Atorvastatin Treatment Improves Myocardial and Peripheral Blood Flow in Familial Hypercholesterolemia Subjects without Evidence of Coronary Atherosclerosis

Lario, Fábio Cerqueira; Miname, Márcio H.; Tsutsui, Jeane Mike; Santos, Raul D.; Kowatsch, Ingrid; Sbano, João; Ramires, José Antônio Franchini; Filho, Roberto Kalil; Mathias, Wilson

doi:10.1111/j.1540-8175.2012.01810.x

Cited by 10 publications

(6 citation statements)

References 36 publications

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“…We found that early treatment with statins was associated with improved microcirculatory function, similar with the findings of previous studies (38,42,48). The mechanisms by which statins protect microcirculatroy function include their anti-inflammatory effect, endothelium protective effect, and antiremodeling effect on left ventricular (60)(61)(62)(63)(64).…”

Section: Discussionsupporting

confidence: 89%

Effects of Oral Drugs on Coronary Microvascular Function in Patients Without Significant Stenosis of Epicardial Coronary Arteries: A Systematic Review and Meta-Analysis of Coronary Flow Reserve

Yong

Tian

Yang

et al. 2020

Front. Cardiovasc. Med.

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This study aims to investigate the impact of cardiovascular medications on the coronary flow reserve (CFR) in patients without obstructive coronary artery disease (CAD).Methods: We searched PubMed, EMBASE, and Cochrane databases from inception to 15 November 2019. Studies were included if they reported CFR from baseline to follow-up after oral drug therapy of patients without obstructive CAD. Data was pooled using random-effects modeling. The primary outcome was change in CFR from baseline to follow-up after oral drug therapy.Results: A total of 46 studies including 845 subjects were included in this study. Relative to baseline, the CFR was improved by angiotensin-converting enzymes (ACEIs), aldosterone receptor antagonists (ARBs) [standard mean difference (SMD): 1.12; 95% CI: 0.77-1.47], and statins treatments (SMD: 0.61; 95%CI: 0.36-0.85). Six to 12 months of calcium channel blocker (CCB) treatments improved CFR (SMD: 1.04; 95% CI: 0.51-1.58). Beta-blocker (SMD: 0.24; 95% CI: −0.39-0.88) and ranolazine treatment (SMD: 0.31; 95% CI: −0.39-1.01) were not associated with improved CFR.Conclusions: Therapy with ACEIs, ARBs, and statins was associated with improved CFR in patients with confirmed or suspicious CMD. CCBs also improved CFR among patients followed for 6-12 months. Beta-blocker and ranolazine had no impact on CFR.

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Section: Discussionsupporting

confidence: 89%

Effects of Oral Drugs on Coronary Microvascular Function in Patients Without Significant Stenosis of Epicardial Coronary Arteries: A Systematic Review and Meta-Analysis of Coronary Flow Reserve

Yong

Tian

Yang

et al. 2020

Front. Cardiovasc. Med.

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“…Three nonrandomized studies reported a significant within‐group effect of treatment with rosuvastatin in patients with hypertension, and of treatment with atorvastatin and simvastatin in patients with angina pectoris and no CAD, respectively . In the remaining 4 nonrandomized studies, no effect was found after treatment with either atorvastatin (3 studies) or simvastatin (1 study), in patients with CAD or hypercholesterolemia …”

Section: Resultsmentioning

confidence: 99%

Treatment strategies in coronary microvascular dysfunction: A systematic review of interventional studies

