Title

Cholesterol reduction rapidly improves endothelial function after acute coronary syndromes. The RECIFE (Reduction of Cholesterol in Ischemia and Function of the Endothelium) trial

Purpose

To evaluate whether cholesterol reduction can result in rapid improvement of endothelial function after acute coronary syndromes

Design

Randomized, placebo-controlled study

Patients

60 patients with acute myocardial infarction or unstable angina and total cholesterol levels at admission ³ 5.2 mmol/L or LDL ³ 3.4 mmol/L

Follow-up

6 weeks. Brachial ultrasound was used to measure endothelium-dependent flow-mediated dilatation (FMD) and endothelium-dependent nitroglycerin. Changes in the levels of markers of platelet activation, coagulation factors, and plasma endothelin levels were also assessed.

Treatment regimen

Pravastatin 40 mg daily vs. placebo.

Results

• Pravastatin decreased total cholesterol and LDL cholesterol by 23% and 33%, respectively.
• FMD was unchanged with placebo, 5.43 ± 0.74% to 5.84 ± 0.81%, but increased with pravastatin, 4.93 ± 0.81% to 7.0 ± 0.79%, representing a 42% relative increase.
• Responses to nitroglycerin were similar during the time course of the study in the 2 groups.
• Markers of platelet activation, coagulation factors and endothelin levels were not affected by pravastatin .

Conclusion

Cholesterol reduction with pravastatin initiated early after acute coronary syndromes rapidly improves endothelial function after 6 weeks of therapy.