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European Heart Journal Advance Access published online on April 25, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn166
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Cholesterol lowering is more important than pleiotropic effects of statins for endothelial function in patients with dysglycaemia and coronary artery disease

Magnus Settergren*, Felix Böhm, Lars Rydén and John Pernow

Department of Cardiology, Karolinska University Hospital, Stockholm SE-171 76, Sweden

Received 14 May 2007; revised 1 April 2008; accepted 4 April 2008.

* Corresponding author. Tel: +46 8 51770807, Fax: +46 8 311044, Email: magnus.settergren{at}karolinska.se

Aims: The importance of pleiotropic effects of statins on endothelial function and inflammatory markers was investigated in patients with dysglycaemia and coronary artery disease (CAD).

Methods and results: Thirty-nine patients were randomized to simvastatin 80 mg daily (S80; n = 20) or ezetimibe 10 mg and simvastatin 10 mg daily (E10/S10; n = 19) for 6 weeks, aiming at similar cholesterol reduction. Endothelial function, evaluated by brachial artery flow-mediated vasodilatation (FMD) and the effect of endothelin receptor blockade, serum lipids, and inflammatory markers were evaluated at baseline and follow-up. At follow-up, low-density lipoprotein cholesterol decreased from 3.1 (2.8–3.4) (median and quartiles) to 1.5 mmol/L (1.4–1.7) and from 3.0 (2.5–3.4) to 1.3 mmol/L (1.1–1.8), in the S80 and E10/S10 groups, respectively. In the entire study group, FMD increased from 4.3% (3.4–6.1) at baseline to 5.5% (3.4–6.6) at follow-up, while C-reactive protein decreased from 3.1 (1.7–7.6) to 2.3 mg/L (0.9–6.5). The changes in FMD and C-reactive protein from baseline to follow-up were not significantly different between patients on S80 and E10/S10 groups. Endothelin blockade enhanced endothelium-dependent vasodilatation both at baseline and follow-up.

Conclusion: Lipid lowering is more important than pleiotropic effects of statins for improvement in endothelial function and inflammatory markers in patients with dysglycaemia and CAD.

Key Words: Statins • Pleiotropic effects • Ezetimibe • Endothelial function • Type 2 diabetes


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