Quinapril improves endothelial function in postmenopausal hypertensive patients.

BACKGROUND/AIM: Hypertension is one of the main cardiovascular risk factors, and it may be responsible for the excess morbidity and mortality in postmenopausal women. Endothelium-dependent dilation of conduit arteries is reduced in women after menopause, as shown by the reduced flow-mediated dilation (FMD) of the brachial artery. The aim of this study was to evaluate changes in FMD during and following a 6-month-long treatment with increasing doses (10, 20 and 40 mg) of quinapril in hypertensive postmenopausal patients. METHODS: A multicenter, open-label, non-comparative, baseline control study in 61 postmenopausal outpatients. RESULTS: The mean baseline FMD (% +/- SD) of the 53 patients in the intent-to-treat population (patients with at least one FMD evaluation) was 2.83 +/- 1.24%; FMD of the 51 subjects on 10 mg quinapril daily was 5.58 +/- 2.179%; FMD of the 52 patients on 20 mg quinapril was 7.06 +/- 2.31%, and FMD of the 53 subjects on 40 mg daily was 8.07 +/- 2.57% (p < 0.001 for each dose, compared to baseline). CONCLUSION: Ourresults confirmed that quinapril improves endothelial function at all examined doses as measured by FMD. Modulation of the renin-angiotensin system may act as a target for reducing cardiovascular risk in postmenopausal hypertensive women.

Effect of simvastatin on endothelial function in cardiac syndrome X patients.

Patients with cardiac syndrome X with mild hypercholesterolemia were randomized to placebo (n = 20) or simvastatin 20 mg/day (n = 20). In the simvastatin group, there was a significant (26%; p < 0.0001) decrease in total cholesterol, a 38% (p < 0.0001) decrease in low-density lipoprotein cholesterol levels, and 7% a (p < 0.0001) increase in high-density lipoprotein cholesterol levels, without significant changes in triglyceride levels. Brachial artery flow-mediated dilation increased significantly (52% relative increase, p < 0.0001), and the time to > 1-mm ST-segment depression during stress testing was longer by the end of the study (p < 0.0001).

[Effect of simvastatin therapy on endothelial function of hypercholesteremic patients with syndrome X]. / A simvastatin-kezelés hatása hypercholesterinaemiás, coronaria X-szindrómás betegek endothelfunkciójára.

INTRODUCTION: Cardiac syndrome X patients often have both reduced coronary circulation and impaired systemic endothelial function. AIMS: The aim of our study was to assess the effect of chronic statin therapy on exercise-induced "ischemic like" ST segment depression and on systemic endothelial function in cardiac syndrome X patients with hypercholesterolemia. PATIENTS/METHODS: In 25 hypercholesterolemic patients (15 males, mean age 55 +/- 3 years) with a normal coronary angiogram and positive exercise ECG test (> 0.1 mV ST segment depression) the flow mediated dilatation (FMD) was assessed by measuring the change in brachial artery diameter in response to hyperemic flow by vascular ultrasound. All patients were treated with 20 mg simvastatin in duration of 12 weeks. Following the treatment the exercise ECG and the vascular ultrasound studies were repeated. RESULTS: There was a significant decrease in total serum cholesterol level (baseline = 5.82 +/- 0.19 mmol/L vs. study end = 4.49 +/- 0.17 mmol/L, p < 0.01) and significant increase in the serum HDL level (baseline = 1.05 +/- 0.16 mmol/L vs. study end = 1.11 +/- 0.14 mmol/L, p < 0.01) following the statin treatment. Parallelly brachial artery FMD increased significantly (baseline = 3.97 +/- 0.91% vs. study end = 6.84 +/- 0.89%, p < 0.05). Responses to nitroglycerin were similar during the time course of the study. The ischemia free stress test time was also higher at the study end (baseline = 5.18 +/- 2.01 min vs. study end = 6.01 +/- 1.94 min, p < 0.001). CONCLUSIONS: The chronic statin therapy exerts beneficial effects both on systemic and coronary endothelial function in hypercholesterolemic patients with cardiac syndrome X.