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Effects of initial and long-term lipid-lowering therapy on vascular wall characteristics
F L Ubels1, J H Muntinga, J J van Doormaal
1Department of Internal Medicine, University Hospital, P.O. Box 30. 001, NL-9700 RB, Groningen, The Netherlands. f.1.ubels@int.azg.nl
Insights
Starting statin therapy initially yields greater vascular benefits than intensifying existing treatment. This suggests HMG-CoA reductase inhibitors offer advantages beyond lipid reduction for vascular health.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) improve vascular properties.
- Limited data exists on the impact of statin treatment intensification on vascular health.
Purpose of the Study:
- To compare the effects of initiating statin therapy versus intensifying existing statin treatment on vascular properties.
- To investigate whether lipid-lowering effects or other mechanisms of statins contribute more to vascular changes.
Main Methods:
- Compared two groups: patients newly starting statins (INITIAL, n=30) and long-term statin users with intensified treatment (LONG-TERM, n=54).
- Measured lipid profiles, intima-media thickness (IMT) of carotid and femoral arteries, aortic distensibility (pulse-wave velocity), and peripheral vascular bed properties (bio-impedance) at baseline and after 1 year.
Main Results:
- The INITIAL group showed significantly better relative changes in lipid profiles compared to the LONG-TERM group.
- Relative changes in IMT differed significantly between groups: -8% (INITIAL) vs. +11% (LONG-TERM) in carotid arteries and -11% (INITIAL) vs. +22% (LONG-TERM) in femoral arteries.
- Most other vascular wall characteristics remained unchanged in both groups after 1 year.
Conclusions:
- Initiating statin therapy resulted in greater beneficial structural alterations of the vascular wall than intensifying existing treatment.
- These findings suggest that HMG-CoA reductase inhibitors exert beneficial vascular effects beyond their lipid-lowering capabilities.
Abstract:
Several studies have demonstrated the beneficial effects of 3 hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors on vascular properties, but little is known about treatment intensification. We compared patients in whom statins were started (INITIAL, n=30) for hypercholesterolaemia (>6.5 mmol l(-1)) with a matched patient group of long-time statin users, with similar baseline characteristics for lipids, intima-media thickness (IMT), and pulse wave velocity, in whom treatment with statins was intensified (LONG-TERM, n=54). At baseline and after 1 year, lipid profile, IMT of the carotid and femoral arteries, aortic distensibility using pulse-wave velocity and various properties of the peripheral vascular bed using a recently developed bio-impedance method were measured. After 1 year the relative changes in lipid profile were significantly better in the INITIAL compared with the LONG-TERM-group. The relative changes in IMT of the mean internal carotid and common femoral arteries significantly differed between the INITIAL and LONG-TERM-group (-8 and +11%, -11 and +22%, respectively). After 1 year, in both groups, most other vascular wall characteristics were unaltered compared with baseline. In conclusion, the beneficial structural alterations of the vascular wall were greater after starting than after intensifying already existing lipid-lowering treatment. This suggests that other effects of HMG-CoA reductase inhibitors than lipid-lowering alone must be involved in vascular changes.