Ryohei Hosokawa, MD; Ryuji Nohara, MD; Li Linxue, MD; Shunichi Tamaki, MD*; Tetsuo Hashimoto, MD**; Masahiro Tanaka, MD   ; Shinji Miki, MD    ; Shigetake Sasayama, MD

Abstract
Fifteen patients with either angina pectoris or old myocardial infarction, who had positive 201 Tl single photon emission computed tomography (SPECT) imaging and coronary sclerosis of more than 50%, were treated with an HMG-CoA reductase inhibitor (simvastatin) for more than 1 year. They were compared with an untreated control group (n=25). Total cholesterol decreased 22% and high-density lipoprotein (HDL) increased 9% with simvastatin; both changes were significantly different from those in controls. Long-term simvastatin induced improvement of myocardial perfusion on ²⁰¹ Tl SPECT images both during exercise and at rest, which was also significantly different from controls. In addition, the improvement of myocardial perfusion on ²⁰¹ Tl SPECT images was clearly related to the improvements in cholesterol values, especially nonHDL cholesterol. Thus, the greater the decrease in nonHDL cholesterol, the greater the improvement in myocardial perfusion at rest or during exercise with long-term treatment using an HMG-CoA reductase inhibitor. These findings indicate that the improvements in cholesterol values caused by HMG-CoA reductase inhibitor therapy are related to improvements of myocardial perfusion seen on ²⁰¹ Tl SPECT images.
(Jpn Circ J 2000; 64: 177-182)

Key Words: Cholesterol; HMG-CoA reductase inhibitor (simvastatin); HDL cholesterol; Myocardial perfusion

Mailing address: Ryuji Nohara, MD, Department of Cardiovascular Medicine, Kyoto University, Graduate School of Medicine, 54 Kawaracho, Shogoin, Sakyoku, Kyoto 606, Japan