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Lisinopril improves arterial function in hyperlipidaemia
A F Lee1, J B Dick, C E Bonnar
1Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, U.K.
Insights
Lisinopril treatment improved arterial function in hypercholesterolaemia patients by enhancing endothelial function. This study suggests angiotensin-converting enzyme inhibitors may benefit cardiovascular health in high cholesterol individuals.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Endothelial dysfunction is a hallmark of hypercholesterolaemia.
- Animal studies indicate angiotensin-converting enzyme inhibitors (ACEIs) may protect against arterial damage.
Purpose of the Study:
- To investigate the effect of lisinopril, an ACEI, on endothelial function in patients with hypercholesterolaemia.
- To assess arterial vasodilatory responses following lisinopril treatment.
Main Methods:
- A 6-month double-blind, placebo-controlled study involving 40 hypercholesterolaemia patients.
- Forearm blood flow assessed using venous occlusion plethysmography before and after treatment.
- Patients received either lisinopril (20 mg/day) or a placebo.
Main Results:
- Lisinopril significantly reduced blood pressure in the treatment group.
- A significant improvement in vasodilatory response to acetylcholine and sodium nitroprusside was observed with lisinopril.
- No significant changes in vasodilatation were noted in the placebo group.
Conclusions:
- Six months of lisinopril therapy demonstrates a beneficial effect on arterial function in hyperlipidaemia.
- Further research is warranted to determine if ACEIs can reduce mortality and morbidity in hypercholesterolaemia.
Abstract:
Endothelial function is defective in hypercholesterolaemia, and animal models have suggested that angiotensin-converting enzyme inhibitors may prevent arterial damage. We studied the effect of 6 months treatment with lisinopril on endothelial function in a group of patients with hypercholesterolaemia. Forty patients were studied. Forearm blood flow responses to acetylcholine and sodium nitroprusside were assessed by venous occlusion plethysmography. Subjects were then randomized in a double-blind fashion to receive either lisinopril, 20 mg/day (n=20), or placebo (n=20) for 6 months. Plethysmography was then repeated. Baseline variables between groups were comparable. In the lisinopril group blood pressure fell significantly [systolic: 145+/-4 to 128+/-4 mmHg (P<0.001); diastolic: 84+/-2 to 74+/-2 mmHg (P<0.001)]. An improvement was found in the vasodilatory response (expressed as a ratio of the infused/control arm) to acetylcholine, e.g. 3.33+/-0.3 (pre) versus 4.45+/-0.48 (post) at 30 microg/ml (P<0.03), and also to nitroprusside, e.g. 3.0+/-0.2 (pre) versus 3.86+/-0.3 (post) at 3.2 microg/ml (P<0.01). In the placebo group vasodilatation did not change significantly in response to acetylcholine, and nitroprusside responses were unchanged. The data presented suggest that 6 months of lisinopril therapy have a beneficial effect on arterial function in subjects with hyperlipidaemia. Further work should now investigate whether angiotensin-converting enzyme inhibitors are beneficial in reducing mortality and morbidity in hypercholesterolaemia.