Atorvastatin therapy improves endothelial-dependent vasodilation in patients with systemic lupus erythematosus: an 8 weeks controlled trial

• Published in: Rheumatology (Oxford, England) England), 2007-10, Vol.46 (10), p.1560-1565
• Main Authors: Ferreira, G. A., Navarro, T. P., Telles, R. W., Andrade, L. E. C., Sato, E. I.
• Format: Article
• Language: English
• Subjects: Adult; atherosclerosis; Atherosclerosis (general aspects, experimental research); atorvastatin; Atorvastatin Calcium; Biological and medical sciences; Blood and lymphatic vessels; Brachial Artery - diagnostic imaging; Brachial Artery - drug effects; Brachial Artery - physiopathology; Cardiology. Vascular system; Coronary Disease - etiology; Coronary Disease - prevention & control; Diseases of the osteoarticular system; endothelial function; Endothelium, Vascular - diagnostic imaging; Endothelium, Vascular - drug effects; Endothelium, Vascular - physiopathology; Female; Heptanoic Acids - pharmacology; Heptanoic Acids - therapeutic use; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - pharmacology; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - diagnostic imaging; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - physiopathology; Medical sciences; Pyrroles - pharmacology; Pyrroles - therapeutic use; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Severity of Illness Index; systemic lupus erythematosus; Ultrasonography; vascular ultrasound; Vasodilation - drug effects
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kem186

Introduction. Patients with systemic lupus erythematosus (SLE) have recognized reduction in endothelium-dependent vasodilation. Evidence demonstrates that statins are able to improve endothelial function independently on their hypolipemic action. Objectives. To evaluate the efficacy of atorvastatin in improving vasodilation in SLE patients with and without conventional risk factors for coronary heart disease (CHD). Patients and methods. Sixty-four SLE women, mean age 31 ± 8 yrs, received atorvastatin 20 mg/day during 8 weeks. Thirty-one patients in this intervention group did not have conventional risk factors for CHD, while 33 others had hypertension, dyslipidaemia and/or obesity. Twenty-four SLE control patients, mean age 34 ± 7.5 yrs, not receiving atorvastatin were followed during the same time period. High-resolution ultrasound was used to measure brachial artery diameter in resting conditions, during reactive hyperaemia and after sub-lingual glyceryl trinitrate (GTN). Measurements were performed at baseline and at the end of the study (8 weeks). Results. Atorvastatin was associated with a significant increase in flow-mediated dilation (FMD) [3.8 (2.8–7.9%) vs 6.9 (4.2–10.7%), P < 0.001] while GTN-mediated dilation (GTND) was unaffected [20.9 (16.6–26.1%) vs 20.1(16.6–25.4%), P = 0.514]. FMD increase was observed in patients with conventional risk factors [4.1 (3.1–8.7%) vs 6.5 (4–10%), P = 0.046] and also for those without conventional risk factors for CHD [3.6 (2.6–7.3%) vs 7.1 (4.5–10.9%), P = 0.001]. Resting brachial artery diameter also increased significantly in patients receiving atorvastatin (2.79 ± 0.30 mm vs 2.92 ± 0.40 mm, P < 0.001). No significant difference in artery diameter and FMD was seen in control patients at the end of the study. When compared to the control patients, atorvastatin treatment was associated with significant increase in resting diameter (+0.13 ± 0.1 mm vs –0.02 ± 0.07 mm, P < 0.001) and FMD (+1.9 ± 3.9% vs –0.3 ± 1.8%, P = 0.009). Conclusion. Our results demonstrate that an 8-week 20 mg/day atorvastatin series improved endothelium-dependent vasodilation in SLE patients independently on the presence of conventional risk factors for atherosclerotic disease.