Effects of a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, fluvastatin, on coronary spasm after withdrawal of calcium-channel blockers.
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.
Yasue
Hirofumi
H
Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto, Japan. yasue@juryo.or.jp
Mizuno
Yuji
Y
Harada
Eisaku
E
Itoh
Teruhiko
T
Nakagawa
Hitoshi
H
Nakayama
Masafumi
M
Ogawa
Hisao
H
Tayama
Shinji
S
Honda
Takasi
T
Hokimoto
Seiji
S
Ohshima
Shuichi
S
Hokamura
Youichi
Y
Kugiyama
Kiyotaka
K
Horie
Minoru
M
Yoshimura
Michihiro
M
Harada
Masaki
M
Uemura
Shiroh
S
Saito
Yoshihiko
Y
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
D002121:Calcium Channel Blockers; D005229:Fatty Acids, Monounsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D009569:Nitric Oxide; D000077340:Fluvastatin; D000109:Acetylcholine