Department of Medicine, Clinic of Angiology, University Hospital Zurich, Switzerland.
Clin Hemorheol Microcirc. 2011;47(4):241-51. doi: 10.3233/CH-2011-1386.
Statins are used for the treatment of hypercholesterolemia. Although they are well known to have pleiotropic effects, their dose-dependent influence on platelet aggregation, hemorheologic properties and the plasma levels of homocysteine in patients with peripheral arterial disease (PAD) has not been thoroughly investigated so far.
From a total of 100 patients with PAD 48 patients were randomized to a treatment with atorvastatin 80 mg/d for six months, and 52 patients served as controls who continued their medication including statins in lower doses. At baseline and at six months' follow up we assessed platelet aggregation upon stimulation with ADP, collagen and epinephrine using light transmission aggregometry. Furthermore, we determined major hemorheologic variables as well as the plasma levels of homocysteine, folic acid, and vitamin B6 and B12. No patient had obtained folic acid or B vitamin supplement. Platelet aggregation upon agonist-induced stimulation did not differ between patients under high-dose atorvastatin therapy and controls at baseline and after six months (p > 0.05). All hemorheologic parameters (plasma viscosity, red cell aggregation, whole blood viscosity, hematocrit, platelets, leucocytes) measured at baseline and after six months were not significantly different between both groups, too. After therapy with 80 mg atorvastatin homocysteine levels were significantly elevated as compared with baseline values (p = 0.0007), whereas levels remained unchanged in the control group. Folic acid levels were higher in the patients receiving high-dose atorvastatin as compared with controls both at baseline (p = 0.002) and at six months' follow up (p = 0.034). No significant difference in vitamin B6 and B12 levels both at baseline and after six months could be detected in either group.
Treatment with 80 mg atorvastatin did not affect platelet aggregation and major hemorheologic parameters. The finding of an increase of homocysteine plasma levels in the presence of rather elevated levels of folic acid needs further investigation.
他汀类药物用于治疗高胆固醇血症。尽管它们具有多种治疗作用已广为人知，但迄今为止，尚未彻底研究其剂量依赖性对周围动脉疾病（PAD）患者血小板聚集、血液流变学特性和同型半胱氨酸血浆水平的影响。
共纳入 100 例 PAD 患者，48 例患者随机接受阿托伐他汀 80mg/d 治疗 6 个月，52 例患者继续接受包括他汀类药物在内的较低剂量药物治疗作为对照组。在基线和 6 个月随访时，我们使用透光比浊法评估了血小板在 ADP、胶原和肾上腺素刺激下的聚集情况。此外，我们还测定了主要血液流变学参数以及同型半胱氨酸、叶酸、维生素 B6 和 B12 的血浆水平。没有患者服用叶酸或 B 族维生素补充剂。高剂量阿托伐他汀治疗组和对照组患者在基线和 6 个月时，激动剂诱导的血小板聚集无差异（p>0.05）。两组在基线和 6 个月时测量的所有血液流变学参数（血浆粘度、红细胞聚集、全血粘度、红细胞压积、血小板、白细胞）也无显著差异。与基线值相比，80mg 阿托伐他汀治疗后同型半胱氨酸水平显著升高（p=0.0007），而对照组同型半胱氨酸水平保持不变。与对照组相比，接受高剂量阿托伐他汀治疗的患者叶酸水平在基线时（p=0.002）和 6 个月随访时（p=0.034）均较高。两组在基线和 6 个月时维生素 B6 和 B12 水平均无显著差异。
80mg 阿托伐他汀治疗不影响血小板聚集和主要血液流变学参数。同型半胱氨酸血浆水平升高而叶酸水平升高的发现需要进一步研究。
