© 2000 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
Cholesterol-Lowering Treatment Is Associated With Improvement in Coronary Vascular Remodeling and Endothelial Function in Patients With Normal or Mildly Diseased Coronary Arteries
From the Center for Coronary Physiology and Imaging, The Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn.
Abstract— Coronary
vascular remodeling and altered endothelial function
have been described in the early stages of native
atherosclerosis. The purpose of this study was to
evaluate the association between cholesterol-lowering
therapy and coronary vascular remodeling and
endothelial function in patients with normal or mildly
diseases coronary arteries. Patients (N=101) with normal or
mildly diseased coronary arteries by coronary
angiography underwent intravascular ultrasound examination of the left
anterior descending coronary artery. Vessel and lumen area,
atherosclerotic plaque area, and plaque morphology were evaluated.
Vascular reactivity was examined with the use of intracoronary
adenosine, acetylcholine, and nitroglycerin.
Patients were divided into 3 groups based on the total
cholesterol levels: group 1 (n=25), patients with a history
of hypercholesterolemia adequately treated
(total cholesterol <240 mg/dL); group 2 (n=26), patients
with hypercholesterolemia not adequately
controlled (total cholesterol 
240 mg/dL); and group 3
(n=50), patients without hypercholesterolemia.
Vessel area and lumen area were significantly greater in groups 1 and 3
than in group 2 (for respective values in groups 1, 2, and 3: vessel
area 11.9±0.5, 10.6±0.4, and 11.8±0.4 mm2, both
P<0.05; lumen area 8.3±0.4, 6.9±0.3, and
8.9±0.3 mm2, both P<0.01). However,
plaque areas in groups 1 and 2 were similar. Furthermore,
acetylcholine-induced percent increases in coronary blood flow
were significantly greater in groups 1 and 3 than in group 2 (for
respective values in groups 1, 2, and 3: 70.5±20.1%, 22.8±13.7%,
and 68.6±14.8%, both P<0.05).
Cholesterol-lowering treatment is associated with an
improvement in coronary lumen area that results not from a
decrease in plaque area but from an increase in vessel area, reflecting
vascular remodeling. Additionally, this adaptive process may occur in
association with an improvement of
endothelium-dependent vasodilation of the resistance
coronary artery.
Key Words: remodeling • hypercholesterolemia • cholesterol • endothelium • ultrasonics
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