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Effect of Aggressive lipid-lowering treatment with Rosuvastatin on vascular endoTHelium function: evaluation of vascular endothelium function (EARTH study)

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Abstract

Vascular endothelial dysfunction plays an important role in the process of atherosclerosis up to the final stage of plaque rupture. Vascular endothelial dysfunction is reversible, and can be recovered by medications and life-style changes. Improvement in endothelial function may reduce cardiovascular events and improve long-term prognosis. A total of 50 patients with stable angina and dyslipidemia were enrolled, including patients who had not received prior treatment with statins and had serum LDL-C levels ≥ 100 mg/dL, and patients who had previously received statin treatment. All agreed to register regardless of their LDL-C level. Rosuvastatin was initially administered at a dose of 2.5 mg and appropriately titrated up to the maximum dose of 20 mg or until LDL-C levels lower than 80 mg/dL were achieved, for 24 weeks. Endothelial function was assessed by the reactive hyperemia peripheral arterial tonometry (RH-PAT) index in the radial artery by Endo-PAT® 2000 (Endo-PAT®2000, software version 3.0.4, Itamar Medical Ltd., Caesarea, Israel). RH-PAT data were digitally analyzed online by Endo-PAT®2000 at baseline and at 24 weeks. LDL-C and MDA-LDL-C decreased from 112.6 ± 23.3 to 85.5 ± 20.2 mg/dL and from 135.1 ± 36.4 to 113.9 ± 23.5 mg/dL respectively (p < 0.0001). However, HDL-C, hs-CRP and TG did not change significantly after treatment. RH-PAT index levels significantly improved, from 1.60 ± 0.31 to 1.77 ± 0.57 (p = 0.04) after treatment, and the percent change of the RH-PAT index was 12.8 ± 36.9%. Results of multivariate analysis show that serum LDL-C levels over 24 weeks did not act as a predictor of improvement of the RH-PAT index. However, HbA1c at baseline was an independent predictor which influenced the 24-week RH-PAT index level. The RH-PAT index of patients with high HbA1c at baseline did not improve after administration of rosuvastatin but it did improve in patients with low HbA1c at baseline. Aggressive lowering of LDL-C with rosuvastatin significantly improved the RH-PAT index, suggesting that it may improve endothelial function in patients with coronary artery disease.

Clinical Trial Registration No: UMIN-CTR, UMIN000010040.

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Acknowledgements

In order to submit this paper, we received support from Shionogi & Co. Ltd. in the form of grammar correction.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan

    Tadateru Takayama, Takafumi Hiro, Shunichi Yoda, Daisuke Fukamachi, Hironori Haruta, Takaaki Kogo, Takashi Mineki, Hironobu Murata, Toru Oshima & Atsushi Hirayama

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  1. Tadateru Takayama
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  2. Takafumi Hiro
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  3. Shunichi Yoda
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  6. Takaaki Kogo
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  10. Atsushi Hirayama
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Correspondence to Tadateru Takayama.

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Conflict of interest

The authors have received honoraria for speeches, lectures and consultations from AstraZeneca K.K., Shionogi & Co. Ltd., Bayer Co. Ltd., Astellas Pharma Inc., Pfizer Japan. Inc., Kowa Company Ltd., and Daiichi Sankyo Co. Ltd., all of which sell statins in Japan.

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Takayama, T., Hiro, T., Yoda, S. et al. Effect of Aggressive lipid-lowering treatment with Rosuvastatin on vascular endoTHelium function: evaluation of vascular endothelium function (EARTH study). Heart Vessels 33, 590–594 (2018). https://doi.org/10.1007/s00380-017-1094-0

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