Hypercholesterolemia is a well-established risk factor for the development of vascular events.
Statins have pleiotropic effects beyond reducing the
low-density lipoprotein-cholesterol (
LDL-C) concentration. This study sought to determine whether treatment with
pitavastatin affects latent regional left ventricular (LV) systolic and diastolic dysfunction and carotid arterial stiffness in patients with
hypercholesterolemia and preserved LV ejection fraction (LVEF), using newly developed ultrasonic strain imaging and carotid ultrasonography.
METHODS AND RESULTS: A total of 30 patients with
hypercholesterolemia (>or=220 mg/dl for serum total
cholesterol, and/or >or=140 mg/dl for
LDL-C) were randomized to either administration of
pitavastatin (1 or 2 mg/day; n=15) or no
statin therapy (n=15) for 12 months. LV systolic and diastolic functions were evaluated by measuring transmitral flow velocity, mitral annular motion velocity, and the myocardial strain and strain rate profiles using pulsed Doppler, tissue velocity, and ultrasonic strain imaging. Subclinical
atherosclerosis also was determined by measuring the intima - media thickness (IMT) and stiffness beta of the left and right common carotid arteries using B- and M-mode ultrasonography. During the follow-up period, the mean peak systolic strains of the LV posterior and inferior walls increased from 39.2+/-15.9% to 51.5+/-17.7% (p<0.01) and 46.0+/-12.2% to 57.5+/-10.3% (p<0.01), respectively, in the
pitavastatin group compared with the no
statin group. The mean peak early diastolic strain rates of the LV posterior and inferior walls also increased from -6.5+/-2.9 s(-1) to -9.5+/-2.8 s(-1) (p<0.01) and -6.5+/-2.5 s(-1) to -9.1+/-2.7 s(-1) (p<0.01), respectively, in the
pitavastatin group. The stiffness beta decreased from 5.6+/-2.5 to 4.1+/-0.8 (p<0.05) in the
pitavastatin group, whereas there was no significant change in IMT.
CONCLUSIONS: One year of
pitavastatin treatment improved not only carotid arterial stiffness but also regional LV systolic and diastolic function in patients with
hypercholesterolemia and preserved LVEF. Ultrasonic strain imaging has the potential to become a sensitive tool for detecting the effects of early medical intervention on latent regional LV myocardial dysfunction in this patient population.