Pravastatin improves cerebral vasomotor reactivity in patients with subcortical small-vessel disease

Background and Purpose-Recent investigations have suggested an important role of statins in the prevention of stroke CIP and dementia independent of their lipid-lowering, properties. Using transcranial Doppler sonography (TCD), we examined acetazolamide reactivity as a marker of cerebral vasoreactivity in patients with subcortical small-vessel disease before and after pravastatin treatment. Methods-In 16 patients (mean age 68 +/- 10 years) with subcortical small-vessel disease, cerebral vasomotor reactivity was tested using TCD insonating the middle cerebral artery. Cerebral blood flow velocity (CBFV) increase after bolus injection of 1 g acetazolamide was determined before and after 2-month treatment with pravastatin sodium 20 mg daily. Results-Relative CBFV increase was significantly greater after pravastatin treatment (41.9 +/- 23.7% versus 55.7 +/- 8.3%, P = 0.004). Comparison of CBFV at rest before and after treatment with pravastatin did not show significant differences, There was a strong negative correlation between the pravastatin-induced enhancement of vasomotor reactivity and the pretreatment CBFV increase (beta = -0.64, P = 0.019). No associations were found between the effect of pravastatin on vasomotor reactivity and pretreatment levels or changes of LDL cholesterol. Conclusions-This pilot study provides the first evidence for a significant improvement of cerebral vasomotor reactivity by statin therapy in patients with cerebral small-vessel disease. The results may help to elucidate the preventive effect of statins and provide insights into the pathophysiology of cerebral small-vessel disease.