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Effects of atorvastatin on arterial endothelial function in coronary bypass surgery
Massimo Chello1, Costanza Goffredo, Giuseppe Patti
1Interdisciplinary Center for Biomedical Research (CIR), Department of Cardiovascular Sciences, Unit of Cardiac Surgery, University Campus Bio Medico di Roma, Via E. Longoni 83, Rome 00155, Italy. m.chello@unicampus.it
Insights
Preoperative atorvastatin treatment improved endothelial function after coronary surgery, independent of cholesterol levels. This finding suggests a protective mechanism against cardiopulmonary bypass-induced endothelial dysfunction.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Pharmacology
Background:
- Endothelial dysfunction is a key factor in organ injury after cardiopulmonary bypass.
- Statins, like atorvastatin, may improve endothelial function irrespective of their lipid-lowering effects.
Purpose of the Study:
- To evaluate the impact of preoperative atorvastatin on endothelial function in patients undergoing coronary surgery.
Main Methods:
- A randomized controlled trial involving 40 coronary surgery patients treated with atorvastatin or placebo for 3 weeks pre-surgery.
- Flow-mediated dilation (FMD) was assessed at baseline, 48 hours, and 5 days postoperatively.
- Endothelium-dependent (reactive hyperemia) and independent (nitroglycerin) dilations were measured.
Main Results:
- Coronary patients showed significantly lower baseline FMD compared to healthy controls.
- Postoperatively, the atorvastatin group exhibited a less pronounced reduction in endothelium-dependent FMD compared to the placebo group.
- No correlation was found between cholesterol levels and FMD; nitroglycerin-induced dilation remained unaffected.
Conclusions:
- Preoperative atorvastatin administration mitigates endothelial dysfunction following cardiopulmonary bypass.
- The beneficial effect of atorvastatin on endothelial function is independent of its cholesterol-lowering properties.
Objective:
Endothelial dysfunction represents a critical early component of organ injury following cardiopulmonary bypass. Recent studies demonstrate that the treatment with atorvastatin is associated with a significant improvement of endothelial function independently of its efficacy on cholesterol levels. Therefore, we investigated the effects of preoperative atorvastatin treatment on endothelium function after coronary surgery.
Methods:
Forty patients undergoing coronary surgery were randomized to treatment with atorvastatin (20 mg/die; N=20) or placebo (N=20) 3 weeks before surgery. Twenty normal patients served as control group. The flow-mediated dilations (FMD) of the brachial artery after both reactive hyperemia (endothelium dependent) and nitroglycerin administration (endothelium independent) were evaluated at baseline, at 48 h, and 5 days postoperatively.
Results:
At baseline, the endothelium-dependent FMD was significantly attenuated in coronary versus normal patients (normal 10.3+/-1.8% vs coronary 4.1+/-1.6%, p<0.01). At 48 h postoperatively all patients exhibited a reduced FMD compared with baseline values: the endothelium-dependent dilatation showed a drop of 60.1+15% in the patients of the placebo group compared with 45.8+16.6% (p<0.05) those in the atorvastatin group. At the univariate analysis, no significant correlation was found between serum levels of either total cholesterol or HDL cholesterol and FMD. The nitroglycerin-induced dilation was not significantly influenced by extracorporeal circulation as well as by atorvastatin treatment.
Conclusions:
The endothelial dysfunction following cardiopulmonary bypass is improved by the treatment with atorvastatin, by a mechanism unrelated to the drug efficacy of controlling serum cholesterol levels.
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