Influence of one-year treatment with lovastatin on myocardial remodeling and ischemia in patients with coronary artery disease.

Objective: Emerging evidence assumes that statins have a benefit to influence the myocardial remodeling and ischemia in patients with coronary artery disease (CAD). Our aim was to investigate the possible and direct favorable effects of lovastatin on left ventricular (LV) systolic, diastolic function and myocardial ischemia in patients with CAD.

Methods: This randomized prospective study consisted of 83 patients (46 males; mean age 54.3 ± 6.5 years) with CAD and dyslipidemia. All patients were randomized to following groups: the 1st group (n=44) received lovastatin (20-60 mg/day), hypolipidemic diet and physical training; the 2nd group (n=39) - hypolipidemic diet and physical training. Lipid spectrum, Doppler-echocardiography, bicycle exercise test and 24-hour ambulatory electrocardiographic monitoring were done at baseline and were repeated after 12 months of treatment. The data were analyzed by using the paired and unpaired Student's t-tests.

Results: In the 1st group there was an improvement of lipid spectrum (p=0.05) without significant changes of liver transaminases and other side effects. After treatment LV ejection fraction increased from 59.8 ± 8.04 to 62.9 ± 4.43% in lovastatin alone group (p=0.01). Unlike 2nd group, the 1st group's patients had also reduction of myocardial ischemia: increased exercise time (5.21 ± 1.81 vs. 5.96 ± 1.76 min; p=0.05), METS (4.42 ± 0.6 vs. 4.78 ± 0.7; p=0.05), magnitude (1.12 ± 0.34 vs. 0.81 ± 0.19 mm; p=0.05) and duration (2.16 ± 0.67 vs. 1.04 ± 0.46 min, p=0.01) of ST segment depression , as well as number of leads with ST segment depression (2.18 ± 0.72 vs. 1.31 ± 0.67; p=0.05).

Conclusion: Lipid-lowering therapy with lovastatin improved the LV systolic function and decreased myocardial ischemia.