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Lipid-lowering and skin vascular responses in patients with hypercholesterolaemia and peripheral arterial obstructive
F Khan1, S J Litchfield, P A Stonebridge
1University Department of Medicine, Ninewells Hospital and Medical School, Dundee, UK.
Insights
Lowering high cholesterol with fluvastatin improved blood vessel function in the skin microvasculature of patients with peripheral artery disease. This study highlights statin therapy
Area of Science:
- Cardiovascular Medicine
- Dermatology
- Pharmacology
Background:
- Elevated blood cholesterol is a significant risk factor for atherosclerosis and vascular disease.
- The precise mechanisms of cholesterol-lowering's vascular benefits and effects on skin microvasculature remain unclear.
- Hypercholesterolemia is associated with impaired vascular function.
Purpose of the Study:
- To investigate the impact of cholesterol-lowering therapy on skin microvasculature in hypercholesterolemic patients with peripheral artery occlusive disease (PAOD).
- To assess endothelium-dependent and -independent vasodilation in forearm skin before and after fluvastatin treatment.
Main Methods:
- Utilized iontophoresis and laser Doppler flowmetry for non-invasive assessment of forearm skin perfusion.
- Measured endothelium-dependent vasodilation using acetylcholine (ACh) and endothelium-independent vasodilation using sodium nitroprusside (SNP).
- Compared vascular responses in hypercholesterolemic PAOD patients to control subjects and monitored changes after 24 weeks of fluvastatin therapy.
Main Results:
- Patients with hypercholesterolemia and PAOD exhibited significantly reduced vascular responses to both ACh and SNP compared to controls.
- Fluvastatin therapy (40 mg/day for 24 weeks) effectively lowered total and LDL cholesterol levels.
- A significant improvement in endothelium-independent vasodilation in response to SNP was observed after fluvastatin treatment.
Conclusions:
- Cholesterol-lowering therapy with fluvastatin significantly enhances endothelium-independent vascular responses in the skin microvasculature of patients with hypercholesterolemia and PAOD.
- Non-invasive techniques like iontophoresis and laser Doppler flowmetry can serve as valuable markers for assessing microvascular function in this patient population.
Abstract:
Elevated blood cholesterol is a major risk factor for atherosclerosis. Recent studies show that lowering cholesterol reduces the risk of vascular disease, but the precise mechanisms for vascular improvement are not fully understood. Furthermore, it is not known whether the beneficial effects of cholesterol lowering extend to the skin microvasculature. In this unrandomized, open design study, we used iontophoresis and laser Doppler flowmetry to examine forearm skin perfusion in hypercholesterolaemic patients with PAOD before and after cholesterol-lowering therapy with fluvastatin. Endothelium-dependent and -independent vasodilatation were measured following skin iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively. Before cholesterol-lowering, vascular responses to ACh and SNP were reduced significantly in patients compared with responses in control subjects (p < 0.001 and p < 0.05, ANOVA, respectively). Fluvastatin therapy (40 mg/day) for 24 weeks significantly reduced total cholesterol (7.3+/-0.3 to 6.0+/-0.2 mmol/l, p < 0.001) and LDL cholesterol (5.4+/-0.5 to 4.2+/-0.4 mmol/l, p < 0.01). Vasodilatation to SNP was significantly improved at week 24 (p < 0.05). In patients with hypercholesterolaemia and PAOD, cholesterol-lowering with statin therapy significantly improved endothelium-independent vascular responses to SNP in skin microvessels. The application of the non-invasive techniques of iontophoresis and laser Doppler flowmetry may provide useful markers for the assessment of microvascular function in this group of patients.