Beneficial effects of atorvastatin on myocardial regions with initially low vasodilatory capacity at various stages of coronary artery disease

  • Peter Wielepp
  • Detlev Baller
  • Ulrich Gleichmann
  • Ewa Pulawski
  • Dieter Horstkotte
  • Wolfgang Burchert
Original Article

Abstract

Purpose

The aim of this study was to analyse non-invasively the regional effect of therapy with an HMG-CoA reductase inhibitor on myocardial blood flow in patients with coronary artery disease (CAD) with special reference to segments with initially substantially impaired vasodilation.

Methods

The study included 26 patients with untreated hypercholesterolaemia. Coronary angiography revealed CAD in nine patients with stenosis >50% and wall irregularities or minimal stenosis <30% in 17 patients. Before and 4.6±1.8 months after atorvastatin therapy, 13N-ammonia positron emission tomography (PET) studies were performed at rest and under pharmacological stress. Minimum coronary vascular resistance (MCR) and coronary flow reserve (CFR) were determined. Segments were divided into those with normal or near-normal (MBF during adenosine ≥2.0 ml/min/g) and those with abnormal (MBF<2.0 ml/min/g) vasodilator flow response. In CAD patients, 156 segments were analysed, 85 of which had abnormal MBF; in the non-obstructive group, 59 of 297 segments had abnormal MBF.

Results

LDL cholesterol decreased after atorvastatin therapy from 186±43 mg/dl to 101±26 mg/dl (p<0.001). In normal segments no significant changes in MBF, CFR and MCR were found. However, initially abnormal segments showed significant improvements in MCR (15%, p<0.0001) and MBF during adenosine (30%, p<0.0001) after therapy.

Conclusion

The improvement in regional coronary vasodilator function after atorvastatin in patients with coronary atherosclerosis may be caused, at least in part, by increased flow-mediated (endothelium-dependent) dilation of the total arteriolar and arterial vascular system. These data further support the concept of non-invasive management of stable CAD by statin therapy and life-style modification guided by PET.

Keywords

Coronary artery disease Hypercholesterolaemia Atherosclerosis Lipid-lowering drugs Positron emission tomography 

Notes

Acknowledgements

The authors thank the members of the radiopharmacy unit for preparation of the PET tracer. Furthermore, we thank the technical assistants of the PET group for their excellent collaboration. The study was supported in part by a national research grant from the E.B. Grimmke Heart Foundation, Düsseldorf, Germany, and in part by an unrestricted scientific grant from Pfizer.

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Peter Wielepp
    • 1
    • 3
  • Detlev Baller
    • 2
    • 3
  • Ulrich Gleichmann
    • 2
  • Ewa Pulawski
    • 2
  • Dieter Horstkotte
    • 2
  • Wolfgang Burchert
    • 1
  1. 1.Institute of Molecular Biophysics, Radiopharmacy and Nuclear MedicineaRuhr-University BochumBad OeynhausenGermany
  2. 2.Department of Cardiology, Heart and Diabetes Center North Rhine-WestphaliaRuhr-University BochumBad OeynhausenGermany
  3. 3.Heart and Diabetes Center North Rhine-WestphaliaBad OeynhausenGermany

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