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Volume 332:481-487 February 23, 1995 Number 8 Next

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ABSTRACT

Background Impaired endothelium-mediated relaxation contributes to vasospasm and myocardial ischemia in patients with coronary artery disease. We hypothesized that cholesterol-lowering therapy with the 3-hydroxy-3-methylglutaryl–coenzyme A reductase inhibitor lovastatin could improve endothelium-mediated responses in patients with coronary atherosclerosis.

Methods In a randomized, double-blind, placebo-controlled trial, we studied coronary endothelial responses in 23 patients randomly assigned to either lovastatin (40 mg twice daily; 11 patients) or placebo (12 patients) plus a lipid-lowering diet (American Heart Association Step 1 diet). Patients were studied 12 days after randomization and again at 51/2 months. These patients had total cholesterol levels ranging from 160 to 300 mg per deciliter (4.1 to 7.8 mmol per liter) and were undergoing coronary angioplasty. At the initial and follow-up studies, patients received serial intracoronary infusions (in a coronary artery not undergoing angioplasty) of acetylcholine to assess endothelium-mediated vasodilatation. The responses of the coronary vessels were analyzed with quantitative angiography.

Results The patients in the placebo and lovastatin groups had similar responses to acetylcholine at a mean of 12 days of therapy (expressed as the percentage of change in diameter in response to acetylcholine doses of 10-⁹ M, 10-⁸ M, 10-⁷ M, and 10-⁶ M). In the placebo group, the respective mean (±SE) changes were 1±2, 0±2, -2±4, and -19±4 percent; in the lovastatin group, they were -2±2, -4±4, -12±5, and -16±7 percent (P =0.32). (coronary-artery constriction is reflected by negative numbers.) The responses to acetylcholine in the placebo group after a mean of 5.5 months of therapy were -3±3, -1±2, -8±4, and -18±5 percent, respectively; there was significant improvement in the lovastatin group, which had responses of 3±3, 3±3, 0±2, and 0±3 percent (P = 0.004).

Conclusions Cholesterol lowering with lovastatin significantly improved endothelium-mediated responses in the coronary arteries of patients with atherosclerosis. Such improvement in the local regulation of coronary arterial tone could potentially relieve ischemic symptoms and signal the stabilization of the atherosclerotic plaque.

Source Information

From the Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta (C.B.T., J.L.K., W.S.W., J.Z., R.W.A.); the Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, Ky. (J.D.T.); the Division of Cardiology, Medical Center of Delaware, Newark (M.E.S.); the Division of Biostatistics, School of Public Health, Emory University, Atlanta (A.S.K.); Merck Research Laboratories, Rahway, N.J. (S.J.B.); and the Division of Cardiology, Sanger Clinic, Charlotte, N.C. (J.C.C.).

Address reprint requests to Dr. Treasure at P.O. Drawer LL, Emory University, Atlanta, GA 30322.

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