Endothelium / physiology

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Research Letter

Influence of Spiritual Well-Being on Blood Pressure, Central Hemodynamics and Endothelial Function

Maria Emília Figueiredo Teixeira et al. Priscila Valverde de Oliveira Vitorino Andrea A. Brandão Ana Luiza Lima Souza … Talles Marcelo Gonçalves de Andrade Barbosa Roberto Esporcatte Mário Henrique Elesbão de Borba Álvaro Avezum Weimar Kunz Sebba Barroso

Introduction

Spirituality and religiosity (S/R) are cultural aspects that have existed since the beginnings of human existence. Having been long considered as opponent to science, only recently, S/R have gained importance in the context of health.

Definitions of S/R have been constantly evolving, according to the need for adaptation to new knowledge. Today, religion has been related to organizational, institutional and dogmatic aspects, that is, the contact with deity occurs through predetermined formats, specific to each religious segment. Spirituality is a wider term, encompassing a quest for personal, psychological and spiritual well-being, and good-quality interpersonal relationships. According to the Department of Studies in Spirituality and Cardiovascular Medicine (DEMCA, Departamento de Estudos em Espiritualidade e Medicina Cardiovascular ) of the Brazilian Cardiology Society, “spirituality is a set of moral, mental and emotional values that guide thoughts, behaviors and attitudes in life circumstances of intra and interpersonal relationships”.

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Original Article

Endothelial Effect of Statin Therapy at a High Dose Versus Low Dose Associated with Ezetimibe

Maristela Magnavita Oliveira Garcia et al. Carolina Garcez Varela Patricia Fontes Silva Paulo Roberto Passos Lima … Paulo Meira Góes Marilia Galeffi Rodrigues Maria de Lourdes Lima Souza e Silva Ana Marice Teixeira Ladeia Armênio Costa Guimarães Luis Claudio Lemos Correia

Abstract

Background:

The effect of statins on the endothelial function in humans remains under discussion. Particularly, it is still unclear if the improvement in endothelial function is due to a reduction in LDL-cholesterol or to an arterial pleiotropic effect.

Objective:

To test the hypothesis that modulation of the endothelial function promoted by statins is primarily mediated by the degree of reduction in LDL-cholesterol, independent of the dose of statin administered.

Methods:

Randomized clinical trial with two groups of lipid-lowering treatment (16 patients/each) and one placebo group (14 patients). The two active groups were designed to promote a similar degree of reduction in LDL-cholesterol: the first used statin at a high dose (80 mg, simvastatin 80 group) and the second used statin at a low dose (10 mg) associated with ezetimibe (10 mg, simvastatin 10/ezetimibe group) to optimize the hypolipidemic effect. The endothelial function was assessed by flow-mediated vasodilation (FMV) before and 8 weeks after treatment.

Results:

The decrease in LDL-cholesterol was similar between the groups simvastatin 80 and simvastatin 10/ezetimibe (27% ± 31% and 30% ± 29%, respectively, p = 0.75). The simvastatin 80 group presented an increase in FMV from 8.4% ± 4.3% at baseline to 11% ± 4.2% after 8 weeks (p = 0.02). Similarly, the group simvastatin 10/ezetimibe showed improvement in FMV from 7.3% ± 3.9% to 12% ± 4.4% (p = 0.001). The placebo group showed no variation in LDL-cholesterol level or endothelial function.

Conclusion:

The improvement in endothelial function with statin seems to depend more on a reduction in LDL-cholesterol levels, independent of the dose of statin administered, than on pleiotropic mechanisms.