Effects of atorvastatin, alone and in combination with probucol on endothelial function in patients with acute coronary syndrome

Objective: To evaluate the effects of combined atorvastatin and probucol use on endothelial function in patients with acute coronary syndrome (ACS).

Methods: Thirty patients with ACS were randomized to receive atorvastatin (20 mg/d) and probucol (500 mg/d, combination group, n = 15) or atorvastatin (20 mg/d) alone (atorvastatin group) within 24 h after admission for 4 weeks. Endothelium-dependent flow-mediated dilatation (FMD) and endothelium-independent sublingual nitroglycerin-mediated dilatation (NMD) as well as the levels of lipids and C-reactive protein were assessed at baseline, 1 week and 4 weeks after therapy.

Results: Compared to baseline, the levels of total cholesterol, LDL-C and C-reactive protein were significantly reduced after 1 week and 4 weeks in both groups, FMD equally increased after 1 week in both groups (atorvastatin group: 3.75% +/- 0.78% vs. 1.09% +/- 0.44%, combination group: 3.67% +/- 0.36% vs. 1.24% +/- 0.37%, P < 0.01). Post 4 weeks therapy, FMD increase was significantly higher in combination group (3.67% +/- 0.36% at 1 week vs. 6.85% +/- 0.64% at 4 weeks, P < 0.01) than that in atorvastatin group (3.75% +/- 0.78% vs. 3.80% +/- 0.31%, P = 0.954). NMD also equally and increased over 4 weeks in two groups (P < 0.01 vs. baseline). There was no correlation between the change in FMD/NMD and the changes in lipids or C-reactive protein levels.

Conclusions: The combined atorvastatin and probucol therapy early after ACS is superior to atorvastatin alone on improving endothelial function.