Treatment of coronary spastic angina with a statin in addition to a calcium channel blocker: a pilot study.
Combined therapy with a statin and a calcium channel blocker, which can improve lipid metabolism and reduce oxidative stress, may attenuate coronary vasoconstriction in patients with coronary spastic angina (CSA). After 6 months of therapy with benidipine and pravastatin, an acetylcholine provocation test was performed a second time in 25 patients with CSA. The patients were divided into 2 groups according to whether the result of this second test was positive (n = 13) or negative (n = 12). The test was designated as positive when the intracoronary injection of acetylcholine induced angiographically demonstrable total or subtotal occlusion (positive-test group). In the negative-test group, significant decrease in the plasma levels of low-density lipoprotein (LDL) cholesterol (-20.7 +/- 11.1%, P < 0.01 versus baseline) were observed along with a dramatic increase in the serum level of high-density lipoprotein (HDL) cholesterol (26.8 +/- 13.2%, P < 0.01 versus baseline). Furthermore, a significant decrease of the malondialdehyde-modified low-density lipoprotein (MDA-LDL) level, a marker of oxidative stress, was also observed (-22.6 +/- 14.1%, P < 0.01 versus baseline) in this group. In the positive-test group, however, no significant changes were found in any of the aforementioned parameters. The results showed that improvement of lipid metabolism, especially an increase of HDL cholesterol level and a reduction of MDA-LDL, may inhibit vascular contractility.
Tani
Shigemasa
S
Department of Cardiology, Nihon University Surugadai Hospital, Tokyo, Japan. tanishigem@yahoo.co.jp
Nagao
Ken
K
Anazawa
Takeo
T
Kawamata
Hirofumi
H
Furuya
Shingo
S
Takahashi
Hiroshi
H
Iida
Kiyoshi
K
Fuji
Takeshi
T
Matsumoto
Michiaki
M
Kumabe
Takamichi
T
Sato
Yuichi
Y
Hirayama
Atsushi
A
D000788:Angina Pectoris, Variant / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003329:Coronary Vasospasm / Q000188:drug therapy*; D004095:Dihydropyridines / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D050356:Lipid Metabolism / Q000187:drug effects; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008315:Malondialdehyde / Q000031:analogs & derivatives / Q000097:blood; D008875:Middle Aged; D010865:Pilot Projects; D017035:Pravastatin / Q000627:therapeutic use*
D002121:Calcium Channel Blockers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D004095:Dihydropyridines; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008077:Lipoproteins, LDL; C502964:malondialdehyde-low density lipoprotein, mouse; C061004:benidipine; D008315:Malondialdehyde; D017035:Pravastatin