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

2000, Arteriosclerosis, Thrombosis, and Vascular Biology

Coronary 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 (Nϭ101) 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 levels: group 1 (nϭ25), patients with a history of hypercholesterolemia adequately treated (total cholesterol Ͻ240 mg/dL); group 2 (nϭ26), patients with hypercholesterolemia not adequately controlled (total cholesterol Ն240 mg/dL); and group 3 (nϭ50), 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 3: vessel area 11.9Ϯ0.5, 10.6Ϯ0.4, and 11.8Ϯ0.4 mm 2 , both PϽ0.05; lumen area 8.3Ϯ0.4, 6.9Ϯ0.3, and 8.9Ϯ0.3 mm 2 , both PϽ0.01). 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 3: 70.5Ϯ20.1%, 22.8Ϯ13.7%, and 68.6Ϯ14.8%, both PϽ0.05). 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.