Abstract 1591: Evidence For Pleiotropic Effects Of Atorvastatin In Patients With Congestive Heart Failure
Introduction: Statins are associated with lipid reduction and improvement of outcome in patients with coronary artery disease. However the effects of statins in patients with congestive heart failure (CSF) are unknown. In order to elucidate the so called “pleiotropic effects we assessed the effect of atorvastatin-treatment on lipid level, on endothelial function in and on inflammatory and thrombotic process in patients with CHF.
Methods. Thirty-four patients with CHF (NYHA II-IV) were randomized to receive atorvastatin 10mg/day (n=17) or no statin (n=17) for 4 weeks. Endothelium dependent dilation (EDD) and endothelium independent dilation (EID) were determined by gauge-strain plethysmography. and on plasma levels of interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), vascular cell adhesion molecule (sVCAM-1) and endothelium-derived components of thrombosis/fibrinolysis such as tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1),
Results. Atorvastatin improved EDD (42.44±4.5 to 83.7±8.5%, p<0.01), decreased plasma levels of tPA (15.5±2.2 to 12.3±1.6 ng/ml p<0.05), and PAI-1 (3.02±0.39 to 1.96±0.34 IU/L, p<0.05). In control group, no significant change was observed in levels of tPA(12.2±1.7 to 11.2±2.1 ng/ml, p=ns) and PAI-1(2.60±0.33 to 3.22±0.30, p=ns). Similarly, levels of sVCAM-1, IL-6 and TNF-a were significantly decreased in atorvastatin group (from 650.7±61.7, 7.69±0.69 and 3.8±0.35 to 471.6±44.5 ng/ml, 6.02±0.81 pg/ml and 2.8±0.22 pg/ml respectively, p<0.05 for all) but not in controls (from 658.2±71.2, 7.40±0.78 and 4.4±0.68 to 646.7±70.2 ng/ml, 6.40±0.80 pg/ml and 4.55±0.58 pg/ml respectively, p=NS for all). EID remained unchanged in both study groups.
Conclusions. Atorvastatin treatment improves endothelial function and decreases the expression of proinflammatory cytokines and adhesion molecules, while it improves the balance between endothelium-derived thrombotic/fibrinolytic molecules in patients with CHF. These findings suggest that statins may be beneficial for patients with heart failure by improving endothelial function and modifying important inflammatory and thrombotic mechanisms.