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J Thorac Cardiovasc Surg 2008;135:117-122
© 2008 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Atorvastatin impairs the myocardial angiogenic response to chronic ischemia in normocholesterolemic swine

Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.

Received for publication February 14, 2007; revisions received March 26, 2007; accepted for publication April 9, 2007.

^_* Reprint requests: Frank W. Sellke, MD, Beth Israel Deaconess Medical Center, 110 Francis Street, LMOB 2A, Boston, MA 02215. (Email: fsellke{at}caregroup.harvard.edu).

Objective: Statins, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, used routinely in patients with coronary disease, can improve endothelial function but can have biphasic and dose-dependent effects on angiogenesis. In vitro evidence suggests that the proangiogenic effects of statins are linked to activation of Akt, a mediator of endothelial cell survival and an activator of endothelial nitric oxide synthase. We investigated the functional and molecular effects of atorvastatin supplementation on microvascular function and the endogenous angiogenic response to chronic myocardial ischemia in normocholesterolemic swine.

Methods: Yucatan miniswine were fed a normal diet with (ATOR, n = 7) or without (control, n = 8) atorvastatin (1.5 mg/kg/d) for 20 weeks. Chronic ischemia was induced by ameroid constrictor placement around the circumflex artery. Myocardial perfusion was assessed at 3 and 7 weeks using isotope-labeled microspheres. In vitro microvessel relaxation responses and myocardial protein expression were evaluated.

Results: Endothelium-dependent relaxation to adenosine diphosphate and endothelium-independent relaxation to sodium nitroprusside were intact in both groups. The ATOR group demonstrated impaired microvessel relaxation to vascular endothelial growth factor (53% ± 3% vs 70% ± 7%, ATOR vs NORM at 10^–10 mol/L, P = .05) and fibroblast growth factor-2 (35% ± 3% vs 57% ± 5%, ATOR vs NORM at 10^–10 mol/L, P = .04). Baseline-adjusted myocardial perfusion in the ischemic circumflex territory was significantly reduced in the ATOR group (–0.29 ± 0.10 mL/min/g vs NORM, P = .009). Phosphorylation of Akt was significantly increased in the ATOR group (+235% ± 72%, P = .009 vs NORM), as was the myocardial expression of endostatin, an antiangiogenic protein (+51% ± 9%, P < .001 vs NORM). Expression of vascular endothelial growth factor, Tie-2, fibroblast growth factor receptor-1, and endothelial nitric oxide synthase was similar in both groups.

Conclusions: Atorvastatin supplementation is associated with impaired growth factor–mediated microvessel relaxation and a significant reduction in collateral-dependent perfusion. Chronic Akt activation, increased myocardial expression of endostatin, and impaired growth factor signaling may account for the diminished endogenous angiogenic response observed with atorvastatin treatment.

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