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Statins enhance postischemic hyperemia in the skin circulation of hypercholesterolemic patients

A monitoring test of endothelial dysfunction for clinical practice?

Christian Binggeli, MD^*, Lukas E. Spieker, MD^*, Roberto Corti, MD^*, Isabella Sudano, MD, PhD^*, Vesna Stojanovic, MD^*, Daniel Hayoz, MD, Thomas F. Lüscher, MD, FACC, FESC, FRCP^* and Georg Noll, MD, FESC^*,*

^* CardioVascular Center, Division of Cardiology, University Hospital, Zürich, Switzerland
Division of Hypertension and Vascular Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

View larger version (16K): [in a new window]   Figure 1 Relation between maximal blood flow during reactive hyperemia of the skin and plasma levels of low-density lipoprotein (LDL) cholesterol. There was a significant inverse correlation between skin blood flow and LDL cholesterol.

View larger version (23K): [in a new window]   Figure 2 Skin blood flow during reactive hyperemia in normocholesterolemic and hypercholesterolemic subjects and before and during therapy with a statin (changes normalized to baseline flow). Hyperemic skin blood flow in hypercholesterolemic patients is reduced compared with healthy controls, *p < 0.0001 versus healthy volunteers and can markedly be increased by statin therapy, p = 0.0005 versus before treatment.

View larger version (19K): [in a new window]   Figure 3 Scattergram: individual patients undergoing cholesterol lowering. Total cholesterol was reduced by statins in every patient and postischemic blood flow increased in every patient.

View larger version (14K): [in a new window]   Figure 4 (A) Skin blood flow during reactive hyperemia before and after cyclooxygenase inhibition with aspirin (percent change from baseline). Hyperemic skin blood flow is markedly reduced after oral administration of aspirin (*p = 0.025). (B) Skin blood flow during reactive hyperemia after intracutaneous administration of L-NAME, an inhibitor of nitric oxide synthase, and control (D-NAME), respectively (percent change from baseline). There is no significant difference in hyperemic skin blood flow.