title: Effects of a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, fluvastatin, on coronary spasm after withdrawal of calcium-channel blockers.
abstract: OBJECTIVE
  The purpose of this study was to determine whether a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) suppresses coronary spasm.
  
  
  BACKGROUND
  Coronary spasm is associated with endothelial dysfunction. Statins have been shown to improve endothelial function.
  
  
  METHODS
  This was a prospective, randomized, open-label, end point study. Sixty-four patients who had no significant organic coronary stenosis and in whom coronary spasm was induced by intracoronary injection of acetylcholine (ACh) were randomly assigned to fluvastatin 30 mg/day plus the conventional calcium-channel blocker (CCB) therapy (31 patients, statin group) or the conventional CCB therapy (33 patients, nonstatin group). After 6 months of treatment, the intracoronary injection of ACh was repeated and the coronary spasm was assessed.
  
  
  RESULTS
  Coronary spasm was suppressed in 16 of the 31 patients (51.5%, p < 0.0001) of the statin group and in 7 of the 33 patients (21.2%, p = 0.0110) of the nonstatin group after 6 months of treatment. Thus, the number of patients with ACh-induced coronary spasm was significantly reduced in the statin group as compared with the nonstatin group (51.6% vs. 21.2%, p = 0.0231) after 6 months of treatment.
  
  
  CONCLUSIONS
  The addition of fluvastatin 30 mg/day to the conventional CCB therapy for 6 months significantly reduced the number of patients with ACh-induced coronary spasm as compared with the conventional CCB therapy. Thus, a statin (fluvastatin) may possibly be a novel therapeutic drug for coronary spasm.
authors.affiliation: Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto, Japan. yasue@juryo.or.jp
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yasue
authors.forename: Yuji
authors.initials: Y
authors.lastname: Mizuno
authors.forename: Eisaku
authors.initials: E
authors.lastname: Harada
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Itoh
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakayama
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.forename: Shinji
authors.initials: S
authors.lastname: Tayama
authors.forename: Takasi
authors.initials: T
authors.lastname: Honda
authors.forename: Seiji
authors.initials: S
authors.lastname: Hokimoto
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ohshima
authors.forename: Youichi
authors.initials: Y
authors.lastname: Hokamura
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Kugiyama
authors.forename: Minoru
authors.initials: M
authors.lastname: Horie
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshimura
authors.forename: Masaki
authors.initials: M
authors.lastname: Harada
authors.forename: Shiroh
authors.initials: S
authors.lastname: Uemura
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000109:Acetylcholine / Q000494:pharmacology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000188:drug therapy* / Q000503:physiopathology; D003331:Coronary Vessels / Q000187:drug effects / Q000473:pathology; D004727:Endothelium / Q000187:drug effects* / Q000503:physiopathology; D005229:Fatty Acids, Monounsaturated / Q000627:therapeutic use*; D005260:Female; D000077340:Fluvastatin; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007211:Indoles / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002121:Calcium Channel Blockers; D005229:Fatty Acids, Monounsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D009569:Nitric Oxide; D000077340:Fluvastatin; D000109:Acetylcholine