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Cholesterol Lowering With Pravastatin Improves Resistance Artery Endothelial Function^*

Report of Six Subjects With Normal Coronary Arteriograms

Jan L. Houghton, MD; Thomas A. Pearson, MD, PhD; Roberta G. Reed, PhD; Mikhail T. Torosoff, MD; Nancy L. Henches, RN; Patricia A. Kuhner, RN and Edward F. Philbin, MD

^* From the Divisions of Cardiology, Albany Medical College (Drs. Houghton, Torosoff, and Mss. Henches and Kuhner), Albany; and Mary Imogene Bassett Hospital (Drs. Pearson, Reed, and Philbin), Cooperstown, NY. Dr. Pearson is now at University of Rochester Medical Center, Rochester, NY. Dr. Philbin is now at Henry Ford Hospital, Detroit, MI.

Correspondence to: Jan L. Houghton, MD, Division of Cardiology, A-44, Albany Medical College, Albany, NY 12208; e-mail: Houghtj{at}mail.amc.edu

Study objectives: Improvement in coronary artery endothelial function has been demonstrated after cholesterol lowering in hypercholesterolemic patients with significant atherosclerosis. However, to our knowledge, no previous study has shown improvement in resistance artery function in subjects with normal coronary arteries after cholesterol lowering. The purpose of our study was to investigate the effect of cholesterol lowering with pravastatin on coronary resistance artery endothelial function in the setting of angiographically normal coronary arteries.

Methods: Invasive testing of coronary endothelial and vasomotor function was performed at baseline and after 6 months of pravastatin treatment in six patients with normal coronary arteriograms.

Results: After 6 months of pravastatin treatment, low-density lipoprotein cholesterol level dropped from 157 ± 11 to 117 ± 8 mg/dL (p = 0.02) and percent increase in coronary blood flow after acetylcholine improved from 97 ± 13% to 160 ± 16% (p = 0.01). There was a trend (p = 0.17) toward enhanced epicardial dilation in response to acetylcholine after pravastatin treatment when compared with the baseline study.

Conclusions: Our study demonstrates significant improvement in coronary resistance artery endothelial function after 6 months of cholesterol lowering with pravastatin in six subjects presenting with chest pain who were found to have normal coronary arteriograms. A trend toward improved epicardial vasomotion was also observed.

Key Words: coronary microcirculation • endothelial dysfunction • 3-hydroxy-3-methylglutaryl-CoA reductase inhibitor

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