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Cholesterol reduction improves myocardial perfusion abnormalities in patients with coronary artery disease and
J M Mostaza1, M V Gomez, F Gallardo
1Nuclear Medicine Service, Centro de Investigaciones Clínicas del Instituto de Salud Carlos III, Madrid, Spain. jmostazap@medynet.com
Insights
Pravastatin treatment significantly improved myocardial perfusion in patients with coronary artery disease (CAD). This cholesterol-lowering drug enhanced blood flow during dipyridamole stress testing, as shown by thallium-201 SPECT.
Area of Science:
- Cardiology
- Pharmacology
- Medical Imaging
Background:
- Cholesterol reduction has been shown to improve endothelial function and myocardial perfusion in hypercholesterolemic patients.
- Coronary artery disease (CAD) affects endothelial function and can lead to reduced myocardial perfusion.
Purpose of the Study:
- To assess if pravastatin improves myocardial perfusion in CAD patients with average cholesterol levels.
- To evaluate changes in myocardial perfusion using dipyridamole thallium-201 SPECT.
Main Methods:
- A randomized, placebo-controlled, cross-over study involving 20 CAD patients.
- Patients received pravastatin or placebo for 16 weeks, followed by a 16-week cross-over period.
- Dipyridamole thallium-201 SPECT and lipid analysis were performed, with quantitative and visual assessment of myocardial perfusion.
Main Results:
- Pravastatin significantly reduced total cholesterol (214 to 170 mg/dl) and LDL cholesterol (148 to 103 mg/dl) compared to placebo.
- Myocardial perfusion improved with pravastatin, indicated by lower summed stress and rest scores (p=0.012 and p=0.043, respectively).
- Quantitative SPECT analysis revealed a smaller perfusion defect with pravastatin (29.2%) versus placebo (33.8%) during dipyridamole stress (p=0.021).
Conclusions:
- Pravastatin therapy effectively improves myocardial perfusion in patients with coronary artery disease.
- Cholesterol reduction with pravastatin positively impacts endothelial function and coronary blood flow during stress.
- Dipyridamole thallium-201 SPECT is a valuable tool for assessing pravastatin's effects on myocardial perfusion in CAD.
Objectives:
We sought to evaluate whether pravastatin treatment increases myocardial perfusion, as assessed by thallium-201 single-photon emission computed tomographic (SPECT) dipyridamole testing, in patients with coronary artery disease (CAD) and average cholesterol levels.
Background:
Previous studies in hypercholesterolemic patients have demonstrated that cholesterol reduction restores peripheral and coronary endothelium-dependent vasodilation and increases myocardial perfusion.
Methods:
This was a randomized, placebo-controlled study with a cross-over design. Twenty patients with CAD were randomly assigned to receive 20 mg of pravastatin or placebo for 16 weeks and then were crossed over to the opposite medication for a further 16 weeks. Lipid and lipoprotein analysis and dipyridamole thallium-201 SPECT were performed at the end of each period. The SPECT images were visually analyzed in eight myocardial segments using a 4-point scoring system by two independent observers. A summed stress score and a summed rest score were obtained for each patient. Quantitative evaluation was performed by the Cedars-Sinai method. The magnitude of the defect was expressed as a percentage of global myocardial perfusion.
Results:
Total and low density lipoprotein cholesterol levels during placebo were 214 +/- 29 mg/dl and 148 +/- 25 mg/dl, respectively. These levels with pravastatin were 170 +/- 23 mg/dl and 103 +/- 23 mg/dl, respectively. The summed stress score and summed rest score were lower with pravastatin than with placebo (7.2 +/- 2.3 vs. 5.9 +/- 2.3, p = 0.012 and 3.2 +/- 1.6 vs. 2.4 +/- 2.2, p = 0.043, respectively). Quantitative analysis showed a smaller perfusion defect with pravastatin (29.2%) as compared with placebo (33.8%) (p = 0.021) during dipyridamole stress. No differences were found at rest.
Conclusions:
Reducing cholesterol levels with pravastatin in patients with CAD improves myocardial perfusion during dipyridamole stress thallium-201 SPECT.