Atorvastatin improves endothelial progenitor cell function and reduces pulmonary hypertension in patients with chronic pulmonary heart disease.

Chronic pulmonary heart disease usually derives from chronic obstructive pulmonary disease (COPD), which involves the pulmonary circulation and is associated with a high rate of mortality (1,2). Pulmonary artery hypertension (PAH) is prevalent in patients with COPD (3,4). Although the pathophysiological mechanisms of PAH in COPD are not entirely clear, vasoconstriction and remodelling of pulmonary arteries are believed to play a major role (3,4). Hypoxia, pulmonary dysfunction with air trapping, inflammation and toxic effects of cigarette smoking are important factors that lead to PAH in COPD patients (3,4). Pulmonary arteriole endothelial injury and lumen stenosis or clogging also play important roles in the pathogenesis of PAH (5). Endothelial progenitor cells (EPCs) have been shown to be involved in COPD pathogenesis, and the number of circulating EPCs has been correlated with disease severity (6). The number of circulating EPCs are lower in COPD patients as a result of excessive lung use in response to cell apoptosis and hypoxemia (6,7). EPCs may be a novel therapeutic target for the treatment of chronic pulmonary heart disease because mounting evidence suggests that early EPC transplantation significantly improves exercise tolerance and pulmonary hemodynamics in PAH patients (8,9). Statins are known to have various pleiotropic effects that are independent of their lipid-lowering functions, including anti-inflammatory and antioxidant effects, suppression of cell proliferation and induction of apoptosis. They have also been shown to enhance EPC counts and improve endothelial function in patients with stable coronary artery disease (10), acute myocardial infarction (11), chronic heart failure (12) and other cardiovascular diseases (13). However, little is known regarding the effect of statins on EPC counts and function in patients with chronic pulmonary heart disease. The aim of the present study was to explore the effect of atorvastatin on peripheral blood EPC numbers and functions, as well as its effects on pulmonary hypertension, in patients with chronic pulmonary heart disease.