title: Fluvastatin attenuates nitrate tolerance in patients with ischemic heart disease complicating hypercholesterolemia.
abstract: BACKGROUND
  Long-term administration of nitrates results in the development of tolerance. Nitrate tolerance is considered to occur in association with oxidative stress, although its underlying mechanisms are multi-factorial. Fluvastatin, a newly developed statin, is considered to have not only a cholesterol-lowering effect but also anti-oxidative properties.
  
  
  METHODS
  In this study, the effect of fluvastatin on nitrate tolerance was investigated in 12 dyslipidemic patients (nine men and three women, aged 63.5+/-6.7 years), who were complicated with ischemic heart disease and had received organic nitrates for a long period.
  
  
  RESULTS
  Four months after fluvastatin therapy, symptoms of angina were significantly reduced. Consumption of sublingual nitrates over 2 weeks significantly decreased (14.4+/-11.2 to 2.3+/-2.5 tablets, P<0.01). In exercise stress testing, exercise duration was significantly prolonged (275+/-73 to 360+/-86 s, P<0.01) and the blood pressure-heart rate products significantly increased (16368+/-2246 to 18381+/-1772, P<0.01). Both the percent change in forearm blood flow with reactive hyperemia (232+/-83 to 282+/-104%, P<0.05) and that after sublingual nitroglycerine (2.5+/-4.7 to 5.8+/-4.7%, P<0.05) were increased. Although the levels of total cholesterol, triglyceride, HDL-cholesterol, and LDL-cholesterol were unchanged, the serum anti-Ox-LDL titer (16.7+/-6.3 to 13.4+/-5.4 AcU/ml, P<0.05) and 8-OHdG level (1.11+/-0.34 to 0.73+/-0.34 ng/ml, P<0.05) decreased.
  
  
  CONCLUSIONS
  Fluvastatin attenuated nitrate tolerance in dyslipidemic patients complicated with ischemic heart disease who had been receiving organic nitrates over long period. The anti-oxidative effect of fluvastatin may attenuate nitrate tolerance.
authors.affiliation: Department of Cardiology, Koshigaya Hospital, Dokkyo University School of Medicine, 2-1-50 Minamikoshigaya, Saitama Koshigaya City 343-8555, Japan. inouet@dokkyomed.ac.jp
authors.forename: Teruo
authors.initials: T
authors.lastname: Inoue
authors.forename: Kan
authors.initials: K
authors.lastname: Takayanagi
authors.forename: Terumi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Shigenori
authors.initials: S
authors.lastname: Morooka
mesh_terms: D000924:Anticholesteremic Agents / Q000494:pharmacology*; D001783:Blood Flow Velocity / Q000187:drug effects; D004361:Drug Tolerance; D005080:Exercise Test; D005229:Fatty Acids, Monounsaturated / Q000494:pharmacology*; D005260:Female; D000077340:Fluvastatin; D005542:Forearm / Q000098:blood supply; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy*; D007211:Indoles / Q000494:pharmacology*; D008077:Lipoproteins, LDL / Q000097:blood / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000188:drug therapy*; D009566:Nitrates / Q000494:pharmacology*; D010991:Plethysmography
chemical_list: D000924:Anticholesteremic Agents; D005229:Fatty Acids, Monounsaturated; D007211:Indoles; D008077:Lipoproteins, LDL; D009566:Nitrates; C099252:oxidized low density lipoprotein; D000077340:Fluvastatin