Egashira K, Hirooka Y, Kai H, Sugimachi M, Suzuki S, Inou T, Takeshita A
Research Institute of Angiocardiology, Kyushu University School of Medicine, Fukuoka, Japan.
Circulation. 1994 Jun;89(6):2519-24. doi: 10.1161/01.cir.89.6.2519.
This study aimed to determine if cholesterol-lowering therapy improves endothelium-dependent coronary vasomotion in patients with hypercholesterolemia.
Nine patients with hypercholesterolemia were studied before and after cholesterol-lowering therapy with pravastatin (an inhibitor of HMG-CoA reductase) for 6 +/- 3 months, which lowered serum cholesterol from 272 +/- 8 to 187 +/- 16 mg/dL (P < .01). Control patients with serum cholesterol of 218 +/- 23 mg/dL also were studied twice in a similar interval (8 +/- 2 months) with no cholesterol-lowering drugs. Acetylcholine (the endothelium-dependent vasodilator) and papaverine and nitrate (endothelium-independent vasodilators) were infused into the study coronary artery. Changes in the diameter of the epicardial coronary artery and coronary blood flow were assessed by quantitative coronary arteriography and an intracoronary Doppler catheter. In patients with hypercholesterolemia, acetylcholine-induced vasoconstriction of the epicardial artery was less (P < .05) and the acetylcholine-induced increases in coronary blood flow were greater (P < .001) after than before pravastatin. In control patients, responses of the epicardial coronary artery and coronary blood flow to acetylcholine did not change over the follow-up period. The vasomotor responses to papaverine or nitrate were similar between the two groups, and no interval changes in their responses were noted in either group.
These results suggest that cholesterol-lowering therapy with pravastatin may improve endothelium-dependent coronary vasomotion, which may possibly contribute to the improvement of myocardial perfusion as well as the regression of coronary atherosclerosis.
本研究旨在确定降胆固醇治疗是否能改善高胆固醇血症患者的内皮依赖性冠状动脉血管运动。
对9例高胆固醇血症患者在接受普伐他汀（一种HMG-CoA还原酶抑制剂）降胆固醇治疗6±3个月前后进行了研究，该治疗使血清胆固醇从272±8降至187±16mg/dL（P<.01）。血清胆固醇为218±23mg/dL的对照患者也在相似的间隔时间（8±2个月）内进行了两次研究，期间未使用降胆固醇药物。将乙酰胆碱（内皮依赖性血管扩张剂）、罂粟碱和硝酸盐（内皮非依赖性血管扩张剂）注入研究的冠状动脉。通过定量冠状动脉造影和冠状动脉内多普勒导管评估心外膜冠状动脉直径和冠状动脉血流的变化。在高胆固醇血症患者中，普伐他汀治疗后，乙酰胆碱诱导的心外膜动脉血管收缩减少（P<.05），乙酰胆碱诱导的冠状动脉血流增加更大（P<.001）。在对照患者中，随访期间心外膜冠状动脉和冠状动脉血流对乙酰胆碱的反应没有变化。两组对罂粟碱或硝酸盐的血管运动反应相似，且两组均未观察到其反应的间隔变化。
这些结果表明，普伐他汀降胆固醇治疗可能改善内皮依赖性冠状动脉血管运动，这可能有助于改善心肌灌注以及冠状动脉粥样硬化的消退。
