Effect of early hypolipidemic therapy of different intensity on endothelial function in patients with acute myocardial infarction with ST segment elevation
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Abstract
The aim – to evaluate the effect of different hypolipidemic therapy on changes in endothelial function in patients with acute myocardial infarction with ST segment elevation (STEMI).
Materials and methods. The study enrolled 135 patients with STEMI within the 12 hours of symptoms onset (average 4.7±1.0) who were admitted to the intensive care unit at NSC «M.D. Strazhesko Institute of Cardiology». Patients were distributed into 4 groups by envelope method. At the enrolment to the hospital patients were prescribed hypolipidemic therapy till the procedure of revascularization – percutaneous coronary intervention. The first (1st) group included 26 pts who were prescribed a combination of atorvastatin (10 mg) and ezetimibe (10 mg). The second (2nd) group included 24 pts, who were prescribed atorvastatin at a dose of 40 mg. The third (3rd) group included 43 pts, who received 80 mg of atorvastatin, the fourth (4th) group included 42 pts who were prescribed a combination of atorvastatin 40 mg and ezetimibe 10 mg. Basic therapy was formed according to the current guidelines of the European Society of Cardiologists and the National Diagnostic Protocols. The selected groups did not have difference in clinical and anamnestic characteristics and methods of treatment. Determination of reactive hyperemia using flow-dependent vasodilatation (FDV) was performed on the 1st and 10th days of the hospital period and within the 90th day of onset of the disease onset.
Results and discussion. Prescription of high-intensity lipid-lowering therapy using 80 mg of atorvastatin (group 3) and 40 mg of atorvastatin and 10 mg of ezetimibe (group 4) caused a greater lipid-lowering effect compared to the medium-intensity therapy (group 1 and 2) in the dynamics of observation. Group 3 patients experienced a significant decrease in low-density lipoprotein cholesterol (LDL cholesterol) on the 10th and 90th days, and its decrease reached values below the recommended values (up to 1.75±0.11 mmol/L. In group 4 on we recorded a significant decrease in LDL cholesterol on the 10th day and by the 90th day it was 1.55 mmol/L. The mean LDL cholesterol level below the target was only reached in groups 3 and 4. Normalization of endothelial function (FDV greater than 10 %) was significantly more frequently observed in patients who reached less than 1.8 mmol/L by the 90th day of target LDL cholesterol.
Conclusions. For the normalization of endothelial function (increase in FDV) during hypolipidemic therapy in patients undergoing STEMI, it is necessary to achieve the target values of LDL cholesterol up to 90 days of the disease, which is possible only when conducting high-intensity hypolipidemic therapy. The absence of improvement in endothelial function during observation in a constant number of patients suggests that there may be additional, possibly genetic, factors that are not affected by the treatments used.
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