Pravastatin improves cerebral vasomotor reactivity in patients with subcortical small-vessel disease.
OBJECTIVE
Recent investigations have suggested an important role of statins in the prevention of stroke and dementia independent of their lipid-lowering properties. Using transcranial Doppler sonography (TCD), we examined acetazolamide reactivity as a marker of cerebral vasoreactivity in patients with subcortical small-vessel disease before and after pravastatin treatment.


METHODS
In 16 patients (mean age 68+/-10 years) with subcortical small-vessel disease, cerebral vasomotor reactivity was tested using TCD insonating the middle cerebral artery. Cerebral blood flow velocity (CBFV) increase after bolus injection of 1 g acetazolamide was determined before and after 2-month treatment with pravastatin sodium 20 mg daily.


RESULTS
Relative CBFV increase was significantly greater after pravastatin treatment (41.9+/-23.7% versus 55.7+/-18.3%, P=0.004). Comparison of CBFV at rest before and after treatment with pravastatin did not show significant differences. There was a strong negative correlation between the pravastatin-induced enhancement of vasomotor reactivity and the pretreatment CBFV increase (beta=-0.64, P=0.019). No associations were found between the effect of pravastatin on vasomotor reactivity and pretreatment levels or changes of LDL cholesterol.


CONCLUSIONS
This pilot study provides the first evidence for a significant improvement of cerebral vasomotor reactivity by statin therapy in patients with cerebral small-vessel disease. The results may help to elucidate the preventive effect of statins and provide insights into the pathophysiology of cerebral small-vessel disease.
Sterzer
P
P
Department of Neurology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. sterzer@em.uni-frankfurt.de
Meintzschel
F
F
Rösler
A
A
Lanfermann
H
H
Steinmetz
H
H
Sitzer
M
M
D000086:Acetazolamide; D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D015140:Dementia, Vascular / Q000188:drug therapy* / Q000503:physiopathology; D004827:Epilepsy / Q000175:diagnosis / Q000209:etiology; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D010865:Pilot Projects; D017035:Pravastatin / Q000627:therapeutic use*; D011446:Prospective Studies; D013382:Subtraction Technique; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D014666:Vasomotor System / Q000187:drug effects* / Q000503:physiopathology
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017035:Pravastatin; D000086:Acetazolamide