Aydin Meryem Ulku, Aygul Nazif, Altunkeser Bulent Behlul, Unlu Ali, Taner Alpaslan
Denizli Servergazi State Hospital, Department of Cardiology, Denizli, Turkey; Denizli State Hospital, Department of Cardiology, Denizli, Turkey.
Selcuk University, Selcuklu School of Medicine, Department of Cardiology, Konya, Turkey.
Atherosclerosis. 2015 Apr;239(2):439-43. doi: 10.1016/j.atherosclerosis.2015.02.003. Epub 2015 Feb 7.
The important role of oxidized low density lipoprotein (oxidized-LDL) in preclinic atherosclerosis and pathophysiology of acute coronary syndromes studies have reported. Oxidation of LDL activates many inflammatory and atherogenic pathways and plays a pivotal role in atherosclerosis. Our aim in this study is to compare the effects of 80 mg daily dose of atorvastatin and 20 mg daily dose of rosuvastatin on lipid profiles and the levels of oxidized-LDL and inflammatory markers in ST elevation myocardial infarction (STEMI).
One hundred and twenty patients with STEMI were enrolled in this study. The patients were randomly assigned to receive atorvastatin (80 mg/day) or rosuvastatin (20 mg/day) by using a ratio of 1:1 after revascularization. The levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), LDL-C, apolipoprotein B and apolipoprotein A were compared between groups after 4-week therapy. The values of oxidized-LDL, tumor necrosis factor receptor 1 and 2, Interleukin-6 and hs-CRP were also compared between groups. The Student's t test was used to detect absolute and percent changes between groups, and p < 0.05 was considered as statistically significant for all tests.
After treatment in both treatment groups LDL-C, oxidized-LDL, hs-CRP, tumor necrosis factor receptor 1 and 2, Interleukin-6 values significantly decreased according to baseline. The only difference was in HDL-C levels. HDL-C slightly decreased in atorvastatin group while it increased in the rosuvastatin group compared baseline (-1.4 ± 8.9 mg/dl vs 2.0 ± 9.4 mg/dl, p = 0.04).
We reported that both statin treatment regiments have comparable effects on LDL-C, oxidized-LDL and inflammatory markers. Moreover, it was observed that rosuvastatin was more effective in terms of ability to increase HDL-C level. Based on these findings, 20 mg daily dose of rosuvastatin may be an alternative to 80 mg daily dose of atorvastatin in patients with acute coronary syndrome.
氧化型低密度脂蛋白（oxidized-LDL）在临床前期动脉粥样硬化及急性冠脉综合征病理生理学中的重要作用已有研究报道。低密度脂蛋白的氧化激活了许多炎症和致动脉粥样硬化途径，在动脉粥样硬化中起关键作用。本研究的目的是比较每日80毫克阿托伐他汀和每日20毫克瑞舒伐他汀对ST段抬高型心肌梗死（STEMI）患者血脂谱、氧化型-LDL水平及炎症标志物的影响。
120例STEMI患者纳入本研究。患者在血运重建后按1:1比例随机分配接受阿托伐他汀（80毫克/天）或瑞舒伐他汀（20毫克/天）治疗。治疗4周后比较两组患者的总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白B和载脂蛋白A水平。同时比较两组患者氧化型-LDL、肿瘤坏死因子受体1和2、白细胞介素-6及高敏C反应蛋白（hs-CRP）的值。采用Student's t检验检测两组间的绝对变化和百分比变化，所有检验中p<0.05被认为具有统计学意义。
两个治疗组治疗后，LDL-C、氧化型-LDL、hs-CRP、肿瘤坏死因子受体1和2、白细胞介素-6的值均较基线显著降低。唯一的差异在于HDL-C水平。与基线相比，阿托伐他汀组HDL-C略有下降，而瑞舒伐他汀组HDL-C升高（-1.4±8.9毫克/分升 vs 2.0±9.4毫克/分升，p= 0.04）。
我们报道两种他汀治疗方案对LDL-C、氧化型-LDL和炎症标志物具有相似的效果。此外，观察到瑞舒伐他汀在提高HDL-C水平方面更有效。基于这些发现，对于急性冠脉综合征患者，每日20毫克瑞舒伐他汀可能是每日80毫克阿托伐他汀的替代选择。
