Effect of intensive lipid-lowering treatment compared to moderate lipid-lowering treatment with rosuvastatin on endothelial function in high risk patients

Background: The healthy endothelium plays a key roll in vascular regulation. This function can be examined non-invasively by use of B-mode ultrasound on the brachial artery. The aim of this study was to measure the effect of low-dose and high-dose lipid-lowering treatment with rosuvastatin on the endothelial function evaluated with endothelium-dependent and endothelium-independent flow-mediated dilatation (FMD). Methods: 87 Statin-naive patients with ST-segment elevation myocardial infarction (STEMI) were randomized to 5 mg or 40 mg rosuvastatin. The FMD was assessed at baseline, 6 months and after 12 months of follow-up by use of B-mode ultrasound of the brachial artery. Results: Baseline low-density lipoprotein (LDL) cholesterol level was reduced by 31.8% in the low-dose group (from 3.1 +/- 0.7 mmol/l to 2.0 +/- 0.4 mmol/l, p<0.001) vs. 49.0% in the high-dose group (from 3.1 +/- 1.0 mmol/l to 1.6 +/- 0.7 mmol/l, p<0.001) (between groups p = 0.001). Treatment with low-dose rosuvastatin did not change the endothelium-dependent FMD (-1.4 +/- 8.2%, p = 0.32) whereas the endothelium-dependent FMD increased significantly in the high-dose group (3.7 +/- 11.0%, p = 0.045) (between group p = 0.029). No significant changes in endothelium-independent FMD were seen. Conclusion: In the present study treatment of statin-naive STEMI patients with high-dose rosuvastatin for 12 months resulted in a significant increase in endothelium-dependent FMD of the brachial artery whereas no significant change was seen in the low-dose rosuvastatin group (Clinicaltrials. gov Identifier: NCT01223625). (C) 2011 Elsevier Ireland Ltd. All rights reserved.