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Study Objectives: Improvement in coronary artery endothelial function has been demonstrated after cholesterol lowering in hypercholesterolemic patients with significant atherosclerosis. However, to our knowledge, no previous study has shown improvement in resistance artery function in subjects with normal coronary arteries after cholesterol lowering. The purpose of our study was to investigate the effect of cholesterol lowering with pravastatin on coronary resistance artery endothelial function in the setting of angiographically normal coronary arteries.Methods: Invasive testing of coronary endothelial and vasomotor function was performed at baseline and after 6 months of pravastatin treatment in six patients with normal coronary arteriograms.Results: After 6 months of pravastatin treatment, low-density lipoprotein cholesterol level dropped from 157+/-11 to 117+/-8 mg/dL (p = 0.02) and percent increase in coronary blood flow after acetylcholine improved from 97+/-13% to 160+/-16% (p = 0.01). There was a trend (p = 0.17) toward enhanced epicardial dilation in response to acetylcholine after pravastatin treatment when compared with the baseline study.Conclusions: Our study demonstrates significant improvement in coronary resistance artery endothelial function after 6 months of cholesterol lowering with pravastatin in six subjects presenting with chest pain who were found to have normal coronary arteriograms. A trend toward improved epicardial vasomotion was also observed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of comprehensive, multidisciplinary management programs on the process of care, resource utilization, health care costs, and clinical outcomes in patients with congestive heart failure.Measurements and Main Results: A MEDLINE search identified seven english-language reports that compared the process of care, clinical outcomes, or economic variables related to implementation of a multidisciplinary congestive heart failure management program of at least 3 month's duration to a control or reference group. The primary intent of the programs was to emphasize compliance with recommended therapeutic principles, enhance patient education, and provide careful patient surveillance. Five of the studies reported improved functional status, aerobic capacity, or patient satisfaction. Six of the studies reported a 50% to 85% reduction in the risk of hospital admission. Three studies reported economic analyses with suggestive but not compelling evidence of financial benefit.Conclusions: Comprehensive, multidisciplinary management programs for congestive heart failure can improve functional status and reduce the risk of hospital admission, and they may lower medical costs. [ABSTRACT FROM AUTHOR]