Hemodynamic changes associated with reduction in total cholesterol by treatment with the HMG-CoA reductase inhibitor pravastatin

Hemodynamic changes associated with the lowering of total cholesterol (TC) by the water-soluble HMG-COA reductase inhibitor pravastatin were investigated in 59 patients with hypercholesterolemia (TC level at least 220 mg/dl) who received pravastatin therapy for 6 months. The patients were divided into two groups according to the reduction in TC: a 15% reduction group and a <15% reduction group. The changes in hemodynamics were compared before and after pravastatin treatment. No changes in blood pressure, heart rate or aortic damping factor were found in either group. However, significant decreases in pulse wave velocity and total peripheral resistance, and increase in cardiac output were seen in the 15% reduction group. All these hemodynamic parameters remained unchanged in the <15% reduction group. The 12 patients with a clear pravastatin-induced reduction in TC maintained over a 5-year period showed no changes in blood pressure, heart rate or aortic damping factor, but the reductions in pulse wave velocity and total peripheral resistance, and increase in cardiac output were maintained. These changes in hemodynamics were not dependent on aortic elasticity, and appeared to result from improved peripheral hemodynamics. Lowering of TC levels by pravastatin results in improvement in the peripheral endothelium-dependent vasodilation disorder associated with hypercholesterolemia.