[Effect of various approaches to therapy with statins in high risk patients from the point of view of vascular endothelium].

In a framework of multicenter study ATLANTIKA in a group of patients we carried out noninvasive ultrasound test of endothelium dependent vasodilatation (EDVD) of brachial artery before and at the background of therapy with atorvastatin. Aim of the study was to assess and compare effects of incremental (10-80 mg/day) and stable (10 mg/day) doses of atorvastatin on functional state of endothelium. The group of observation comprised 148 patients A 86 men, 62 women aged 59.5 (55;66) years, who were included into ATLANTIKA study and randomized to 3 groups: group A - active therapy with stable dose of atorvastatin (10 mg/day) (n=52), active therapy with titration of atorvastatin dose from 10 to 80 mg/day (n=50), group C - common therapy which could include lipid lowering drugs (n=46). At baseline there were no statistically significant differences between groups in main demographical, laboratory and instrumental parameters. Median EDVD was 5.4 (3.5; 8.0), 5.1 (3.9; 7.6) and 5.6 (3.2; 8.1)% in groups A, B, and C, respectively. After 12 and 24 weeks of observation statistically significant increases of brachial artery EDVD occurred only in group B (by 27.2 and 31.9%, respectively). There was no statistically significant positive dynamics of EDVD in groups A and C. Results of the presented work show that for achievement of statistically significant positive vascular effect it is necessary to titrate dose of atorvastatin until target level of low density lipoprotein cholesterol (< 2.5 mmol/l) is achieved. Vascular effect of therapy with atorvastatin in a fixed dose 10 mg/day is inferior to that of aggressive therapy, however it is substantially superior to common treatment.

[Randomized FARVATER study. Part 2. Effect of atorvastatin on endothelial function, distensibility and stiffness of vascular wall].

AIM: To elucidate effect of two doses of atorvastatin (10 and 20 mg/day) on endothelial function, distensibility and stiffness of vascular wall. MATERIAL AND METHODS: Patients (n=50) with documented ischemic heart disease and hyperlipidemia were randomized to 10 or 20 mg/day of atorvastatin (Atoris, KRKA). Endothelial function and common carotid artery wall distensibility and stiffness were assessed at baseline and after 12 and 24 weeks of treatment. RESULTS: Administration of both 10 and 20 mg/day doses of atorvastatin for 6 weeks was associated with significant lowering of total cholesterol (CH), triglycerides (TG) and low density lipoprotein (LDL) CH (24.5, 18.4, 34.9% and 29.1, 28.2, 40.9%, respectively). After 24 weeks LDL CH lowering from baseline reached 34.9 and 43.9% (p<0.001) and that of TG - 22 and 15%, in 10 and 20 mg/day groups, respectively. There were no significant differences between 10 and 20 mg/day groups in baseline values of endothelium dependent vasodilation (EDV), carotid artery distensibility and stiffness (7.28 and 6.64%, 21.60 and 20.15, 8.04 and 9.19 U, in 10 and 20 mg/day groups, respectively). After 3 months of treatment there occurred significant 38.4% (10 mg/day) and 45.4% (20 mg/day) increases of EDV. Significant 27.6% (10 mg/day) and 28.8% (20 mg/day) enhancement of vascular distensibility was noted after 24 weeks. Vascular wall stiffness decreased 33.4% (p=0.008) and 31.3% (p=0.002) in 10 and 20 mg/day groups, respectively.