Cholesterol lowering with statins reduces exercise-induced myocardial ischemia in hypercholesterolemic patients with coronary artery disease

Coronary flow reserve is mainly influenced by the combination of luminal st enosis and vascular dilation capacity. Thus, after statin treatment, the re duction of ischemic threshold in patients submitted to exercise testing cou ld be intensely influenced by angiographic; severity. In this study, we ver ify the effect of statin treatment on exercise-induced myocardial ischemia in hypercholesterolemic patients with a broad range of coronary angiographi c severities. Patients with 2 consecutive positive exercise tests, coronary stenosis greater than or equal to 70%, total cholesterol greater than or e qual to 300 mg/dl, and triglycerides less than or equal to 200 mg/dl were r andomly assigned to a 16-week treatment period with either diet alone (n=39 ) or diet plus statins (simovastatin, n=31 and pravastatin, n=10). Statin-t reated patients had a significant variation in total cholesterol (-46% vs - 2.7%; p<0.01), low-density lipoprotein cholesterol (-58% vs 0.8%; p<0.01), and high-density cholesterol (+28% vs -6%; p<0.05) in comparison with the d iet-only group. After 16 weeks of treatment, 36 patients (92%) in the diet group still had positive exercise tests, whereas only 7 patients (15%) of t he statin group had a positive test (p<0.01). The proportion of positive te sts was significantly reduced in subgroups of patients with 1-, 2-, or 3-ve ssel disease. Regarding the severity of coronary stenosis, the proportion o f positive tests was significantly reduced in patients with stenosis betwee n 70% and 90% and in patients with stenosis greater than or equal to 90%. M oreover, the proportion of positive tests tended to decrease to a greater e xtent in patients with mild coronary disease. In conclusion, cholesterol-lo wering treatment with statins reduces exercise-induced myocardial ischemia in hypercholesterolemic patients with mild or severe epicardial coronary st enosis. (C) 2001 by Excerpta Medica, Inc.