High-dose atorvastatin in peripheral arterial disease (PAD): effect on endothelial function, intima-media-thickness and local progression of PAD. An open randomized controlled pilot trial

• Published in: Thrombosis and haemostasis Vol. 99; no. 1; p. 182
• Main Authors: Spring, Silviana, Simon, Roger, van der Loo, Bernd, Kovacevic, Tamara, Brockes, Christiane, Rousson, Valentin, Amann-Vesti, Beatrice, Koppensteiner, Renate
• Format: Journal Article
• Language: English
• Published: Germany 01.01.2008
• Subjects: Aged; Ankle - blood supply; Atorvastatin Calcium; Blood Pressure - drug effects; Brachial Artery - diagnostic imaging; Brachial Artery - drug effects; Brachial Artery - physiopathology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Carotid Arteries - diagnostic imaging; Carotid Arteries - drug effects; Disease Progression; Endothelium, Vascular - diagnostic imaging; Endothelium, Vascular - drug effects; Endothelium, Vascular - physiopathology; Female; Heptanoic Acids - administration & dosage; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Lipids - blood; Male; Middle Aged; Peripheral Vascular Diseases - complications; Peripheral Vascular Diseases - diagnostic imaging; Peripheral Vascular Diseases - drug therapy; Peripheral Vascular Diseases - physiopathology; Pilot Projects; Prospective Studies; Pyrroles - administration & dosage; Research Design; Time Factors; Treatment Outcome; Tunica Intima - diagnostic imaging; Tunica Intima - drug effects; Tunica Media - diagnostic imaging; Tunica Media - drug effects; Ultrasonography; Vasodilation - drug effects
• ISSN: 0340-6245
• DOI: 10.1160/TH07-04-0265

Beneficial effects of aggressive lipid-lowering with high-dose atorvastatin (80 mg/day) have been demonstrated in patients with coronary and cerebrovascular disease. The impact of such a therapy in patients with peripheral arterial disease (PAD) is less known so far. Here we studied the effects of high-dose atorvastatin on brachial artery endothelial function, common carotid intima-media thickness (IMT) and local progression of PAD in these patients. One hundred of 500 patients screened with documented PAD were randomly assigned to receive 80 mg of atorvastatin daily for six months or to continue on conventional medical treatment. Ninety-six percent of patients in the control group were on standard statin treatment. High resolution B-mode ultrasonography was used to study brachial artery flow-mediated dilation (FMD), IMT and ankle-brachial index (ABI) at baseline and at six months. FMD and IMT at baseline and at six months were 4.1 (0.06-8.6) versus 5.0 (0.76 vs. 8.1) %, p = 0.96, and 0.76 (0.66-0.82) versus 0.73 (0.63-0.81) mm, p = 0.41, respectively, in the atorvastatin group, and 2.66 (-1.9-6.9) versus 3.65 (0.0-8.6)%, p = 0.02, and 0.78 (0.71-0.90) versus 0.77 (0.70-0.90) mm, p = 0.48, in the control group. ABI at baseline and at six months was not different in either group. LDL cholesterol was reduced from 2.53 (2.21-3.28) to 1.86 (1.38-2.29) mM (p < 0.0001) in the atorvastatin group, whereas levels remained stable in the control group [2.38 (1.94-3.16) vs. 2.33 (1.82-2.84) mM, p = 0.61]. Major adverse cardiovascular events occurred in 2.1% in the atorvastatin group and 1.9% in the control group (p = 0.61). In conclusion, in this pilot trial aggressive lipid-lowering with 80 mg of atorvastatin daily for six months had no effect on brachial artery FMD in patients with PAD. IMT and ABI were also similar in patients with and without high-dose atorvastatin at six months.