Vascular effects of simvastatin combined with ramipril in hypercholesterolemic patients with coronary artery disease,

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Kwang Kon Koh1, Ji Won Son, Jeong Yeal Ahn

  • 1kVascular Medicine and Atherosclerosis Unit, Cardiology, Gil Heart Center, Gachon Medical School, Kuwol-dong 1198, Namdong-gu, Incheon 405-760, Korea. kwangk@ghil.com

Atherosclerosis
|October 19, 2004
PubMed

Insights

Statin (simvastatin) and ACE inhibitor (ramipril) therapies improved endothelial function in patients with coronary artery disease. Combination therapy showed greater, though not always significant, benefits compared to statin alone.

Area of Science:

  • Cardiovascular Pharmacology
  • Endothelial Function Research
  • Lipid Metabolism Studies

Background:

  • Coronary artery disease (CAD) and hypercholesterolemia are significant cardiovascular risk factors.
  • Statin and angiotensin-converting enzyme (ACE) inhibitor therapies have distinct mechanisms impacting vascular health.
  • Understanding their combined effects on vascular function in CAD patients is crucial.

Purpose of the Study:

  • To investigate the vascular responses to simvastatin and ramipril in hypercholesterolemic patients with CAD.
  • To compare the efficacy of monotherapy versus combination therapy on endothelial function and inflammatory markers.
  • To assess the differential biological effects of statins and ACE inhibitors in this patient population.

Main Methods:

  • Randomized, double-blind, placebo-controlled, crossover study design.
  • 32 hypercholesterolemic patients with CAD received simvastatin (20 mg) or ramipril (10 mg) daily for 2 months, followed by a 2-month washout period.
  • Vascular responses, including flow-mediated dilation, and plasma levels of nitrate, MDA, MCP-1, CRP, and PAI-1 antigen were measured.

Main Results:

  • Both simvastatin alone and in combination with ramipril significantly improved flow-mediated dilation and reduced MDA and MCP-1 levels.
  • Combination therapy demonstrated a trend towards greater improvement in flow-mediated dilation and reduction in certain markers compared to simvastatin alone, but differences were not always statistically significant.
  • Simvastatin alone or combined with ramipril significantly altered lipoproteins and showed beneficial effects on endothelial function.

Conclusions:

  • Simvastatin and ramipril monotherapies, as well as their combination, exert significant beneficial effects on endothelial function in hypercholesterolemic patients with CAD.
  • While combination therapy may offer additive benefits, the incremental advantage over statin monotherapy was not consistently statistically significant for all measured parameters.
  • Further research may be warranted to elucidate the optimal therapeutic strategies for managing vascular dysfunction in CAD.

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