Cholesterol-Lowering Treatment Is Associated With Improvement in Coronary Vascular Remodeling and Endothelial Function in Patients With Normal or Mildly Diseased Coronary Arteries

• Published in: Arteriosclerosis, thrombosis, and vascular biology Vol. 20; no. 3; pp. 737 - 743
• Main Authors: Hamasaki, Shuichi, Higano, Stuart T, Suwaidi, Jassim Al, Nishimura, Rick A, Miyauchi, Katsumi, Holmes, David R, Lerman, Amir
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Heart Association, Inc 01.03.2000; Hagerstown, MD Lippincott
• Subjects: Anticholesteremic Agents - administration & dosage; Biological and medical sciences; Cholesterol - blood; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Coronary Circulation - physiology; Coronary Disease - blood; Coronary Disease - diagnostic imaging; Coronary Disease - pathology; Coronary Vessels - pathology; Echocardiography; Endothelium, Vascular - physiology; Female; General and cellular metabolism. Vitamins; Humans; Hypercholesterolemia - diagnostic imaging; Hypercholesterolemia - drug therapy; Hypercholesterolemia - pathology; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Prospective Studies; Triglycerides - blood; Ventricular Remodeling - physiology; Sonography; Human; Echocardiography; Treatment efficiency; Cardiovascular disease; Metabolic diseases; Lipids; Endovascular route; Hyperlipoproteinemia; Coronary heart disease; Vascular remodeling; Chemotherapy; Hypercholesterolemia; Treatment; Risk factor; Dyslipemia; Antilipemic agent
• ISSN: 1079-5642; 1524-4636
• DOI: 10.1161/01.ATV.20.3.737

ABSTRACTCoronary vascular remodeling and altered endothelial function have been described in the early stages of native atherosclerosis. The purpose of this study was to evaluate the association between cholesterol-lowering therapy and coronary vascular remodeling and endothelial function in patients with normal or mildly diseases coronary arteries. Patients (N=101) with normal or mildly diseased coronary arteries by coronary angiography underwent intravascular ultrasound examination of the left anterior descending coronary artery. Vessel and lumen area, atherosclerotic plaque area, and plaque morphology were evaluated. Vascular reactivity was examined with the use of intracoronary adenosine, acetylcholine, and nitroglycerin. Patients were divided into 3 groups based on the total cholesterol levelsgroup 1 (n=25), patients with a history of hypercholesterolemia adequately treated (total cholesterol <240 mg/dL); group 2 (n=26), patients with hypercholesterolemia not adequately controlled (total cholesterol ≥240 mg/dL); and group 3 (n=50), patients without hypercholesterolemia. Vessel area and lumen area were significantly greater in groups 1 and 3 than in group 2 (for respective values in groups 1, 2, and 3vessel area 11.9±0.5, 10.6±0.4, and 11.8±0.4 mm, both P <0.05; lumen area 8.3±0.4, 6.9±0.3, and 8.9±0.3 mm, both P <0.01). However, plaque areas in groups 1 and 2 were similar. Furthermore, acetylcholine-induced percent increases in coronary blood flow were significantly greater in groups 1 and 3 than in group 2 (for respective values in groups 1, 2, and 370.5±20.1%, 22.8±13.7%, and 68.6±14.8%, both P <0.05). Cholesterol-lowering treatment is associated with an improvement in coronary lumen area that results not from a decrease in plaque area but from an increase in vessel area, reflecting vascular remodeling. Additionally, this adaptive process may occur in association with an improvement of endothelium-dependent vasodilation of the resistance coronary artery.