E. Iraculis et al., Improvement of endothelial function in patients with hypercholesterolemia and normal coronary arteries with lipid-lowering therapy, REV ESP CAR, 54(6), 2001, pp. 685-692
Introduction and aims. In patients with coronary risk factors the presence
of endothelial dysfunction in epicardial arteries has been documented. The
purpose of this study was to determine whether endothelial dysfunction, doc
umented hypercholesterolemic patients and angiographycally normal coronary
arteries, improves by reduction and normalization of lipid levels.
Patients and method. In 10 patients with hypercholesterolemia and normal co
ronary angiography, the endothelium-dependent coronary vasomotion was studi
ed by intracoronary infusion of acetylcholine into the left anterior descen
ding coronary artery. Vasomotion changes in response to acetylcholine were
analized by quantitative angigraphy. Five patients without coronary risk fa
ctors and normal coronary arteries formed the control group. Patients with
hypercholesterolemia were treated with lipid-lowering therapy (diet and lov
astatin) and endothelial function was reevaluated after 24 +/- 4 months.
Results. In the initial study, hypercholesterolemic patients compared with
the control group showed a vasocontrictor response to serial doses of acety
lcholine (10(-6) M, 10(-5) M, 10(-4) M) indicative of endothelial dysfuncti
on (study group: -0.3 +/- 10%, -6 +/- 4%, -18 +/- 10% vs control group: -0.
6 +/- 6%, -2 +/- 6%, 3 +/- 6%; p < 0.01 to 10(-4) M acetylcholine dose). Du
ring follow-up hypercholesterolemic patients showed a significant reduction
in total cholesterol levels and LDL. Compared to first study, at follow-up
, there was an improvement in the response to acetylcholine (-0.4 +/- 4%, -
3 +/- 6%, -3 +/- 10%; p < 0.001 vs basal values at 10-4 M acetylcholine con
centration). Reduction in total cholesterol during follow-up was related to
the improvement in the vasoconstrictor response to acetylcholine (r = 0.53
; p < 0.05).
Conclusion. In patients with hypercholesterolemia and angiographycally norm
al coronary arteries with documentated endothelial dysfunction, the reducti
on and normalization of lipid levels during follow-up may improve endotheli
um-dependent coronary vasomotion.