Published Online
on August 24, 2006

A more recent version of this article appeared on October 1, 2006

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Submitted on April 15, 2006
Revised on June 22, 2006
Accepted on July 18, 2006

Influence of Atorvastatin Treatment on L-Arginine Cerebrovascular Reactivity and Flow-Mediated Dilatation in Patients With Lacunar Infarctions

Janja Pretnar-Oblak MD, PhD^*; Miso Sabovic MD, PhD; Miran Sebestjen MD, PhD; Tomaz Pogacnik MD, PhD; and Marjan Zaletel MD, PhD

From the Ljubljana Medical Centre, Department of Neurology, Ljubljana, Slovenia.

^* To whom correspondence should be addressed. E-mail: janja.pretnar{at}kclj.si.

Background and Purpose--In our study we hypothesized that statins improve endothelial function in patients with lacunar infarctions (LI). Cerebral and systemic endothelial function was determined before and after 3-months treatment with atorvastatin.

Methods--Cerebral endothelial function was determined by L-arginine reactivity and systemic endothelial function by flow-mediated dilatation (FMD) in patients with LI (18 patients, aged 61.1±7.6 years), 20 age- and gender-matched patients with similar risk factors (SR) and 19 age- and gender-matched healthy controls. The mean arterial velocity (v_m) in both middle cerebral arteries was measured by transcranial Doppler sonography before, during and after a 30-minute intravenous infusion of L-arginine. FMD of the brachial artery after hyperaemia was determined. The measurements were repeated after 3-months treatment with 40 mg of atorvastatin per day.

Results--L-arginine reactivity was decreased in LI patients (13.1±8.4%) and in patients with SR compared with healthy controls (P0.01). FMD was more impaired in patients with LI (0.06±4.9%) compared with patients with SR and healthy controls (P0.01). After atorvastatin treatment, L-arginine reactivity and FMD improved in both patients with LI (17.1±7.6%; 7.0±5.7%) and patients with SR (P0.01). Previously mildly increased cholesterol values normalized.

Conclusion--The decreased L-arginine reactivity and FMD improve after atorvastatin treatment in both patients with LI and patients with SR.

Key words: endothelium • lacunar infarction • risk factors • statins • transcranial Doppler sonography

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Statins and Cerebral Vasomotor Reactivity: Implications for a New Therapy?

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