FMD increased wit h FLU from 0.23 <plus/minus> 0.08 to 0.54 +/- 0.08 mm (P < 0.05), whereas P LA did not alter FMD (0.22 <plus/minus> 0.07 vs. 0.14 +/-: 0.05 mm at basel ine and after six months of PLA treatment, respectively, P = NS). In contra st, NMD did not change significantly with either treatment (0.76 +/- 0.13 v s. 0.83 +/- 0.15 mm at baseline and after 6 months of FLU treatment, respec tively, P = NS, and 0.64 +/- 0.09 vs. 0.66 +/- 0.10 mm at baseline and afte r 6 months of PLA treatment, respectively, P = NS). Also, brachial artery D C was not altered by FLU (6.4 +/- 1.0 vs. 5.8 +/- +/- 0.6 x 10(-3)/kPa, P = NS) or PLA treatment (5.8 +/- 0.6 vs. 6.8 +/- 0.8 x 10(-3)/kPa, P = NS). Conclusions. In hypercholesterolemic NTX, the HMG-CoA reductase inhibitor F LU significantly improves brachial artery FMD as a measure of endothelial f unction after six months of treatment. In contrast, FLU does not have a ben eficial effect on brachial artery DC.