Reduction in Arterial Stiffness after Switching from Pravastatin or Atorvastatin to Fluvastatin

Abstract

Background and aims: Fluvastatin is reported to have a stronger influence on vessel walls than other statins; however, it is unclear whether there is a significant difference between the clinical effect of fluvastatin and that of other statins on arterial stiffness. The present study tested whether fluvastatin has a more beneficial effect on arterial stiffness, inflammatory biomarkers, and oxidative stress than other statins.

Methods: The study included 80 patients who had been on cholesterol-lowering therapy for more than 12 months. Brachial-ankle pulse wave velocity (baPWV), carotid artery intima-media thickness (IMT), high sensitivity C-reactive protein (hs-CRP), and malondialdehyde-modified low density lipoprotein (MDA-LDL) were measured before and after (at 3, 6, and 12 months) switching from atorvastatin (n=25), pravastatin (n=30), or non-statin therapy (n=25) to fluvastatin.

Results: LDL-cholesterol increased after switching from atorvastatin to fluvastatin, but not from pravastatin. After 12 months of fluvastatin treatment, baPWV was significantly decreased by 9%, 16%, and 19% in the atorvastatin, pravastatin, and non-statin groups, respectively. The hs-CRP level decreased significantly by 16%, 24%, and 48% in each group, respectively. The max IMT showed a significant decrease in the pravastatin and non-statin groups after fluvastatin treatment. Stepwise regression analysis showed that the change in hs-CRP was a significant determinant of the change in baPWV (F=9.13, p=0.005), and that baPWV was significantly correlated with hs-CRP (r=0.43, p=0.003).

Conclusions: Fluvastatin has a more favorable influence on arterial stiffness than atorvastatin or pravastatin, due to its anti-inflammatory effect. Therefore, lipid-lowering therapy with fluvastatin may better prevent cardiovascular events than atorvastatin or pravastatin.