Prospective serial evaluation of myocardial perfusion and lipids during the first six months of pravastatin therapy

Abstract

Serial SPECT MPI demonstrated improved stress myocardial perfusion in 48% of patients treated for six months with pravastatin. Time course of improved myocardial perfusion during pravastatin therapy is delayed compared to lipids. Direction and magnitude of changes in the myocardial perfusion vary and do not correlate closely with improvements in lipids.

Early insights of cardiac risk and treatment response with quantitative PET monitoring of coronary-specific endothelial dysfunction and myocardial perfusion reserve

“…This report makes an important contribution to the seminal observations by Gould et al of reductions in extent and severity of Rb-82 PET perfusion defects with lipid lowering and lifestyle modification 31,32 and provides evidence of the incremental value of quantification of absolute flow and serial changes of indices of coronary-specific endothelial dysfunction with CPT for assessment of treatment effectiveness of dyslipidemia. Consistent with one prior report of rapid improvement in quantitative flow reserve with low fat diet and cardiac conditioning, 33 these findings document therapeutic responsiveness of prognostically important coronary vasomotor function well before the development of clinical events and substantially earlier than the observation periods noted in most prior reports with PET 31,32,38,39 and SPECT [40][41][42][43][44][45] techniques using visual and semi-quantitative analyses of extent and severity of defect resolution on statin therapy. This study also has important potential implications for primary and secondary prevention efforts to monitor treatment effectiveness.…”

“…29 The stress-induced changes of myocardial blood flow and visible perfusion defects associated with the vasomotor response likely account for the consistent observation in the literature of their incremental value for prediction of clinical events when compared to clinical, exercise ECG, and arteriographic variables. 4,5,[7][8][9][10] Therapeutic reversibility of the stress-induced vasospastic response with statin and other lipid lowering therapy in patients with hyperlipidemia or CAD has been demonstrated by both angiographic 30 and scintigraphic data with PET [31][32][33][34][35][36][37][38][39] and SPECT, [40][41][42][43] as previously reviewed in the Journal. 44,45 In this issue of the Journal, Alexanderson et al 46 have extended these observations using N-13 ammonia PET with measurements of both coronary-specific endothelial dysfunction with CPT as well as adenosine-induced MFR reflecting total vasodilator capacity in patients with dyslipidemia treated daily for 8 weeks with the combination of simvastatin 40 mg and the intestinal cholesterol absorption inhibitor ezetimibe 10 mg.…”

Effect of Intensive Lipid Lowering, With or Without Antioxidant Vitamins, Compared With Moderate Lipid Lowering on Myocardial Ischemia in Patients With Stable Coronary Artery Disease

“…ole 21 or exercise stress testing, 22 LDL lowering with pravastatin from 148 to 103 mg/dL was associated with significant improvement in the size of thallium perfusion defects. These benefits of lipid lowering may represent the effects of preventing the coronary vasoconstriction associated with exercise.…”

Resolution of Asymptomatic Myocardial Ischemia in Patients With Type 2 Diabetes in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Study

“…Although this observation should be interpreted with caution, it is of interest in view of previous studies that have shown the beneficial effect of aggressive lipid-lowering treatment on myocardial perfusion imaging abnormalities. Schwartz et al (11) showed that myocardial perfusion abnormalities improved in 48% of dyslipidemic patients after 6 months of treatment with pravastatin. Similarly, Sdringola et al (12) observed marked decreases in the size and severity of myocardial perfusion abnormalities, as well as in cardiac events after intensive lifestyle changes and pharmacological antilipid treatment (12).…”