Cardiovascular Journal of Africa: Vol 29 No 3 (May/Junel 2018)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 3, May/June 2018

162

AFRICA

The effects of treatment with atorvastatin versus

rosuvastatin on endothelial dysfunction in patients with

hyperlipidaemia

Vahit Demir, Mehmet Tolga Do

ru, Hüseyin Ede, Samet Yılmaz, Ca

lar Alp, Yunus Celik, Nesligül Yıldırım

Abstract

Introduction:

Statins can reduce cardiovascular events and

improve endothelial function. However, differences in the

effect of statins on endothelial dysfunction have not been

researched sufficiently. Here, we aimed to compare the effects

of atorvastatin versus rosuvastatin on endothelial function

via flow-mediated and endothelial-independent dilation.

Methods:

Hyperlipidaemic subjects on treatment with statins

for one year (either 20 mg/day atorvastatin or 10 mg/day rosu-

vastatin) were enrolled in the study. In accordance with the

literature, flow-mediated dilation (FMD) and nitrate-medi-

ated endothelium-independent dilation (EID) were measured

by ultrasonography on the right brachial artery of each

subject. Baseline and final measurements were compared in

each group and between the groups.

Results:

One hundred and four subjects (50 atorvastatin and

54 rosuvastatin users) were enrolled in the study. Fifty-eight

subjects were female. The groups were statistically similar in

terms of age and body mass index, and haemoglobin, creati-

nine, total cholesterol, triglyceride, high-density lipoprotein

and low-density lipoprotein cholesterol levels. In each group,

the mean final FMD and EID values were higher compared

to their respective baseline values, but the mean changes in

FMD and EID were statistically similar in both groups (

0.958 for FMD and 0.827 for EID). There was no statistically

significant difference between the atorvastatin and rosuvasta-

tin groups in terms of final FMD and EID values (

0.122

and 0.115, respectively).

Conclusion:

This study demonstrated that both one-year ator-

vastatin and rosuvastatin treatments significantly improved

endothelial function, when assessed with FMD and EID

and measured by ultrasonography. However, the amount of

improvement in endothelial dysfunction was similar in the

two treatments.

Keywords:

atorvastatin, endothelial function, flow-mediated

vasodilatation, rosuvastatin

Submitted 31/8/17, accepted 14/1/18

Published online 8/3/18

Cardiovasc J Afr

2018;

: 162–166

www.cvja.co.za

DOI: 10.5830/CVJA-2018-008

Hyperlipidaemia is an important risk factor for the development

of atherosclerosis. Statins may reduce the risk of cardiovascular

events and improve endothelial function.

1,2

The positive effect of

statins on endothelial dysfunction is carried out via endothelial

nitric oxide enzyme activation.

Pleiotropic effects of statins

include improvement in endothelial function, anti-thrombosis,

plaque stabilisation and anti-oxidative effects, and decreasing

the duration of vascular inflammation.

However, differences

in the effect of statins on endothelial dysfunction has not

been researched sufficiently. Earlier studies demonstrated that

improved endothelial dysfunction in different vascular beds

started after a few days of treatment with statins.

5-8

Endothelial dysfunction is the early sign of atherosclerosis

and enhances the risk of cardiovascular events.

Flow-mediated

dilation (FMD) is a well-known method used for predicting

the extent of atherosclerosis. FMD is measured on the brachial

arteries and reflects the ability of an artery to enlarge after

being compressed for a certain time. Nitric oxide (NO) is the

most important vascular vasodilator and is produced by the

endothelium in response to certain factors such as shear stress.

Its production is impaired in the case of endothelial dysfunction.

Increased production of NO after increased vascular blood flow

is the underlying mechanism of FMD.

Studiesonprimaryandsecondarypreventionof cardiovascular

disease and its complications by statins revealed that their effect

occurs not only due to their lipid-lowering effect but also due

to pleiotropic effects, the mechanism of which remains unclear.

In this study we aimed to compare the effect of one-year

rosuvastatin versus atorvastatin therapy on endothelial function

in hyperlipidaemic patients, using FMD and endothelium-

independent dilation (EID), measured ultrasonographically on

the brachial artery.

Methods

A total of 112 patients diagnosed with hyperlipidaemia and

without a history of previous lipid-lowering medication for

at least the previous two months, and with an indication for

medical treatment despite a first-line, four-week, lipid-lowering

diet, applied to the cardiology out-patient unit and were enrolled

Cardiology Department, Faculty of Medicine, Bozok

University, Yozgat, Turkey

Vahit Demir, MD,

dr.vdemir@hotmail.com

Hüseyin Ede, MD

Cardiology Department, Faculty of Medicine, Kırıkkale

University, Kırıkkale, Turkey

Mehmet Tolga Do

ru, MD

lar Alp, MD

Yunus Celik, MD

Nesligül Yıldırım, MD

Cardiology Department, Yozgat State Hospital, Yozgat,

Turkey

Samet Yılmaz, MD