© 1995 American Heart Association, Inc.
Articles |
Inhibition of Thromboxane Biosynthesis and Platelet Function by Simvastatin in Type IIa Hypercholesterolemia
Presented in part at the 66th Scientific Sessions of the American Heart Association, Atlanta, Ga, November 8-11, 1993, and published in abstract form (Circulation. 1993;88:519).
From the Department of Medicine, University of Palermo (A.N., C.M.B., A.G., C.G., F.P.La P.); the Department of Medicine, University of Catania (M.A.); and the Departments of Hematology (G.D.) and Pharmacology (C.P), University of Chieti, Italy.
Correspondence to Prof Carlo Patrono, Cattedra di Farmacologia I, Università degli Studi "G. D'Annunzio," Facoltà di Medicina e Chirurgia, Via dei Vestini 31, 66013 Chieti, Italy.
Abstract Thromboxane A2 (TXA2) biosynthesis is enhanced in the majority of patients with type IIa hypercholesterolemia. Because simvastatin (a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor) was previously shown to reduce platelet aggregation and TXB2 production ex vivo, we investigated TXA2 biosynthesis and platelet function in 24 patients with type IIa hypercholesterolemia randomized to receive in a double-blind fashion simvastatin (20 mg/d) or placebo for 3 months. The urinary excretion of 11-dehydro-TXB2, largely a reflection of platelet TXA2 production in vivo, was measured by a previously validated radioimmunoassay technique. Blood lipid levels and urinary 11-dehydro-TXB2 excretion were significantly (P<.001) reduced by simvastatin. In contrast, placebo-treated patients did not show any statistically significant changes in either blood lipids or 11-dehydro-TXB2 excretion. The reduction in 11-dehydro-TXB2 associated with simvastatin was correlated with the reduction in total cholesterol (r=.81, P<.0001), LDL cholesterol (r=.79, P<.0001), and apolipoprotein B (r=.76, P<.0001) levels. Platelets from patients with type IIa hypercholesterolemia required significantly (P<.01) more collagen and ADP to aggregate and synthesized less TXB2 in response to both agonists after simvastatin therapy. Bleeding time, platelet sensitivity to Iloprost, and blood lipoprotein(a) and HDL cholesterol levels were not significantly affected by either treatment. We conclude that enhanced TXA2 biosynthesis in type IIa hypercholesterolemia is, at least in part, dependent on abnormal cholesterol levels and/or other simvastatin-sensitive mechanisms affecting platelet function.
Key Words: thromboxane A2 • platelet function • simvastatin • 11-dehydrothromboxane B2 • type IIa hypercholesterolemia
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