Yang Yujin, Hwang EunSoon, Lee Seung Ah, Lee Sahmin, Kim Dae Hee, Song Jong Min, Kang Duk Hyun
Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
J Cardiovasc Imaging. 2021 Jul;29(3):255-262. doi: 10.4250/jcvi.2020.0244. Epub 2021 Mar 15.
It has been unclear whether statin therapy directly improves coronary flow reserve (CFR) in hypertensive patients at cardiovascular risk, independent of lifestyle modification and antihypertensive medications.
In this double-blind, randomized controlled trial, we randomly assigned 95 hypertensive patients at cardiovascular risk to receive either rosuvastatin 10 mg or placebo for 12 months, in addition to antihypertensive therapy and lifestyle modification for hypercholesterolemia. Using Doppler echocardiography, coronary flow velocity in the distal left anterior descending artery was measured and CFR was calculated as the ratio of hyperemic to basal averaged peak diastolic flow velocity. The primary end point was change in CFR from baseline to 12 months follow-up.
Low-density lipoprotein-cholesterol was changed from 157 ± 23 to 84 ± 16 mg/dL in the rosuvastatin group (p < 0.001) and from 152 ± 19 to 144 ± 22 mg/dL in the control group (p = 0.041, but there were no significant differences between the treatment groups in the changes in C-reactive protein, high-density lipoprotein cholesterol, and blood pressures. CFR was changed from 3.03 ± 0.44 to 3.25 ± 0.49 in the rosuvastatin group (p < 0.001) and from 3.15 ± 0.54 to 3.17 ± 0.56 in the control group (p = 0.65). The primary end point of change in CFR was significantly different between the rosuvastatin group and the control group (0.216 ± 0.279 vs. 0.015 ± 0.217; p < 0.001).
Compared with lifestyle modification alone, addition of rosuvastatin significantly improved CFR in hypertensive patients at cardiovascular risk.
目前尚不清楚他汀类药物治疗是否能独立于生活方式改变和抗高血压药物，直接改善有心血管风险的高血压患者的冠状动脉血流储备（CFR）。
在这项双盲、随机对照试验中，我们将95例有心血管风险的高血压患者随机分为两组，除接受抗高血压治疗和针对高胆固醇血症的生活方式改变外，一组接受10mg瑞舒伐他汀治疗，另一组接受安慰剂治疗，为期12个月。使用多普勒超声心动图测量左前降支远端的冠状动脉血流速度，并将CFR计算为充血期与基础期平均舒张期峰值流速之比。主要终点是从基线到12个月随访时CFR的变化。
瑞舒伐他汀组低密度脂蛋白胆固醇从157±23mg/dL降至84±16mg/dL（p<0.001），对照组从152±19mg/dL降至144±22mg/dL（p=0.041），但治疗组之间在C反应蛋白、高密度脂蛋白胆固醇和血压变化方面无显著差异。瑞舒伐他汀组CFR从3.03±0.44变为3.25±0.49（p<0.001），对照组从3.15±0.54变为3.17±0.56（p=0.65）。瑞舒伐他汀组和对照组之间CFR变化的主要终点有显著差异（0.216±0.279 vs. 0.015±0.217；p<0.001）。
与单纯生活方式改变相比，加用瑞舒伐他汀可显著改善有心血管风险的高血压患者的CFR。
