Abstract
Background: It has been shown that statin treatment improves endothelial function in many cardiovascular conditions. However, it remains unclear wheter the beneficial effects of statin treatment on endothelial function in patients with acute myocardial infarction (AMI) are dependent of statin dosage. The aim of our study was to assess the effects of different statin doses on endothelial function as assessed by flow mediated vasodilatation of brachial artery (FMD), in patients with myocardial infarction. Methods: Ninty patients with acute myocardial infarction were randomized, within 24-72h from hospitalization, in three groups according to the statin dose used-Group I-commonly used statin dose in CCU, Group II-atorvastatin 40mg, Group III atorvastatin 80mg. Endothelial function was assessed by FMD of brachial artery prior to randomization, on day 7, and on day 30 after the randomization, as well as lipid fractions-total cholesterol (Chol), LDL-cholesterol (LDL), HDL-cholesterol (HDL) and triglycerides (TG). Results: There was no difference in clinical characteristics (age, peak-creatinine kinase, prevalence of smoking and diabetes, p=NS for all), baseline FMD (2.69±4.32% (group I) vs. 4.39±4.76% (group II) vs. 3.39±5.22% (group III), p=NS for all) and all lipid fractions (p=NS for all comparisons). During the follow-up period of 30 days, 4 patients died, one patient was lost to follow-up and one patient was excluded from the study due to more than triple increase in transaminase levels. Overall, statin treatment improved FMD after 7 days (baseline: 3.18±4.74% vs. 5.21±4.30% day 7, p<0.01), with further improvement after 30 days (FMD 6.77±4.39%, p<0.001 vs. baseline and day 7). However, there was no difference in FMD between the groups after 7 days (4.07±4.92% (I) vs. 5.56±4.36% (II) vs. 5.92±3.48% (III), p=NS) and after 30 days (6.55±4.53% (I) vs. 7.20±4.29% (II) vs. 6.97±4.26% (III) of treatment. With 30 days statin treatment there was significant decrease in total cholesterol (6.04±1.59 vs. 4.24±1.00mmol/L) and LDL cholesterol (4.1±1.09 vs. 3.13±0.94mmol/L) (p<0.01 for both), without the significant changes in HDL and TG. However, there was no siginificant correlation between FMD and lipid fractions during the study. Conclusion: Early statin treatment improves endothelial function in patients with acute myocardial infarction, soon after the treatment initiation. However, the observed effects are not dependent on the dose of statin used.
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