Effects of atorvastatin on arterial endothelial function in coronary bypass surgery

• Published in: European journal of cardio-thoracic surgery 2005-12, Vol.28 (6), p.805-810
• Main Authors: Chello, Massimo, Goffredo, Costanza, Patti, Giuseppe, Candura, Dario, Melfi, Rosetta, Mastrobuoni, Stefano, Di Sciascio, Germano, Covino, Elvio
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analysis of Variance; Atorvastatin; Atorvastatin Calcium; Biological and medical sciences; Brachial Artery - drug effects; Brachial Artery - physiopathology; Cardiology. Vascular system; Cardiopulmonary bypass; Cholesterol - blood; Coronary Artery Bypass; Double-Blind Method; Endothelium; Endothelium, Vascular - drug effects; Endothelium, Vascular - physiopathology; Female; Hemodynamics - drug effects; Heptanoic Acids - pharmacology; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - pharmacology; Hyperemia - physiopathology; Male; Medical sciences; Middle Aged; Nitroglycerin; Pneumology; Postoperative Period; Pyrroles - pharmacology; Statistics, Nonparametric; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Vasodilation - drug effects; Vasodilator Agents
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2005.09.013

Objective: Endothelial dysfunction represents a critical early component of organ injury following cardiopulmonary bypass. Recent studies demonstrate that the treatment with atorvastatin is associated with a significant improvement of endothelial function independently of its efficacy on cholesterol levels. Therefore, we investigated the effects of preoperative atorvastatin treatment on endothelium function after coronary surgery. Methods: Forty patients undergoing coronary surgery were randomized to treatment with atorvastatin (20 mg/die; N = 20) or placebo (N = 20) 3 weeks before surgery. Twenty normal patients served as control group. The flow-mediated dilations (FMD) of the brachial artery after both reactive hyperemia (endothelium dependent) and nitroglycerin administration (endothelium independent) were evaluated at baseline, at 48 h, and 5 days postoperatively. Results: At baseline, the endothelium-dependent FMD was significantly attenuated in coronary versus normal patients (normal 10.3 ± 1.8% vs coronary 4.1 ± 1.6%, p < 0.01). At 48 h postoperatively all patients exhibited a reduced FMD compared with baseline values: the endothelium-dependent dilatation showed a drop of 60.1 + 15% in the patients of the placebo group compared with 45.8 + 16.6% (p < 0.05) those in the atorvastatin group. At the univariate analysis, no significant correlation was found between serum levels of either total cholesterol or HDL cholesterol and FMD. The nitroglycerin-induced dilation was not significantly influenced by extracorporeal circulation as well as by atorvastatin treatment. Conclusions: The endothelial dysfunction following cardiopulmonary bypass is improved by the treatment with atorvastatin, by a mechanism unrelated to the drug efficacy of controlling serum cholesterol levels.