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Hemodynamic changes associated with reduction in total cholesterol by treatment with the HMG-CoA reductase inhibitor
J Muramatsu1, A Kobayashi, N Hasegawa
1Department of Internal Medicine, Kitasato University, School of Medicine, Kanagawa, Japan.
Insights
Pravastatin significantly improves cardiovascular hemodynamics in hypercholesterolemia by reducing total cholesterol. These beneficial changes, including lower pulse wave velocity and peripheral resistance, are sustained long-term.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Hypercholesterolemia is linked to adverse hemodynamic changes.
- Statins like pravastatin are used to lower cholesterol levels.
Purpose of the Study:
- To investigate the hemodynamic effects of pravastatin in hypercholesterolemia.
- To determine if cholesterol reduction correlates with hemodynamic improvements.
Main Methods:
- 59 hypercholesterolemic patients received pravastatin for 6 months.
- Patients were grouped by total cholesterol reduction (> or = 15% vs. < 15%).
- Hemodynamic parameters were measured before and after treatment.
Main Results:
- A > or = 15% reduction in total cholesterol correlated with decreased pulse wave velocity and total peripheral resistance, and increased cardiac output.
- No significant hemodynamic changes were observed in patients with < 15% cholesterol reduction.
- These improvements were maintained over 5 years and were not dependent on aortic elasticity.
Conclusions:
- Lowering total cholesterol with pravastatin improves peripheral hemodynamics.
- Pravastatin may reverse endothelium-dependent vasodilation disorders associated with hypercholesterolemia.
Abstract:
Hemodynamic changes associated with the lowering of total cholesterol (TC) by the water-soluble HMG-COA reductase inhibitor pravastatin were investigated in 59 patients with hypercholesterolemia (TC level at least 220 mg/dl) who received pravastatin therapy for 6 months. The patients were divided into two groups according to the reduction in TC: a > or = 15% reduction group and a < 15% reduction group. The changes in hemodynamics were compared before and after pravastatin treatment. No changes in blood pressure, heart rate or aortic damping factor were found in either group. However, significant decreases in pulse wave velocity and total peripheral resistance, and increase in cardiac output were seen in the > or = 15% reduction group. All these hemodynamic parameters remained unchanged in the < 15% reduction group. The 12 patients with a clear pravastatin-induced reduction in TC maintained over a 5-year period showed no changes in blood pressure, heart rate or aortic damping factor, but the reductions in pulse wave velocity and total peripheral resistance, and increase in cardiac output were maintained. These changes in hemodynamics were not dependent on aortic elasticity, and appeared to result from improved peripheral hemodynamics. Lowering of TC levels by pravastatin results in improvement in the peripheral endothelium-dependent vasodilation disorder associated with hypercholesterolemia.