Statins may improve CV risk and arterial function in hypercholesterolemic patients
MedWire News: Treatment with statins significantly improves arterial properties in patients with familial hypercholesterolemia (FH), Greek researchers say, and among these patients the intensity and duration of lipid-lowering therapy correlate with arterial characteristics.
In addition, they suggest that impaired arterial function may explain the increased risk for cardiovascular disease (CVD) in patients with FH and familial combined hyperlipidemia (FCH).
"Both FH and FCH phenotypes are accompanied by subclinical atherosclerosis (increased intima-media thickness [IMT]) and endothelial dysfunction (lower flow mediated dilation [FMD]), compared to normolipidemic controls of similar age," explain Constantina Masoura and colleagues from Athens Medical School in Greece.
They add that evaluation of arterial thickness and endothelial function may be a useful risk stratification tool to detect FH and FCH patients who are more prone to development of atherosclerotic disease.
To examine the effects of these disorders on IMT and FMD, the team meta-analyzed 51 studies providing data for 4057 FH patients and 732 FCH patients. They also measured how treatment with statins in these patients impacted arterial function when compared with normolipidemic controls. Case control sample sizes ranged from 10 to 436 patients.
Pooled data showed that IMT was increased by 0.12 mm (carotid) and 0.35 mm (femoral) in FH patients, and by 0.06 mm (carotid) in FCH patients, and FMD was decreased by 5.3% in FH and 3.6% in FCH patients, when compared with controls.
Levels of total and low-density lipoprotein cholesterol were significantly positively related to femoral IMT in FH patients and carotid IMT in FCH patients, and negatively related to FMD in both.
Writing in the journal Atherosclerosis, Masoura's team suggests that the severity of hypercholesterolemia and the degree of endothelial impairment are positively related, and that lipid levels may be a determinant of structural arterial impairment.
Relative to baseline, treatment with statins in FH patients improved brachial artery FMD by 5.39% and reduced carotid IMT by 0.025 mm, and these changes were significantly related to the duration and intensity of lipid-lowering therapy.
Furthermore, statins improved FMD by 2.06% in FCH patients, but data on this, and the effect of statins on IMT were limited.
"These findings suggest that arterial structure and function may comprise a successful tool for the risk stratification, management, and evaluation of response to treatment in patients with genetic dyslipidemia, as they may integrate the cumulative damage both of genetic background and lipids/other risk factors on the arterial wall," the team concludes.
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By Nikki Withers