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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
52
VOLUME 15 NUMBER 2 • NOVEMBER 2018
The effects of treatment with atorvastatin versus
rosuvastatin on endothelial dysfunction in patients with
hyperlipidaemia
Vahit Demir, Mehmet Tolga Do
ğ
ru, Hüseyin Ede, Samet Yılmaz, Ca
ğ
lar Alp, Yunus Celik,
Nesligül Yıldırım
Correspondence to: Vahit Demir
Cardiology Department, Faculty of Medicine, Bozok University, Yozgat, Turkey
e-mail:
dr.vdemir@hotmail.comHüseyin Ede
Cardiology Department, Faculty of Medicine, Bozok University, Yozgat, Turkey
Mehmet Tolga Do
ğ
ru, Ca
ğ
lar Alp, Yunus Celik, Nesligül Yıldırım
Cardiology Department, Faculty of Medicine, Kırıkkale University, Kırıkkale,
Turkey
Samet Yılmaz
Cardiology Department, Yozgat State Hospital, Yozgat, Turkey
Previously published in
Cardiovasc J Afr
2018;
29
(3): 162–166
S Afr J Diabetes Vasc Dis
2018;
15
: 52–56
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
rosuvastatin) were enrolled in the study. In accordance with
the literature, flow-mediated dilation (FMD) and nitrate-
mediated 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,
creatinine, 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 (
p
= 0.958 for FMD and 0.827 for EID). There was no
statistically significant difference between the atorvastatin
and rosuvastatin groups in terms of final FMD and EID values
(
p
= 0.122 and 0.115, respectively).
Conclusion:
This study demonstrated that both one-year
atorvastatin 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
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.
3
Pleiotropic effects of statins include
improvement in endothelial function, anti-thrombosis, plaque
stabilisation and anti-oxidative effects, and decreasing the duration
of vascular inflammation.
4
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.9 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.
10
Studies on primary and secondary prevention of 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
studywe aimed to compare the effect of one-year rosuvastatin versus
atorvastatin therapy on endothelial function in hyperlipidaemic
patients, using FMD and endotheliumindependent 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 in the
study between May 2010 and August 2011. Approval of the local
ethics committee and informed consents of the participants were
obtained accordingly.