The management of the effect of the atorvastatin on diastolic functions of the heart by echocardiography and the relation of this effect with the level of coenzyme q10 in the plasma

Its proven in most clinical trials that lipid lowering therapy reduces the risk of coronary artery disease. Statins are the cornerstone of lipid lowering therapy. Statins which are non-selective inhibitors of HMG-CoA, inhibite the synthesis of both cholesterol and CoQ10 in the same time. CoQ10 plays an important role in energy production. Diastolic functions are highly energy dependant. Statins may impair diastolic functions by lowering CoQ10. The aim of this study is to asses the effect of atorvastatin on diastolic functions and to investigate the relationship between CoQ10 levels and the diastolic functions. Material-Method: 40 patients were included in this study. The patients were given 20 mg atorvastatin once a day during 12 weeks. Total cholesterol, triglyceride, HDL-C levels were measured before and after the therapy. LDL-C levels were calculated via the Freidwald formula. Diastolic functions were assesed from mitral inflow by conventional Doppler method, pulsed wave tissue Doppler and colored M mode flow propagation velocity. The measurements were obtained before and at the 12th week of the treatment. Blood samples for CoQ10 levels were obtained in the same time with echocardiographic investigation. Results: Mean age of the patients were 51.9 ± 7.9. Mitral E wave velocity decreased significantly after 12 weeks of therapy ( from 0,76 ± 0,12 cm/sec to 0,68 ± 0,13 cm/sec, p<0,001; Mitral A wave velocity increased significantly from 0,75 ± 0,16 cm/sec to 0,81 ± 0,14 cm/sec, p=0,001). E/A ratio decreased significantly (from 1,05 ± 0,25 to 0,86 ± 0,14 cm/sec; P<0,001). Both E wave deceleration time (EDT) and isovolumetric relaxation time (IVRT) were prolonged significantly (EDT, from 190,5 ± 20,7 msec to 215,5 ± 31,6 msec; IVRT, from 95,1 ± 16,3 msec to 107,3 ± 12,5 msec; p<0,001). Tissue Doppler parameters, Septal Em and Am were significantly reduced (septal Em from 8,56 ± 1,77 cm/sec to 7,37 ± 1,72 cm/sec, p<0,001; septal Am from 11,65 ± 1,65 cm/sec to 10,96 ± 1,73 cm/sec, p=0,002). The FPV levels were 54,5 ± 15,0 cm/sec in the beginning, and after 12 weeks mean FPV decreased to 38,4 ± 10,6 cm/sec (p<0,001). After 12 weeks therapy mean CoQ10 level decreased %43.6 (from 1,423 ± 0,405 ?g/ml to 0,775 ± 0,41 ?g/ml , p<0,001). A significant correlation between CoQ10 decrease percentage and the reduction percentage of tissue Doppler parameters and FPV values has been determined. Conculusion: The atorvastatin therapy caused significant decrease in serum CoQ10 levels and impairment in diastolic functions was noted. The patients on statin therapy should be monitored for diastolic functions with TTE and serum CoQ10 levels should be controlled intermitantly on the statin treatment period. Key Words: Atorvastatin, Coenzyme Q10, Diastolic Function