Effect of Rosuvastatin on Coronary Flow Reserve in Hypertensive Patients at Cardiovascular Risk
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
BACKGROUND: It has been unclear whether statin therapy directly improves coronary flow reserve (CFR) in hypertensive patients at cardiovascular risk, independent of lifestyle modification and antihypertensive medications. METHODS: In this double-blind, randomized controlled trial, we randomly assigned 95 hypertensive patients at cardiovascular risk to receive either rosuvastatin 10 mg or placebo for 12 months, in addition to antihypertensive therapy and lifestyle modification for hypercholesterolemia. Using Doppler echocardiography, coronary flow velocity in the distal left anterior descending artery was measured and CFR was calculated as the ratio of hyperemic to basal averaged peak diastolic flow velocity. The primary end point was change in CFR from baseline to 12 months follow-up. RESULTS: Low-density lipoprotein-cholesterol was changed from 157 ± 23 to 84 ± 16 mg/dL in the rosuvastatin group (p < 0.001) and from 152 ± 19 to 144 ± 22 mg/dL in the control group (p = 0.041, but there were no significant differences between the treatment groups in the changes in C-reactive protein, high-density lipoprotein cholesterol, and blood pressures. CFR was changed from 3.03 ± 0.44 to 3.25 ± 0.49 in the rosuvastatin group (p < 0.001) and from 3.15 ± 0.54 to 3.17 ± 0.56 in the control group (p = 0.65). The primary end point of change in CFR was significantly different between the rosuvastatin group and the control group (0.216 ± 0.279 vs. 0.015 ± 0.217; p < 0.001). CONCLUSIONS: Compared with lifestyle modification alone, addition of rosuvastatin significantly improved CFR in hypertensive patients at cardiovascular risk.
Abstract
BACKGROUND: It has been unclear whether statin therapy directly improves coronary flow reserve (CFR) in hypertensive patients at cardiovascular risk, independent of lifestyle modification and antihypertensive medications. METHODS: In this double-blind, randomized controlled trial, we randomly assigned 95 hypertensive patients at cardiovascular risk to receive either rosuvastatin 10 mg or placebo for 12 months, in addition to antihypertensive therapy and lifestyle modification for hypercholesterolemia. Using Doppler echocardiography, coronary flow velocity in the distal left anterior descending artery was measured and CFR was calculated as the ratio of hyperemic to basal averaged peak diastolic flow velocity. The primary end point was change in CFR from baseline to 12 months follow-up. RESULTS: Low-density lipoprotein-cholesterol was changed from 157 ± 23 to 84 ± 16 mg/dL in the rosuvastatin group (p < 0.001) and from 152 ± 19 to 144 ± 22 mg/dL in the control group (p = 0.041, but there were no significant differences between the treatment groups in the changes in C-reactive protein, high-density lipoprotein cholesterol, and blood pressures. CFR was changed from 3.03 ± 0.44 to 3.25 ± 0.49 in the rosuvastatin group (p < 0.001) and from 3.15 ± 0.54 to 3.17 ± 0.56 in the control group (p = 0.65). The primary end point of change in CFR was significantly different between the rosuvastatin group and the control group (0.216 ± 0.279 vs. 0.015 ± 0.217; p < 0.001). CONCLUSIONS: Compared with lifestyle modification alone, addition of rosuvastatin significantly improved CFR in hypertensive patients at cardiovascular risk.
참고문헌 (13)
- Anderson TJ, "The effect of cholesterol-lowering and antioxidant therapy on endothelium-dependent coronary vasomotion", N Engl J Med, 332, pp.488~493 (1995)
- Treasure CB, "Beneficial effects of cholesterol-lowering therapy on the coronary endothelium in patients with coronary artery disease", N Engl J Med, 332, pp.481~487 (1995)
- Baller D, "Improvement in coronary flow reserve determined by positron emission tomography after 6 months of cholesterol-lowering therapy in patients with early stages of coronary atherosclerosis", Circulation, 99, pp.2871~2875 (1999)
- Sever PS, "Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial", Lancet, 361, pp.1149~1158 (2003)
- Yusuf S, "Cholesterol lowering in intermediate-risk persons without cardiovascular disease", N Engl J Med, 374, pp.2021~2031 (2016)
- Hozumi T, "Noninvasive assessment of coronary flow velocity and coronary flow velocity reserve in the left anterior descending coronary artery by Doppler echocardiography : comparison with invasive technique", J Am Coll Cardiol, 32, pp.1251~1259 (1998)
- Caiati C, "New noninvasive method for coronary flow reserve assessment : contrast-enhanced transthoracic second harmonic echo Doppler", Circulation, 99, pp.771~778 (1999)
- Caiati C, "Validation of a new noninvasive method(contrast-enhanced transthoracic second harmonic echo Doppler)for the evaluation of coronary flow reserve : comparison with intracoronary Doppler flow wire", J Am Coll Cardiol, 34, pp.1193~1200 (1999)
- Sun BJ, "Effect of rosuvastatin on coronary flow reserve in patients with systemic hypertension", Am J Cardiol, 114, pp.1234~1237 (2014)
- Baigent C, "Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins", Lancet, 366, pp.1267~1278 (2005)
- Schwartzkopff B, "Structural and functional alterations of the intramyocardial coronary arterioles in patients with arterial hypertension", Circulation, 88, pp.993~1003 (1993)
- Treasure CB, "Hypertension and left ventricular hypertrophy are associated with impaired endothelium-mediated relaxation in human coronary resistance vessels", Circulation, 87, pp.86~93 (1993)
- Kelm M, "Coronary flow reserve measurements in hypertension", Med Clin North Am, 88, pp.99~113 (2004)