Document Detail


Cholesterol lowering with statins reduces exercise-induced myocardial ischemia in hypercholesterolemic patients with coronary artery disease.
MedLine Citation:
PMID:  11703958     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Coronary flow reserve is mainly influenced by the combination of luminal stenosis and vascular dilation capacity. Thus, after statin treatment, the reduction of ischemic threshold in patients submitted to exercise testing could be intensely influenced by angiographic severity. In this study, we verify the effect of statin treatment on exercise-induced myocardial ischemia in hypercholesterolemic patients with a broad range of coronary angiographic severities. Patients with 2 consecutive positive exercise tests, coronary stenosis > or =70%, total cholesterol > or =300 mg/dl, and triglycerides < or =200 mg/dl were randomly assigned to a 16-week treatment period with either diet alone (n = 39) or diet plus statins (simavastatin, n = 31 and pravastatin, n = 10). Statin-treated 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 diet-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 the statin group had a positive test (p <0.01). The proportion of positive tests was significantly reduced in subgroups of patients with 1-, 2-, or 3-vessel disease. Regarding the severity of coronary stenosis, the proportion of positive tests was significantly reduced in patients with stenosis between 70% and 90% and in patients with stenosis > or =90%. Moreover, the proportion of positive tests tended to decrease to a greater extent in patients with mild coronary disease. In conclusion, cholesterol-lowering treatment with statins reduces exercise-induced myocardial ischemia in hypercholesterolemic patients with mild or severe epicardial coronary stenosis.
Authors:
J A Ramires; A C Sposito; A P Mansur; O R Coelho; M Maranhão; L A Cesar
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The American journal of cardiology     Volume:  88     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2001-11-12     Completed Date:  2001-12-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1134-8     Citation Subset:  AIM; IM    
Affiliation:
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. jramires@incor.usp.be
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anticholesteremic Agents / therapeutic use*
Coronary Angiography
Coronary Disease / classification,  complications*
Exercise Test*
Female
Humans
Hypercholesterolemia / complications*,  diet therapy,  drug therapy
Male
Middle Aged
Myocardial Ischemia / etiology,  prevention & control*
Pravastatin / therapeutic use*
Simvastatin / therapeutic use*
Chemical
Reg. No./Substance:
0/Anticholesteremic Agents; 79902-63-9/Simvastatin; 81093-37-0/Pravastatin

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