The Role of Short-term Low-Dose Atorvastatin in Improving Endothelial Function in Normolipidemic Heart Failure with Preserved Ejection Fraction

Background: Heart failure with preserved ejection fraction (HFpEF) imposes a heavy burden on Iran’s health system. Although therapeutics are prescribed for HFpEF, no evidence-based therapy has been generally accepted. Endothelial dysfunction is currently recognized as a promising therapeutic target for patients with HFpEF. Methods: A total of 40 patients who referred to the echocardiography clinic of Imam Khomeini hospital in Ahvaz participated in this randomized clinical trial. Echocardiographic and clinical criteria for HFpEF and normal coronary angiography were recorded in all subjects. The patients did not have indications of statin therapy or a prior history of statin consumption. They were randomly assigned to the atorvastatin (20 mg once daily) and placebo groups (n=20 per group). Flow-mediated dilatation (FMD) of the brachial artery was measured in the two groups before the trial and after the two-month treatment period. Clinical trial registration is available from: https://irct.behdasht.gov.ir/, (identifier: IRCT2015010320538N1). Results: The patients’ mean age was 65 years, 40% were male, and 60% were female. There was a significant improvement in FMD only in the atorvastatin group (+41.5% in males and+18.25% in females) (P<0.001). The low-density lipoprotein (LDL) level significantly decreased after treatment in the atorvastatin group but not in the placebo group. The variation in FMD was not dramatically associated with the reduction in serum LDL in the two groups. Conclusion: Atorvastatin has advantageous effects on the vascular endothelial function of HFpEF, and this effect is not associated with its lipid-lowering properties.