Yang N, Feng J-P, Chen G, Kou L, Li Y, Ren P, Zhao L-L, Qin Q
Department of Cardiology, and Department of Cardiology Medicine, Tianjin Chest Hospital, Tianjin, China.
Eur Rev Med Pharmacol Sci. 2014;18(24):3761-6.
Despite the amply evidence and guidelines in treating coronary artery disease (CAD) with lipid-lowering therapy, physicians still have concerns in treating acute myocardial infarction (AMI) patients who have the low serum lipid level. We explored the adequacy of lipid-lowering therapy in treating AMI patients.
Over 3000 CAD lipid profile data were collected, their data were divided into 3 groups (AMI; stable angina pectoris (SAP) and unstable angina pectoris (UAP) group) based their clinical characteristics. Statistical analyses were performed to compare their baseline lipid levels and clinical feature.
The total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) level in AMI patients were the lowest, followed by UAP patient group and SAP patient group. There were significant differences in white blood count (WBC) and ejection fraction (EF) between 3 groups. A good correlation was confirmed between EF% and the lipid parameters of TC, LDL-c, HDL-c, non-HDL-c. WBC did not correlate with the lipid except HDL-c. AMI is an acute inflammatory reaction that is accompanied with the change of lipid level.
Although the level of TC, LDL-c and HDL-c are lower in AMI, but it is related with acute inflammatory reaction during the rupture of atherosclerotic plaques. Lipid-lowering therapy should not be delayed in treating AMI patients with lower lipid level.
尽管有充分的证据和指南支持使用降脂疗法治疗冠状动脉疾病(CAD),但医生在治疗血清脂质水平较低的急性心肌梗死(AMI)患者时仍存在顾虑。我们探讨了降脂疗法治疗AMI患者的充分性。
收集了3000多例CAD患者的血脂谱数据,并根据其临床特征将数据分为3组(AMI组;稳定型心绞痛(SAP)组和不稳定型心绞痛(UAP)组)。进行统计分析以比较他们的基线血脂水平和临床特征。
AMI患者的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-c)和高密度脂蛋白胆固醇(HDL-c)水平最低,其次是UAP患者组和SAP患者组。3组之间的白细胞计数(WBC)和射血分数(EF)存在显著差异。EF%与TC、LDL-c、HDL-c、非HDL-c的血脂参数之间证实有良好的相关性。WBC除了与HDL-c外,与其他血脂均无相关性。AMI是一种急性炎症反应,伴有脂质水平的变化。
虽然AMI患者的TC、LDL-c和HDL-c水平较低,但这与动脉粥样硬化斑块破裂时的急性炎症反应有关。对于血脂水平较低的AMI患者,降脂治疗不应延迟。