Simvastatin but not ezetimibe reduces sympathetic activity despite similar
reductions in cholesterol levels.
Author(s): Lewandowski J(1), Siński M(2), Puchalska L(3), Symonides B(1), Gaciong Z(1).
Affiliation(s): Author information:
(1)Department of Internal Medicine, Hypertension and Vascular Diseases, Medical
University of Warsaw, Warsaw, Poland. (2)Department of Internal Medicine,
Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland.
Electronic address: msinski@wum.edu.pl. (3)Department of Experimental and
Clinical Physiology, Medical University of Warsaw, Warsaw, Poland.
Publication date & source: 2014, J Am Soc Hypertens. , 8(10):715-23
The relationship between the sympatholytic effects of statins and their
lipid-lowering activity remains unclear. Ezetimibe lowers cholesterol, but its
sympatholytic activity is unknown. The purpose of study was to compare the
influence of equipotent doses of simvastatin and ezetimibe on sympathetic
activity. This randomized double-blinded study was performed in 22 hypertensive
patients (age, 45.6 ± 2.2 years; female/male, 2/20) with untreated
hypercholesterolemia. The subjects were administered 20 mg/d of simvastatin
(n = 11) or 20 mg/d of ezetimibe (n = 11) for 6 weeks. Pre- and post-treatment
measurements of muscle sympathetic nerve activity (MSNA), baroreceptor control of
heart rate (baroreflex sensitivity), and impedance cardiography were recorded.
Simvastatin and ezetimibe produced similar reductions of total (-58.0 ± 23.4 vs.
-45.2 ± 17.2 mg/dL; P = .15, respectively) and low-density lipoprotein
cholesterol (-52.6 ± 20.9 vs. -37.9 ± 17.6 mg/dL; P = .09, respectively). There
was a significant difference in the effect of simvastatin and ezetimibe on muscle
sympathetic nerve activity (-8.5 ± 5.1 vs. -0.7 ± 3.5 bursts/min; P = .0005).
Simvastatin improved baroreflex sensitivity as compared with ezetimibe
(10.0 ± 14.3 vs. -2.8 ± 6.1 ms/mm Hg; P = .01). There was no difference in the
effect of both treatments on blood pressure, heart rate, cardiac output, stroke
volume, total peripheral resistance, high-density lipoprotein, and triglycerides.
Simvastatin reduced sympathetic activity via lipid-independent mechanisms, but
ezetimibe exerts no sympatholytic effects.
|