Impaired myocardial vasodilatation during hyperaemic stress is improved by simvastatin but not by pravastatin in patients with hypercholesterolaemia.
OBJECTIVE
Impaired myocardial vasodilatation during hyperaemic stress with dipyridamole has been documented in hypercholesterolaemics without evidence of ischaemia. This study investigated whether two commonly used hydroxymethylglutaryl coenzyme A reductase inhibitors, simvastatin and pravastatin, are equally effective in restoring myocardial vasodilatation.


RESULTS
Forty-four hypercholesterolaemics with a low probability of coronary artery disease and 22 controls were studied. Before and after lipid-lowering therapy with simvastatin (n = 22) or pravastatin (n = 22), myocardial blood flow at rest and during dipyridamole loading was measured using positron emission tomography with [(13)N]ammonia, and myocardial vasodilatation was assessed. Treatments with simvastatin and pravastatin similarly reduced plasma total cholesterol and plasma low-density lipoprotein cholesterol. Resting myocardial blood flow was comparable in the controls, simvastatin group, and pravastatin group and unchanged after therapy. Myocardial blood flow during dipyridamole loading and myocardial vasodilatation was lower in the two therapy groups before treatment than in the controls. These parameters improved significantly after therapy with simvastatin, whereas no improvement was observed after pravastatin therapy. The per cent change in myocardial vasodilatation after simvastatin therapy was significantly and inversely correlated with per cent changes in plasma lipid fractions.


CONCLUSIONS
Diminished myocardial vasodilatation in hypercholesterolaemics is improved by simvastatin but not by pravastatin, suggesting differences in vascular effects among statins.
Yokoyama
Ikuo
I
Department of Radiology, Institute of Medical Science, University of Tokyo, Tokyo, Japan. yokochan-tky@umin.ac.jp
Inoue
Yusuke
Y
Moritan
Toshiyuki
T
Ohtomo
Kuni
K
Nagai
Ryozo
R
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D003331:Coronary Vessels / Q000187:drug effects*; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000503:physiopathology; D006940:Hyperemia / Q000188:drug therapy* / Q000503:physiopathology; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D009206:Myocardium; D017035:Pravastatin / Q000627:therapeutic use*; D019821:Simvastatin / Q000627:therapeutic use*; D013312:Stress, Physiological / Q000188:drug therapy*; D014055:Tomography, Emission-Computed; D014664:Vasodilation / Q000187:drug effects*
D000924:Anticholesteremic Agents; D000960:Hypolipidemic Agents; D019821:Simvastatin; D017035:Pravastatin