Effect of cholesterol lowering treatment on positive exercise tests in patients with hypercholesterolaemia and normal coronary angiograms
A P Mansur, C V Serrano Jr, J C Nicolau, L A M César, J A F Ramires
Heart
Institute, São Paulo University, Av Dr Enéas de Carvalho Aguiar
44, 05403-000 São Paulo, Brazil
Correspondence to: Dr Mansur. email: corantonio{at}incor.usp.br
Accepted for publication 13 April 1999
AIM
To assess the
impact of cholesterol lowering on positive exercise stress tests in
hypercholesterolaemic patients with normal coronary angiograms.
METHODS43
non-diabetic patients aged 43-61 years, with total serum cholesterol
concentrations of more than 7.75 mmol/l, positive exercise tests, and
normal coronary angiograms, were started on the American Heart
Association step 1 diet. After 12 weeks these patients were randomly
assigned to treatment for another 16 weeks with the diet alone (diet
group, n = 20) or with the diet plus lovastatin or simvastatin
(statin group, n = 23). After this 28 week run in period, statins
were withdrawn and lipid profile tests and exercise tests were done and
repeated 20 weeks later.
RESULTSAt week 28, the statin group but not the diet group had significant reductions from
baseline (week 12) in plasma total cholesterol (p < 0.0001), low
density lipoprotein (p < 0.0001), and triglyceride (p < 0.0001).
The number of patients with positive exercise tests decreased from 23 to three in the statin group and from 20 to 15 in the diet group
(p = 0.01). After the final 20 weeks without statins, lipid profiles
returned to baseline levels in all 17 patients remaining in the statin
group, and exercise tests were again positive in 15 of these patients.
CONCLUSIONSIn
hypercholesterolaemic patients with normal coronary arteries,
cholesterol lowering treatment reduces myocardial ischaemia, as shown
by the beneficial effects on exercise testing.
Keywords: hypercholesterolaemia; exercise stress testing; myocardial ischaemia; endothelium
© 1999 by Heart
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