Reduction of myocardial ischemia with simvastatin in addition to conventional treatment in patients with chronic coronary artery disease.

BACKGROUND

Coronary artery disease is becoming more prevalent every day. We now know that controlling the risk factors for this pathology is of the utmost importance, not only to prevent the formation of atheromatous plaques (primary prevention), but also to slow its progression, or even promote regression of existing plaques (secondary prevention). There is no longer any doubt that an increase in serum cholesterol is essential for the development and progression of atherosclerosis. Therefore, lowering cholesterol levels is a key factor in controlling this disease. It has been shown that cholesterol reduction with statins is associated with a reduction in cardiovascular morbidity and mortality. It has also been demonstrated that reducing cholesterol restores peripheral and coronary vasodilation even in subjects with no angiographic evidence of the disease.

OBJECTIVE

The present study aimed at assessing the effect of simvastatin in reducing myocardial ischemia in patients with chronic atherosclerotic coronary artery disease.

PATIENTS AND

METHODS

Twenty-five patients with stable angina and dyslipidemia undergoing clinical treatment were studied prospectively. Their lipid profile was analyzed and the diagnosis of effort-induced ischemia was confirmed by means of exercise testing. They were then randomly distributed in two groups: the simvastatin group and the placebo group. After a four- to six-month follow-up period (average of 5.72 months), they underwent new laboratory and exercise tests.

RESULTS

A significant reduction in the variation of total cholesterol (p < 0.0002) and LDL-C levels (p < 0.001) was observed in the simvastatin group, compared to the placebo group. The parameters assessed during the exercise test revealed a significant improvement in ST-segment depression during effort (p < 0.046), as well as a decrease in precordial pain in the treated group during exertion, when comparing pre- and post-treatment periods. Patients receiving simvastatin also improved their functional capacity (p < 0.016), subjectively assessed by the angina pectoris classification of the Canadian Cardiovascular Society.

CONCLUSIONS

These results suggest that the association of simvastatin and conventional treatment in patients with stable angina reduces effort-induced ischemia, and can be used with this group of patients, particularly those considered ineligible for invasive therapeutic intervention.