Simvastatin blunts the increase of circulating adhesion molecules after coronary artery bypass surgery with cardiopulmonary bypass
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Massimo Chello1, Massimiliano Carassiti, Felice Agrò
1Department of Cardiovascular Sciences, University Campus BioMedico of Rome, Rome, Italy. m.chello@unicampus.it
Insights
Preoperative simvastatin treatment reduces key adhesion molecules, ICAM-1 and ELAM-1, after coronary artery bypass surgery. This protective effect on endothelial function is independent of cholesterol-lowering efficacy.
Area of Science:
- Cardiovascular Science
- Endothelial Biology
- Pharmacology
Background:
- Endothelial dysfunction is a critical early factor in organ injury following myocardial ischemia and reperfusion.
- Circulating adhesion molecules serve as indicators of endothelial activation.
- Statins may protect the endothelium by reducing adhesion molecule levels.
Purpose of the Study:
- To investigate the effect of preoperative simvastatin on plasma levels of VCAM-1, ICAM-1, and ELAM-1.
- To assess if simvastatin's endothelial protective effects are linked to its cholesterol-lowering ability.
Main Methods:
- A case-control study was conducted at a university hospital.
- Participants included 15 patients on simvastatin with controlled cholesterol, 15 on simvastatin with poor control, and 15 normocholesterolemic controls undergoing coronary artery bypass surgery.
- Plasma levels of VCAM-1, ICAM-1, and ELAM-1 were measured at multiple postoperative time points.
Main Results:
- Postoperative plasma levels of ICAM-1 and ELAM-1 were lower in both simvastatin-treated groups compared to controls.
- No significant differences in ICAM-1 or ELAM-1 were observed between responsive and non-responsive simvastatin groups.
- VCAM-1 plasma levels did not differ significantly between control and simvastatin-treated groups.
Conclusions:
- Pretreatment with simvastatin significantly attenuates the postoperative increase in ICAM-1 and ELAM-1 after coronary artery bypass surgery.
- The mechanism of this endothelial protection appears unrelated to simvastatin's cholesterol-lowering effects.
Objectives:
Endothelial dysfunction has been shown to be a critical early component of organ injury after myocardial ischemia and reperfusion. Circulating levels of adhesion molecules have been regarded as a valid index of endothelial activation. Recent reports suggest that statins, widely used in the control of hypercholesterolemia, exert a protective effect on the endothelium reflected by a reduced level of circulating adhesion molecules. In this study, the effects of preoperative simvastatin treatment, at doses equivalent to those used orally for cholesterol control, were studied on plasma levels of VCAM-1, ICAM-1, and ELAM-1.
Design:
A case-control study.
Setting:
University hospital.
Participants:
Fifteen patients taking simvastatin with good control of cholesterol levels, 15 patients not responsive to the simvastatin treatment, and 15 normocholesterolemic patients (control) undergoing elective coronary artery bypass surgery.
Measurements And Main Results:
The plasma levels of VACM-1, ICAM-1, and ELAM-1 were evaluated at baseline; during cardiopulmonary bypass; and 6 hours, 24 hours, and 48 hours postoperatively. In the late postoperative samples, the plasma levels of ICAM-1 and ELAM-1 were lower in both simvastatin-treated patients compared with the control patients. No significant difference was found between the patients responsive to statin and those not responsive. Finally, no significant difference was found for VCAM-1 plasma levels between the control group and the 2 treatment groups.
Conclusions:
Pretreatment with simvastatin significantly reduces the increase of ICAM-1 and ELAM-1 after coronary artery bypass surgery, by a mechanism that seems not related to its efficacy in lowering cholesterol levels.
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