2019

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Coronary microvascular dysfunction has been associated with a wide spectrum of diseases and conditions, and it has proven to be a strong prognostic marker of morbidity and mortality. Despite increased attention guideline-based treatment recommendations are lacking. We performed a systematic review of pharmacological and non-pharmacological interventions to improve coronary perfusion, assessed by intracoronary Doppler, transthoracic Doppler echocardiography, positron emission tomography, cardiac magnetic resonance imaging, transthoracic contrast perfusion echocardiography and dilution techniques. No restrictions were made regarding the study design (randomized, placebo-controlled/ randomized with active comparators/ non-randomized with or without a control group), the cardiac condition studied or the coronary microvascular function at baseline. An electronic database search yielded 4,485 records of which 80 studies met our inclusion criteria. Included studies were sorted according to intervention and study design. Studies were small and heterogeneous in methodology and only few were placebo controlled. Although some treatments looked promising, we found that no specific treatment was sufficiently well-documented to be recommended in any patient groups. There is a need for larger well-designed clinical trials and we suggest that future studies stratify study populations according to pathogenic mechanisms, thereby investigating whether an individualized treatment approach would be more successful. This article is protected by copyright. All rights reserved.

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“…Several studies showed that glycemic improvement normalizes microvascular function in diabetic patients 22,23 . Medications such as statins 24 or glucagon-like peptide-1 agonists 25 might improve microvascular function. Nicorandil moderately improved exercise-induced myocardial ischemia in microvascular angina patients by dilating both epicardial and resistance vessels and modulating the vasomotor responses of the vessels to sympathetic stimulation 26 .…”

Section: Discussionmentioning

confidence: 99%

Impact of Abnormal Remote Stress Myocardial Blood Flow by Dynamic CT Perfusion on Clinical Outcomes

Tomizawa

Chou

Fujino

et al. 2020

Sci Rep

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The objective of this study was to investigate the incremental prognostic value for adverse events of myocardial blood flow (MBF) derived from stress computed tomography perfusion (CTP) at remote myocardium over cardiac risk factors and ischemia. We prospectively analyzed 242 patients who underwent dynamic CTP and CT angiography. Adverse events were defined as a composite of all-cause mortality, non-fatal myocardial infarction, unstable angina, heart failure requiring hospitalization, peripheral artery disease, and stroke. MBF value was calculated in each myocardial segment and ischemia was defined as mild decrease in MBF in two consecutive segments or moderate decrease in a single segment accompanied with a coronary stenosis ≥50%. The mean MBF of the non-ischemic segments was defined as remote MBF. We divided the patients into two groups by median MBF value of 1.15 ml/min/g. During a median follow-up of 18 months, 18 patients had adverse events. Annual event rate showed a significant difference between patients with low (≤1.15 ml/min/g) and high (>1.15 ml/min/g) MBF (6.1% vs 1.8%, p = 0.02). Univariate analysis showed that low MBF was a significant predictor of events (hazard ratio (HR): 3.4; 95% confidence interval (CI): 1.2 to 12.0; p = 0.02). This relationship maintained significant after adjusted for the presence of ischemia and cardiac risk factors (HR: 3.0; 95%CI: 1.1 to 11.1; p = 0.04). In conclusion, MBF value ≤1.15 ml/min/g derived from dynamic CTP in remote myocardium is significantly related with poor outcome and this relationship was independent of myocardial ischemia and cardiac risk factors.

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Atorvastatin Treatment Improves Myocardial and Peripheral Blood Flow in Familial Hypercholesterolemia Subjects without Evidence of Coronary Atherosclerosis

Abstract: Patients with FH and no obstructive CAD have blunted MBF reserve and lower FMD values as compared with healthy volunteers. Both FMD and MBF reserve were normalized after atorvastatin treatment.

Cited by 10 publications

References 36 publications

Effects of Oral Drugs on Coronary Microvascular Function in Patients Without Significant Stenosis of Epicardial Coronary Arteries: A Systematic Review and Meta-Analysis of Coronary Flow Reserve

Effects of Oral Drugs on Coronary Microvascular Function in Patients Without Significant Stenosis of Epicardial Coronary Arteries: A Systematic Review and Meta-Analysis of Coronary Flow Reserve

Treatment strategies in coronary microvascular dysfunction: A systematic review of interventional studies

Impact of Abnormal Remote Stress Myocardial Blood Flow by Dynamic CT Perfusion on Clinical Outcomes

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