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Lipid Lowering Therapy and Endothelial Function in Patients with Metabolic Syndrome

Merkovska L, Jedlickova L, Jackova L, Fedacko J, Janicko M, Novakova B and Pella D

Introduction: Endothelial dysfunction (ED) plays an important role in the development and clinical manifestation of atherosclerosis. Endothelial dysfunction has been defined as the barometer of vascular health. Therefore, the development of reliable, safe, and noninvasive methods of endothelial function assessment is important for their use in cardiovascular risk stratification. We investigated the effects of lipid lowering therapy on endothelial dysfunction in patients with metabolic syndrome.

Methods: 74 patients (36 men, 38 women) with metabolic syndrome treated with atorvastatin monotherapy not reaching plasma target levels of LDL cholesterol were enrolled to trial. In first group up titration with atorvastatin, in second group combination therapy atorvastatin+fenofibrate and in third group atorvastatin+omega 3-fatty acid were used to reach plasma target levels of LDL cholesterol for follow up of 3 months treatment. The endothelial function/ dysfunction was assessed by laboratory biomarkers according to change of the lipid levels.

Results: After 3 months of follow up we observed statistically significant changes in laboratory biomarkers of endothelial dysfunction in all patients. We observed increase in glutation peroxidase (48.53 ± 10.52 vs 45.61 ± 10.50, p <0.05), as well as the decrease in hsCRP (2.96 ± 2.20 vs 2.49 ± 1.77, p <0.05), Lp (a) (0.30 ± 0.38 vs 0.35 ± 0.46, p <0.05), apo B (0.97 ± 0.34 vs 1.18 ± 0.36, p <0.05) and homocysteine (12.99 ± 3.48 vs 17.54 ± 5.42, p <0.05).

Conclusion: The lipid lowering therapy improved endothelial function in patients with metabolic syndrome. Based on the currently available evidence, combination therapy may provide similar beneficial effects on endothelial function as statin monotherapy.