Cerivastatin, a Hydroxymethylglutaryl Coenzyme A Reductase Inhibitor, Improves Endothelial Function in Elderly Diabetic Patients Within 3 Days

To the Editor:In the July 24, 2001, issue of Circulation , Tsunekawa et al1 found that 3 days of statin therapy resulted in significant improvement of endothelial function, independent of lipid-lowering, in a study population of elderly patients with diabetes mellitus. The study provides new insight into statins’ direct effect on endothelial function over such a short period of time. However, we have some questions concerning flow-mediated dilatation (%FMD) and nitroglycerin-induced dilatation (%NTG).Noninvasive techniques for examining endothelium-dependent and endothelium-independent vasodilatation using sonography have been widely applied in human studies since their first publication.2 Endothelium-dependent dilatation, which is measured as %FMD, is thought to be caused by smooth muscle relaxation secondary to nitric oxide production and/or release from endothelial cells. Nitroglycerin administration is thought to provide nitric oxide exogenously. It is not known whether the amount of nitric oxide provided by sublingual administration of nitroglycerin is greater than …