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Effect of cholesterol lowering treatment on positive exercise tests in patients with hypercholesterolaemia and normal
A P Mansur1, C V Serrano, J C Nicolau
1Heart Institute, São Paulo University, Av Dr Enéas de Carvalho Aguiar 44, 05403-000 São Paulo, Brazil. corantonio@incor.usp.br
Insights
Cholesterol lowering treatment significantly reduced myocardial ischemia in hypercholesterolemic patients with normal coronary arteries, as evidenced by improved exercise stress test results. These benefits were reversed upon statin withdrawal.
Area of Science:
- Cardiology
- Clinical Lipidology
Background:
- Hypercholesterolemia is a significant risk factor for cardiovascular disease.
- Exercise stress tests are used to assess for myocardial ischemia.
Purpose of the Study:
- To evaluate the effect of cholesterol-lowering therapy on exercise stress test outcomes in hypercholesterolemic patients with normal coronary angiograms.
Main Methods:
- 43 hypercholesterolemic patients with positive exercise tests and normal coronary angiograms were studied.
- Patients received diet therapy, with random assignment to diet alone or diet plus statins (lovastatin or simvastatin) for 16 weeks.
- Lipid profiles and exercise tests were performed before and after treatment, and again after a 20-week withdrawal period.
Main Results:
- Statin therapy significantly reduced total cholesterol, LDL, and triglycerides compared to diet alone.
- Positive exercise tests decreased from 23 to 3 in the statin group versus 20 to 15 in the diet group (p=0.01).
- Upon statin withdrawal, lipid levels and exercise test positivity returned to baseline.
Conclusions:
- Cholesterol lowering treatment effectively reduces myocardial ischemia in hypercholesterolemic patients with normal coronary arteries.
- The beneficial effects on exercise testing are directly linked to lipid-lowering therapy and are reversible upon discontinuation.
Aim:
To assess the impact of cholesterol lowering on positive exercise stress tests in hypercholesterolaemic patients with normal coronary angiograms.
Methods:
43 non-diabetic patients aged 43-61 years, with total serum cholesterol concentrations of more than 7.75 mmol/l, positive exercise tests, and normal coronary angiograms, were started on the American Heart Association step 1 diet. After 12 weeks these patients were randomly assigned to treatment for another 16 weeks with the diet alone (diet group, n = 20) or with the diet plus lovastatin or simvastatin (statin group, n = 23). After this 28 week run in period, statins were withdrawn and lipid profile tests and exercise tests were done and repeated 20 weeks later.
Results:
At week 28, the statin group but not the diet group had significant reductions from baseline (week 12) in plasma total cholesterol (p < 0.0001), low density lipoprotein (p < 0.0001), and triglyceride (p < 0.0001). The number of patients with positive exercise tests decreased from 23 to three in the statin group and from 20 to 15 in the diet group (p = 0.01). After the final 20 weeks without statins, lipid profiles returned to baseline levels in all 17 patients remaining in the statin group, and exercise tests were again positive in 15 of these patients.
Conclusions:
In hypercholesterolaemic patients with normal coronary arteries, cholesterol lowering treatment reduces myocardial ischaemia, as shown by the beneficial effects on exercise testing.