Zhang Xinling, Li Qiang, Zhao Jing, Li Xiangting, Sun Xiaofei, Yang Hongyan, Wu Zongyin, Yang Jianmin
aThe Heart Center, Jining First People's Hospital, Jining Departments of bNeurology cOncology, Jinan Central Hospital affiliated to Shandong University dThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital, Shandong University, Jinan, People's Republic of China.
Coron Artery Dis. 2014 Jan;25(1):40-4. doi: 10.1097/MCA.0000000000000054.
Statins and calcium channel blockers have been proven beneficial toward improvement of endothelial function. The aim of this study was to compare the effect of combination therapy of statin and calcium channel blocker with solo treatment in patients with cardiac syndrome X.
Sixty-eight patients with cardiac syndrome X were divided randomly into three groups: fluvastatin (40 mg/day, n=23), diltiazem (90 mg/day, n=22), and combination of fluvastatin (40 mg/day) and diltiazem (90 mg/day, n=23). At the end of 90 days, the coronary flow reserve was improved in the three groups (fluvastatin-treated group: 23.2%; diltiazem-treated group: 12.4%; fluvastatin+diltiazem-treated group: 29.1%, all P<0.05). The time to 1 mm ST segment depression increased significantly in the fluvastatin-treated group (from 241±97 to 410±140 s, P<0.05), the diltiazem-treated group (from 258±91 to 392±124 s, P<0.05), and the fluvastatin+diltiazem-treated group (from 250±104 to 446±164 s, P<0.05). The improvement in coronary flow reserve and prolonged time to 1 mm ST segment depression in the combination treatment group were more remarkable than in those who received monotherapy. Combination therapy also induced a significant increase (35.6%, P<0.05) in nitric oxide and an apparent reduction (48.7%, P<0.05) in endothelin-1.
Combination treatment with fluvastatin and diltiazem is more effective on endothelial function and exercise tolerance than solo treatment in patients with cardiac syndrome X. The benefits of these drugs may be related to the elevation of nitric oxide and reduction of endothelin-1.
他汀类药物和钙通道阻滞剂已被证明对改善内皮功能有益。本研究的目的是比较他汀类药物与钙通道阻滞剂联合治疗与单独治疗对心脏X综合征患者的效果。
68例心脏X综合征患者被随机分为三组：氟伐他汀（40毫克/天，n = 23）、地尔硫䓬（90毫克/天，n = 22）以及氟伐他汀（40毫克/天）与地尔硫䓬（90毫克/天，n = 23）联合治疗组。90天结束时，三组的冠状动脉血流储备均有所改善（氟伐他汀治疗组：23.2%；地尔硫䓬治疗组：12.4%；氟伐他汀+地尔硫䓬治疗组：29.1%，均P<0.05）。氟伐他汀治疗组1毫米ST段压低的时间显著增加（从241±97秒增至410±140秒，P<0.05），地尔硫䓬治疗组（从258±91秒增至392±124秒，P<0.05），氟伐他汀+地尔硫䓬治疗组（从250±104秒增至446±164秒，P<0.05）。联合治疗组冠状动脉血流储备的改善以及1毫米ST段压低时间的延长比接受单一疗法的患者更显著。联合治疗还使一氧化氮显著增加（35.6%，P<0.05），内皮素-1明显降低（48.7%，P<0.05）。
在心脏X综合征患者中，氟伐他汀与地尔硫䓬联合治疗在内皮功能和运动耐量方面比单独治疗更有效。这些药物的益处可能与一氧化氮升高和内皮素-1降低有关。
