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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Moderate-dose atorvastatin improves arterial endothelial function in patients with angina pectoris and normal
Amela Kabaklić1, Zlatko Fras2,3
1Department of Hypertension, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Insights
Atorvastatin therapy improved large artery endothelial function in patients with angina and normal coronary angiograms. However, it did not significantly impact microcirculation or quality of life.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Medical Research
Background:
- Endothelial dysfunction is implicated in the pathophysiology of angina pectoris (AP) in patients with normal coronary angiograms.
- Statins, beyond lipid-lowering, offer pleiotropic effects, including the enhancement of endothelial function.
Purpose of the Study:
- To evaluate the effect of atorvastatin on endothelial function in patients diagnosed with angina pectoris and normal coronary angiograms.
- To assess atorvastatin's impact on macrovascular and microvascular endothelial function, as well as arterial stiffness and quality of life.
Main Methods:
- A double-blind study involving 58 patients with AP and normal coronary angiograms.
- Comparison of 20 mg daily atorvastatin versus placebo for six months.
- Endothelial function assessed by brachial artery flow-mediated dilation (FMD) and peripheral arterial tonometry (EndoPAT) measuring reactive hyperemia index (RHI) and augmentation index (AI). Quality of life was measured using the Seattle Angina Questionnaire (SAQ).
Main Results:
- Significant improvement in brachial artery FMD in the atorvastatin group compared to placebo at 3 and 6 months.
- No significant difference in reactive hyperemia index (RHI) between groups, indicating no effect on microcirculation.
- A trend towards improvement in augmentation index (AI) was observed, but not statistically significant. Quality of life scores did not improve.
Conclusions:
- Moderate-dose atorvastatin therapy effectively improves endothelial function in large conduit arteries for patients with AP and normal coronary angiograms.
- These findings suggest potential benefits for coronary artery endothelial function, though effects on peripheral microcirculation were not observed.
- Atorvastatin did not improve the quality of life in this patient cohort.
Introduction:
Endothelial dysfunction could contribute to the pathophysiology of angina pectoris (AP) in patients with normal coronary angiograms. Besides lipid-lowering effects, statins exert pleiotropic effects including improving endothelial function.
Material And Methods:
Our double-blind study included 58 patients with AP, noninvasively confirmed myocardial ischemia and a normal coronary angiogram. The effect of once-daily 20 mg atorvastatin (A) was compared with placebo (P) for 6 months. Endothelial function was evaluated by flow-mediated dilation (FMD) of the brachial artery, and microcirculation by peripheral arterial tonometry (EndoPAT) measuring the reactive hyperemia index (RHI), indicating microcirculatory endothelial function, and the augmentation index (AI), an indicator of arterial stiffness. The impact of AP on the quality of life was monitored using the Seattle Angina Questionnaire (SAQ).
Results:
Brachial artery endothelial dysfunction was found in 91.4% of patients at study entry, and subnormal RHI in 41%. Group A showed an improvement of FMD compared with group P, both at 3 and 6 months (+120.8% vs. -21.2%, and +70.8% vs. -1.9%, respectively, p < 0.001). No difference was detected in the RHI. Rate-normalized AI showed an improvement (-114.49% group A vs. -30.77% group P, p = 0.077), although the differences between the groups were not significant. According to the SAQ, an improvement was found in almost all observed variables with the exception of the issue of quality of life (QoL), where patients in both groups assessed their QoL at the control study visits as poorer compared with baseline.
Conclusions:
Moderate-dose atorvastatin therapy improves endothelial function of large conduit arteries in patients with AP and a normal coronary angiogram, which probably reflects positive effects on coronary artery endothelial function. No effect was found with vascular effects at the level of the peripheral microcirculation.
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