Effects of a 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitor, fluvastatin, on coronary spasm after withdrawal of calcium-channel blockers
Effects of a 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitor, fluvastatin, on coronary spasm after withdrawal of calcium-channel blockers
复制标题
DOI：
10.1016/j.jacc.2007.12.049
复制
发表时间：
2008-05-06
影响因子：
24
通讯作者：
Saito, Yoshihiko
中科院分区：
文献类型：
--
作者：
Yasue, Hirofumi;Mizuno, Yuji;Saito, Yoshihiko
目的 本研究的目的是确定 3-羟基-3-甲基戊二酰辅酶 A 还原酶抑制剂（他汀类药物）是否能抑制冠状动脉痉挛。 背景 冠状动脉痉挛与内皮功能障碍有关。他汀类药物已被证明可以改善内皮功能。方法这是一项前瞻性、随机、开放标签的终点研究。 64 例无明显器质性冠状动脉狭窄且因冠状动脉内注射乙酰胆碱（ACh）引起冠状动脉痉挛的患者被随机分配至氟伐他汀 30 mg/天加常规钙通道阻滞剂（CCB）治疗（他汀组 31 例）或常规 CCB 治疗（非他汀组 33 例）。治疗6个月后，重复冠状动脉内注射ACh并评估冠状动脉痉挛。结果治疗6个月后，他汀类药物组31名患者中有16名（51.5％，p < 0.0001）和非他汀类药物组33名患者中有7名（21.2％，p = 0.0110）冠状动脉痉挛受到抑制。因此，治疗6个月后，他汀类药物组与非他汀类药物组相比，ACh引起的冠状动脉痉挛的患者数量显着减少（51.6% vs. 21.2%，p = 0.0231）。 结论 在常规CCB治疗中加入氟伐他汀30 mg/天，持续6个月，与常规CCB相比，ACh引起的冠状动脉痉挛的患者数量显着减少。 治疗。因此，他汀类药物（氟伐他汀）可能成为冠状动脉痉挛的新型治疗药物。
Objectives The purpose of this study was to determine whether a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) suppresses coronary spasm.Background Coronary spasm is associated with endothelial dysfunction. Statins have been shown to improve endothelial function.Methods This was a prospective, randomized, open-label, end point study. Sixty-four patients who had no significant organic coronary stenosis and in whom coronary spasm was induced by intracoronary injection of acetylcholine (ACh) were randomly assigned to fluvastatin 30 mg/day plus the conventional calcium-channel blocker (CCB) therapy (31 patients, statin group) or the conventional CCB therapy (33 patients, nonstatin group). After 6 months of treatment, the intracoronary injection of ACh was repeated and the coronary spasm was assessed.Results Coronary spasm was suppressed in 16 of the 31 patients (51.5%, p < 0.0001) of the statin group and in 7 of the 33 patients (21.2%, p = 0.0110) of the nonstatin group after 6 months of treatment. Thus, the number of patients with ACh-induced coronary spasm was significantly reduced in the statin group as compared with the nonstatin group (51.6% vs. 21.2%, p = 0.0231) after 6 months of treatment.Conclusions The addition of fluvastatin 30 mg/day to the conventional CCB therapy for 6 months significantly reduced the number of patients with ACh-induced coronary spasm as compared with the conventional CCB therapy. Thus, a statin (fluvastatin) may possibly be a novel therapeutic drug for coronary spasm.