Akuzawa Nobuhiro, Hatori Takashi, Imai Kunihiko, Kitahara Yonosuke, Kurabayashi Masahiko
Department of Internal Medicine, Gunma Chuo Hospital, 1-7-13 Koun-cho, Maebashi, Gunma 371-0025, Japan.
Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
J Clin Med Res. 2015 May;7(5):324-31. doi: 10.14740/jocmr2113w. Epub 2015 Mar 1.
Although statin therapy significantly reduces cardiovascular morbidity and mortality, atherosclerotic plaque progresses in some patients taking statins. This study investigated the factors associated with onset of acute coronary syndrome (ACS) early after the initiation of statin therapy.
Consecutive patients taking statins who presented with ACS (n = 64) were divided into < 1-year and > 1-year groups based on the duration of statin therapy. Patient characteristics, coronary risk factors, lesion locations, and percutaneous intervention procedures were compared between groups.
The < 1-year group was significantly younger (57.6 ± 11.9 years vs. 76.6 ± 9.1 years, P < 0.01), had significantly higher body mass index (27.22 ± 4.20 kg/m(2) vs. 24.60 ± 4.65 kg/m(2), P < 0.05), higher proportion of males (94% vs. 70%, P < 0.05), higher proportion of current smokers (61% vs. 17%, P < 0.01), and lower proportions taking aspirin and calcium antagonists (both 17% vs. 57%, P < 0.05) than the > 1-year group. In the < 1-year group, there were significant correlations between the low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels (r = 0.649, P = 0.004) and between the TG and hemoglobin (Hb)A1c levels (r = 0.552, P = 0.018), but these correlations were not observed a year before admission. TG level was the only parameter associated with LDL-C and HbA1c levels.
A linear correlation between the LDL-C and TG levels, obesity, older age, male sex, and smoking may be associated with increased risk of onset of ACS early after the initiation of statin therapy. Prospective cohort studies are needed to further explore these interactions.
尽管他汀类药物治疗能显著降低心血管疾病的发病率和死亡率，但在一些服用他汀类药物的患者中，动脉粥样硬化斑块仍会进展。本研究调查了他汀类药物治疗开始后早期发生急性冠状动脉综合征（ACS）的相关因素。
将连续出现ACS症状且正在服用他汀类药物的患者（n = 64）根据他汀类药物治疗时长分为<1年组和>1年组。比较两组患者的特征、冠状动脉危险因素、病变部位及经皮介入治疗情况。
<1年组患者明显更年轻（57.6±11.9岁 vs. 76.6±9.1岁，P < 0.01），体重指数显著更高（27.22±4.20kg/m² vs. 24.60±4.65kg/m²，P < 0.05），男性比例更高（94% vs. 70%，P < 0.05），当前吸烟者比例更高（61% vs. 17%，P < 0.01），服用阿司匹林和钙拮抗剂的比例更低（均为17% vs. 57%，P < 0.05）。在<1年组中，低密度脂蛋白胆固醇（LDL-C）与甘油三酯（TG）水平之间（r = 0.649，P = 0.004）以及TG与糖化血红蛋白（Hb）A1c水平之间（r = 0.552，P = 0.018）存在显著相关性，但入院前一年未观察到这些相关性。TG水平是与LDL-C和HbA1c水平相关的唯一参数。
LDL-C与TG水平之间的线性相关性、肥胖、老年、男性及吸烟可能与他汀类药物治疗开始后早期发生ACS的风险增加有关。需要进行前瞻性队列研究以进一步探索这些相互作用。
