Department of paediatrics, Wuhan Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, China.
Cardiovasc Drugs Ther. 2009 Oct;23(5):369-76. doi: 10.1007/s10557-009-6186-3.
Statins have been demonstrated to significantly affect the prognosis and outcome of patients with cardiac diseases. Several studies have suggested pleiotropic effects of the statins in these patients. The present study was designed to examine the effects of atorvastatin on inflammation, endothelial function, cardiac performance and exercise tolerance in patients with idiopathic dilated cardiomyopathy (IDCM).
Sixty-four patients with IDCM were divided randomly into an atorvastatin treatment group (atorvastatin 10 mg/d orally) and a placebo control group. Before and 12 weeks after the treatment, circulating soluble intercellular adhesion molecule-1 (sICAM-1), Von Willebrand factor (vWF) and C-reactive protein (CRP) levels were detected using enzyme-linked immunosorbent assay (ELISA); Flow-mediated dilatation (FMD) of the brachial artery was measured, and left ventricular ejection fraction (LVEF) and the 6-min walk test (6MWT) evaluated.
After atorvastatin treatment, LVEF increased from 34.5 +/- 5.7% to 41.4 +/- 4.5% (P < 0.05), and from 32.8 +/- 4.0% to 36.9 +/- 5.2% (P < 0.05) in the placebo group. Also, the distances covered in the 6MWT increased from 358 +/- 61 m to 431 +/- 66 m in the atorvastatin group, and from 351 +/- 70 m to 382 +/- 74 m in the placebo group (both p < 0.05 vs. baseline). The increases in LVEF and 6MWT distances were significantly greater in the atorvastatin than in the placebo group. sICAM-1, CRP and vWF levels decreased and FMD increased significantly in the atorvastatin group, but not in the control group. Correlation analysis showed that the baseline sICAM-1 level was positively correlated with plasma CRP and vWF levels (r = 0.554 and 0.628, respectively); FMD was inversely correlated with serum sICAM-1 and plasma vWF levels (r = -0.579 and -0.590, respectively) and positively correlated with LVEF and distance attained in 6MWT (r = 0.536 and 0.522, respectively).
Twelve weeks of treatment with atorvastatin significantly decreased serum sICAM-1, CRP and vWF levels, and improved the FMD, LVEF and 6MWT outcomes. Inhibition of inflammation, alleviating endothelium damage and endothelial dysfunction might comprise part of the underlying mechanisms leading to the improvement of LV function and exercise tolerance in patients with IDCM.
他汀类药物已被证明能显著影响心脏病患者的预后和结局。一些研究表明他汀类药物对这些患者有多种有益作用。本研究旨在探讨阿托伐他汀对特发性扩张型心肌病（IDCM）患者炎症、内皮功能、心功能和运动耐量的影响。
64 例 IDCM 患者随机分为阿托伐他汀治疗组（阿托伐他汀 10mg/d 口服）和安慰剂对照组。治疗前和治疗 12 周后，采用酶联免疫吸附试验（ELISA）检测循环可溶性细胞间黏附分子-1（sICAM-1）、血管性血友病因子（vWF）和 C 反应蛋白（CRP）水平；测量肱动脉血流介导的舒张功能（FMD），评估左心室射血分数（LVEF）和 6 分钟步行试验（6MWT）。
阿托伐他汀治疗后，LVEF 从 34.5%±5.7%增加到 41.4%±4.5%（P<0.05），从 32.8%±4.0%增加到 36.9%±5.2%（P<0.05），安慰剂组无明显变化。阿托伐他汀组 6MWT 距离从 358±61m 增加到 431±66m，安慰剂组从 351±70m 增加到 382±74m（均 P<0.05）。阿托伐他汀组 LVEF 和 6MWT 距离的增加明显大于安慰剂组。阿托伐他汀组 sICAM-1、CRP 和 vWF 水平降低，FMD 明显升高，但安慰剂组无明显变化。相关性分析显示，基线 sICAM-1 水平与 CRP 和 vWF 呈正相关（r=0.554 和 0.628）；FMD 与血清 sICAM-1 和血浆 vWF 呈负相关（r=-0.579 和-0.590），与 LVEF 和 6MWT 距离呈正相关（r=0.536 和 0.522）。
阿托伐他汀治疗 12 周可显著降低血清 sICAM-1、CRP 和 vWF 水平，改善 FMD、LVEF 和 6MWT 结果。抑制炎症、减轻内皮损伤和内皮功能障碍可能是改善 IDCM 患者左心功能和运动耐量的部分机制。
