Complex Fluids Group, Instituto de Física, Universidade de São Paulo, São Paulo, Brazil.
Centro Universitário São Camilo, São Paulo, Brazil.
PLoS One. 2022 Aug 30;17(8):e0273292. doi: 10.1371/journal.pone.0273292. eCollection 2022.
Despite lipid-lowering and antiplatelet therapy, the pattern of residual lipoproteins seems relevant to long-term cardiovascular outcomes. This study aims to evaluate the effects of combined therapies, commonly used in subjects with acute myocardial infarction, in the quality of low-density lipoprotein (LDL) particles.
Prospective, open-label trial, included patients with acute myocardial infarction. Patients were randomized to antiplatelet treatment (ticagrelor or clopidogrel) and subsequently to lipid-lowering therapy (rosuvastatin or simvastatin/ezetimibe) and were followed up for six months. Nonlinear optical properties of LDL samples were examined by Gaussian laser beam (Z-scan) to verify the oxidative state of these lipoproteins, small angle X-ray scattering (SAXS) to analyze structural changes on these particles, dynamic light scattering (DLS) to estimate the particle size distribution, ultra violet (UV)-visible spectroscopy to evaluate the absorbance at wavelength 484 nm (typical from carotenoids), and polyacrylamide gel electrophoresis (Lipoprint) to analyze the LDL subfractions.
Simvastatin/ezetimibe with either clopidogrel or ticagrelor was associated with less oxidized LDL, and simvastatin/ezetimibe with ticagrelor to lower cholesterol content in the atherogenic subfractions of LDL, while rosuvastatin with ticagrelor was the only combination associated with increase in LDL size.
The quality of LDL particles was influenced by the antiplatelet/lipid-lowering strategy, with ticagrelor being associated with the best performance with both lipid-lowering therapies. Trial registration: NCT02428374.
尽管进行了降脂和抗血小板治疗，但脂蛋白的残留模式似乎与长期心血管结局相关。本研究旨在评估联合治疗对低密度脂蛋白（LDL）颗粒质量的影响，这些联合治疗常用于急性心肌梗死患者。
前瞻性、开放标签试验，纳入急性心肌梗死患者。患者随机接受抗血小板治疗（替格瑞洛或氯吡格雷），随后接受降脂治疗（瑞舒伐他汀或辛伐他汀/依折麦布），并随访 6 个月。采用高斯激光束（Z 扫描）检测 LDL 样本的非线性光学特性，以验证这些脂蛋白的氧化状态；采用小角 X 射线散射（SAXS）分析这些颗粒的结构变化；采用动态光散射（DLS）估计颗粒大小分布；采用紫外可见分光光度法（UV-Vis）评估 484nm 波长处的吸光度（典型的类胡萝卜素）；采用聚丙烯酰胺凝胶电泳（Lipoprint）分析 LDL 亚组分。
氯吡格雷或替格瑞洛联合辛伐他汀/依折麦布治疗与较少的氧化 LDL 相关，替格瑞洛联合辛伐他汀/依折麦布治疗与降低 LDL 中致动脉粥样硬化亚组分中的胆固醇含量相关，而替格瑞洛联合瑞舒伐他汀是唯一与 LDL 大小增加相关的联合治疗。
抗血小板/降脂策略影响 LDL 颗粒的质量，替格瑞洛与两种降脂治疗均具有最佳效果。
NCT02428374。
