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Immediate effect of intensive atorvastatin therapy on lipid parameters in patients with acute coronary syndrome.

Vondrakova D, Ostadal P, Kruger A - Lipids Health Dis (2010)

Bottom Line: The therapy with atorvastatin 80 mg resulted in a decrease of TC levels in the first morning (D1) by 6.1% and in the second morning (D2) by 13.2% (p<0.001 for all comparisons with the entry value D0); LDL was decreased by 5.8% (D1) and 15.6% (D2) (p<0.001 vs.D0); the level of HDL was decreased by 7.5% (D1) and 12.1% (D2) (p<0.001 vs.Since TC and LDL levels were decreased as predicted, reduction in HDL and increase in TG levels suggest a different acute effect of high-dose statin on lipid levels in comparison with long-term treatment of ACS patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cardiovascular Center, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic.

ABSTRACT

Background: Intensive statin therapy decreases mortality and incidence of coronary events in patients after acute coronary syndrome (ACS). Recently it has been reported that spontaneous lipid levels remain clinically stable during ACS. The immediate influence of lipid levels by high-dose statin therapy initiated at admission in ACS patients is, however, not clear.

Methods: We have analyzed a group of 114 patients with ACS (mean age 63.7; females 25.4%). Atorvastatin 80 mg was administered at admission and then once daily for the rest of hospitalization. The levels of total cholesterol (TC), LDL-cholesterol (LDL), HDL-cholesterol (HDL), and triglycerides (TG) were measured at admission (D0), and then every morning of hospitalization (D1, D2).

Results: The mean entry values (D0) of TC, LDL, HDL and TG (in mmol/L) were 5.24, 3.26, 1.07 and 1.31, respectively. The therapy with atorvastatin 80 mg resulted in a decrease of TC levels in the first morning (D1) by 6.1% and in the second morning (D2) by 13.2% (p<0.001 for all comparisons with the entry value D0); LDL was decreased by 5.8% (D1) and 15.6% (D2) (p<0.001 vs. D0); the level of HDL was decreased by 7.5% (D1) and 12.1% (D2) (p<0.001 vs. D0). In contrast, the TG level was higher in the first morning (D1) by 20.6% and in the following morning (D2) by 25.5% (p<0.05 vs. D0).

Conclusions: We have shown that intensive statin therapy started at admission in ACS patients has a highly significant, immediate effect on all monitored lipid levels. Since TC and LDL levels were decreased as predicted, reduction in HDL and increase in TG levels suggest a different acute effect of high-dose statin on lipid levels in comparison with long-term treatment of ACS patients.

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Serum levels of lipid parameters in early phases of acute coronary syndrome in patients (N = 114) with atorvastatin 80 mg therapy initiated at admission. Serum lipids were measured at admission (D0), first morning of hospitalization (D1), and second morning of hospitalization (D2). Panel A: levels of total cholesterol. Panel B: levels of LDL-cholesterol. Panel C: levels of HDL-cholesterol. Panel D: levels of triglycerides.
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Figure 1: Serum levels of lipid parameters in early phases of acute coronary syndrome in patients (N = 114) with atorvastatin 80 mg therapy initiated at admission. Serum lipids were measured at admission (D0), first morning of hospitalization (D1), and second morning of hospitalization (D2). Panel A: levels of total cholesterol. Panel B: levels of LDL-cholesterol. Panel C: levels of HDL-cholesterol. Panel D: levels of triglycerides.

Mentions: From January to December 2009 114 patients with ACS were recruited. The mean age was 63.7, majority were males (75%), ST-elevation ACS was experienced by 65% of enrolled subjects (Table 1). The mean baseline levels (D0) of TC, LDL-C, HDL-C and TG were 5.24 ± 0.07, 3.26 ± 0.07, 1.07 ± 0.02, and 1.31 ± 0.07 mmol/L, respectively. The administration of atorvastatin 80 mg resulted in a decrease of TC levels in the first morning of hospitalization (D1) to 4.92 ± 0.07 and in the second morning (D2) to 4.55 ± 0.08 (mmol/L; P < 0.001 for all comparisons with D0) (Figure 1A); LDL-C was decreased to 3.07 ± 0.07 (D1) and to 2.75 ± 0.08 (D2) (mmol/L; P < 0.001 for all comparisons with D0) (Figure 1B); the level of HDL-C was reduced to 0.99 ± 0.02 (D1) and 0.94 ± 0.02 (D2) (mmol/L; P < 0.001 for all comparisons with D0) (Figure 1C). In contrast, the TG level was increased to 1.58 ± 0.06 in D1 and 1.64 ± 0.07 in D2 (mmol/L; P < 0.05 for all comparisons with D0) (Figure 1D). The therapy with atorvastatin 80 mg was well tolerated: we did not register any case of myopathy, myositis, rhabdomyolysis or statin-related elevation of alanine aminotransferase; creatine phosphokinase and aspartate aminotransferase were elevated in most subjects as a result of myocardial necrosis.


