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(Circulation. 2006;114:I-402 – I-408.)
© 2006 American Heart Association, Inc.

Surgery for Coronary Artery Disease

High-Dose Atorvastatin Improves Hypercholesterolemic Coronary Endothelial Dysfunction Without Improving the Angiogenic Response

Munir Boodhwani, MD; Yasunari Nakai, MD; Pierre Voisine, MD; Jun Feng, MD, PhD; Jian Li, PhD; Shigetoshi Mieno, MD, PhD; Basel Ramlawi, MD; Cesario Bianchi, MD; Roger Laham, MD; Frank W. Sellke, MD

From the Division of Cardiothoracic Surgery and Cardiology (J.L., R.L.), Beth Israel Deaconess Medical Center, Boston, Mass.

Reprint requests to Dr Frank W. Sellke, Beth Israel Deaconess Medical Center, 110 Francis St, LMOB 2A, Boston, MA 02215. E-mail fsellke{at}caregroup.harvard.edu

Background— Although 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) can restore endothelial function in coronary disease, in vitro and murine studies have shown their effects on myocardial angiogenesis to be biphasic and dose dependent. We investigated the functional and molecular effects of high-dose atorvastatin on the endogenous angiogenic response to chronic myocardial ischemia in hypercholesterolemic swine.

Methods and Results— Yucatan pigs were fed either a normal (NORM group; n=7) or high-cholesterol diet, with (CHOL-ATR group; n=7) or without (CHOL group; n=6) atorvastatin (3 mg/kg per day) for 13 weeks. Chronic ischemia was induced by ameroid constrictor placement around the circumflex artery. Seven weeks later, microvessel relaxation responses, myocardial perfusion, and myocardial protein expression were assessed. The CHOL group demonstrated impaired microvessel relaxation to adenosine diphosphate (29±3% versus 61±6%, CHOL versus NORM; P<0.05), which was normalized in the CHOL-ATR group (67±2%; P=NS versus NORM). Collateral-dependent myocardial perfusion, adjusted for baseline, was significantly reduced in the CHOL group (–0.27±0.07 mL/min per gram versus NORM; P<0.001) as well as the CHOL-ATR group (–0.35±0.07 mL/min per gram versus NORM; P<0.001). Atorvastatin treatment was associated with increased phosphorylation of Akt (5.7-fold increase versus NORM; P=0.001), decreased vascular endothelial growth factor expression (–68±8%; P<0.001 versus NORM), and increased expression of the antiangiogenic protein endostatin (210±48%; P=0.004 versus NORM).

Conclusions— Atorvastatin improves hypercholesterolemia-induced endothelial dysfunction without appreciable changes in collateral-dependent perfusion. Increased myocardial expression of endostatin, decreased expression of vascular endothelial growth factor, and chronic Akt activation associated with atorvastatin treatment may account for the diminished angiogenic response.

Key Words: angiogenesis • endothelium • hypercholesterolemia • ischemia • HMG-CoA reductase inhibitors