Effects of Low Dose versus High Dose Statin Therapy on the Changes of Endothelial Function and Carotid Intima-Media Thickness in Patients with Variant Angina

Abstract

BackgroundTo compare the effects of low dose and high dose of statin treatment on endothelial function and carotid intima-media thickness (IMT) in patients with variant angina (VAP).MethodsA total of 70 patients with VAP were divided into two groups; atorvastatin 10 mg treatment group (group I: n = 35, 54.2 ± 12.5 years) versus atorvastatin 40 mg treatment group (group II: n = 35, 52.6 ± 9.8 years). Flow mediated vasodilation (FMD) of the brachial artery and IMT of the carotid artery were compared between the groups after 6 months of statin treatment.ResultsThe baseline FMD and carotid IMT were not different between the groups. After 6 months of statin therapy, FMD was significantly improved in both groups (7.7 ± 2.5% to 8.9 ± 2.2% in group I, p = 0.001, 7.9 ± 2.7% to 9.5 ± 2.8% in group II, p < 0.001), but the degree of FMD change and FMD at 6 month were not different between the groups. Carotid IMT were not changed in both groups after 6 months of statin therapy.ConclusionThe use of statin for 6 months significantly improved endothelial function in patients with VAP, but carotid IMT was not changed. The use of high dose statin did not show significant additional benefit as compared with the use of low dose statin. The present study suggested that statin therapy would be beneficial in the treatment of VAP.

The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation

“…Apart from antihypertensive drugs, statins have been shown to reduce cIMT in patients with familial hypercholesterolaemia [255] and dyslipidaemia in general [276]. Nevertheless, some studies failed to show a decrease in cIMT after a 6-month treatment with statins [257,277]. Whether a more prolonged statin treatment might lead to a reduction in cIMT is not clear.…”

Statins in Variant Angina

“…Finally, the numbers of the study subjects are relatively small to detect the difference of vascular function between atorvastatin 40 mg and atorvastatin 10 mg. In the study of Kim et al,11) it seems to be more increase of flow mediated dilation in atorvastatin 40 mg group (7.9 ± 2.7% to 9.5 ± 2.8%) than those in atorvastatin 10 mg group (7.7 ± 2.5% to 8.9 ± 2.2%). But, these results were statistically insignificant due to under-powered sample size.…”

“…Recent clinical evidences also showed that combined therapy with a statin and a calcium channel blocker may attenuate coronary vasoconstriction as well as systemic endothelial dysfunction in patients with VAP 9)10). In this issue of Journal of Cardiovascular Ultrasound , Kim et al11) also support the evidence that the use of atorvastatin, regardless of dosage, could improve systemic endothelial function as measured by flow mediated dilation of the brachial artery in patients with VAP. Collectively, statin might modify the underlying pathogenesis of coronary artery spasm and be a novel therapeutic drug for coronary artery spasm in patients with VAP.…”

“…However, Kim et al11) in this issue of J Cardiovasc Ultrasound concluded that the use of high dose statin (atorvastatin 40 mg) did not show significant additional benefit as compared with the use of low dose statin (atorvastatin 10 mg) with regarding carotid intima media thickness and endothelial function. I have some comments about this study.…”

“…Kim et al11) also hypothesized that atorvastatin 40 mg could improve more endothelial function and carotid intima media thickness than those of atorvastatin 10 mg. It has not been demonstrated the dose-dependent effects of statin therapy on vascular function in patients with VAP.…”