Immediate effect of intensive atorvastatin therapy on lipid parameters in patients with acute coronary syndrome.

Vondrakova D, Ostadal P, Kruger A - Lipids Health Dis (2010)

Serum levels of lipid parameters in early phases of acute coronary syndrome in patients (N = 114) with atorvastatin 80 mg therapy initiated at admission. Serum lipids were measured at admission (D0), first morning of hospitalization (D1), and second morning of hospitalization (D2). Panel A: levels of total cholesterol. Panel B: levels of LDL-cholesterol. Panel C: levels of HDL-cholesterol. Panel D: levels of triglycerides.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2914010&req=5

Figure 1: Serum levels of lipid parameters in early phases of acute coronary syndrome in patients (N = 114) with atorvastatin 80 mg therapy initiated at admission. Serum lipids were measured at admission (D0), first morning of hospitalization (D1), and second morning of hospitalization (D2). Panel A: levels of total cholesterol. Panel B: levels of LDL-cholesterol. Panel C: levels of HDL-cholesterol. Panel D: levels of triglycerides.
Mentions: From January to December 2009 114 patients with ACS were recruited. The mean age was 63.7, majority were males (75%), ST-elevation ACS was experienced by 65% of enrolled subjects (Table 1). The mean baseline levels (D0) of TC, LDL-C, HDL-C and TG were 5.24 ± 0.07, 3.26 ± 0.07, 1.07 ± 0.02, and 1.31 ± 0.07 mmol/L, respectively. The administration of atorvastatin 80 mg resulted in a decrease of TC levels in the first morning of hospitalization (D1) to 4.92 ± 0.07 and in the second morning (D2) to 4.55 ± 0.08 (mmol/L; P < 0.001 for all comparisons with D0) (Figure 1A); LDL-C was decreased to 3.07 ± 0.07 (D1) and to 2.75 ± 0.08 (D2) (mmol/L; P < 0.001 for all comparisons with D0) (Figure 1B); the level of HDL-C was reduced to 0.99 ± 0.02 (D1) and 0.94 ± 0.02 (D2) (mmol/L; P < 0.001 for all comparisons with D0) (Figure 1C). In contrast, the TG level was increased to 1.58 ± 0.06 in D1 and 1.64 ± 0.07 in D2 (mmol/L; P < 0.05 for all comparisons with D0) (Figure 1D). The therapy with atorvastatin 80 mg was well tolerated: we did not register any case of myopathy, myositis, rhabdomyolysis or statin-related elevation of alanine aminotransferase; creatine phosphokinase and aspartate aminotransferase were elevated in most subjects as a result of myocardial necrosis.

Bottom Line: The therapy with atorvastatin 80 mg resulted in a decrease of TC levels in the first morning (D1) by 6.1% and in the second morning (D2) by 13.2% (p<0.001 for all comparisons with the entry value D0); LDL was decreased by 5.8% (D1) and 15.6% (D2) (p<0.001 vs.D0); the level of HDL was decreased by 7.5% (D1) and 12.1% (D2) (p<0.001 vs.Since TC and LDL levels were decreased as predicted, reduction in HDL and increase in TG levels suggest a different acute effect of high-dose statin on lipid levels in comparison with long-term treatment of ACS patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cardiovascular Center, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic.

ABSTRACT

Background: Intensive statin therapy decreases mortality and incidence of coronary events in patients after acute coronary syndrome (ACS). Recently it has been reported that spontaneous lipid levels remain clinically stable during ACS. The immediate influence of lipid levels by high-dose statin therapy initiated at admission in ACS patients is, however, not clear.

Methods: We have analyzed a group of 114 patients with ACS (mean age 63.7; females 25.4%). Atorvastatin 80 mg was administered at admission and then once daily for the rest of hospitalization. The levels of total cholesterol (TC), LDL-cholesterol (LDL), HDL-cholesterol (HDL), and triglycerides (TG) were measured at admission (D0), and then every morning of hospitalization (D1, D2).

Results: The mean entry values (D0) of TC, LDL, HDL and TG (in mmol/L) were 5.24, 3.26, 1.07 and 1.31, respectively. The therapy with atorvastatin 80 mg resulted in a decrease of TC levels in the first morning (D1) by 6.1% and in the second morning (D2) by 13.2% (p<0.001 for all comparisons with the entry value D0); LDL was decreased by 5.8% (D1) and 15.6% (D2) (p<0.001 vs. D0); the level of HDL was decreased by 7.5% (D1) and 12.1% (D2) (p<0.001 vs. D0). In contrast, the TG level was higher in the first morning (D1) by 20.6% and in the following morning (D2) by 25.5% (p<0.05 vs. D0).

Conclusions: We have shown that intensive statin therapy started at admission in ACS patients has a highly significant, immediate effect on all monitored lipid levels. Since TC and LDL levels were decreased as predicted, reduction in HDL and increase in TG levels suggest a different acute effect of high-dose statin on lipid levels in comparison with long-term treatment of ACS patients.

Show MeSH
Related in: MedlinePlus