[Effect of various approaches to therapy with statins in high risk patients from the point of view of vascular endothelium].
In a framework of multicenter study ATLANTIKA in a group of patients we carried out noninvasive ultrasound test of endothelium dependent vasodilatation (EDVD) of brachial artery before and at the background of therapy with atorvastatin. Aim of the study was to assess and compare effects of incremental (10-80 mg/day) and stable (10 mg/day) doses of atorvastatin on functional state of endothelium. The group of observation comprised 148 patients A 86 men, 62 women aged 59.5 (55;66) years, who were included into ATLANTIKA study and randomized to 3 groups: group A - active therapy with stable dose of atorvastatin (10 mg/day) (n=52), active therapy with titration of atorvastatin dose from 10 to 80 mg/day (n=50), group C - common therapy which could include lipid lowering drugs (n=46). At baseline there were no statistically significant differences between groups in main demographical, laboratory and instrumental parameters. Median EDVD was 5.4 (3.5; 8.0), 5.1 (3.9; 7.6) and 5.6 (3.2; 8.1)% in groups A, B, and C, respectively. After 12 and 24 weeks of observation statistically significant increases of brachial artery EDVD occurred only in group B (by 27.2 and 31.9%, respectively). There was no statistically significant positive dynamics of EDVD in groups A and C. Results of the presented work show that for achievement of statistically significant positive vascular effect it is necessary to titrate dose of atorvastatin until target level of low density lipoprotein cholesterol (< 2.5 mmol/l) is achieved. Vascular effect of therapy with atorvastatin in a fixed dose 10 mg/day is inferior to that of aggressive therapy, however it is substantially superior to common treatment.
Kulev
B D
BD
Ageev
F T
FT
D000368:Aged; D000069059:Atorvastatin; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D004305:Dose-Response Relationship, Drug; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D006949:Hyperlipidemias / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011758:Pyrroles / Q000008:administration & dosage*; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014664:Vasodilation / Q000187:drug effects* / Q000502:physiology
D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D011758:Pyrroles; D000069059:Atorvastatin