Abstract
BackgroundIntensive statin therapy decreases mortality and incidence of coronary events in patients after acute coronary syndrome (ACS). Recently it has been reported that spontaneous lipid levels remain clinically stable during ACS. The immediate influence of lipid levels by high-dose statin therapy initiated at admission in ACS patients is, however, not clear.MethodsWe have analyzed a group of 114 patients with ACS (mean age 63.7; females 25.4%). Atorvastatin 80 mg was administered at admission and then once daily for the rest of hospitalization. The levels of total cholesterol (TC), LDL-cholesterol (LDL), HDL-cholesterol (HDL), and triglycerides (TG) were measured at admission (D0), and then every morning of hospitalization (D1, D2).ResultsThe mean entry values (D0) of TC, LDL, HDL and TG (in mmol/L) were 5.24, 3.26, 1.07 and 1.31, respectively. The therapy with atorvastatin 80 mg resulted in a decrease of TC levels in the first morning (D1) by 6.1% and in the second morning (D2) by 13.2% (p < 0.001 for all comparisons with the entry value D0); LDL was decreased by 5.8% (D1) and 15.6% (D2) (p < 0.001 vs. D0); the level of HDL was decreased by 7.5% (D1) and 12.1% (D2) (p < 0.001 vs. D0). In contrast, the TG level was higher in the first morning (D1) by 20.6% and in the following morning (D2) by 25.5% (p < 0.05 vs. D0).ConclusionsWe have shown that intensive statin therapy started at admission in ACS patients has a highly significant, immediate effect on all monitored lipid levels. Since TC and LDL levels were decreased as predicted, reduction in HDL and increase in TG levels suggest a different acute effect of high-dose statin on lipid levels in comparison with long-term treatment of ACS patients.
Highlights
Statins, 3-hydroxy-3-methylglutaryl coenzyme A (HMGCoA) reductase inhibitors, have been for two decades successfully used in the therapy of hypercholesterolemia and stable ischemic heart disease
Only a limited number of authors focused on lipid levels in acute coronary syndrome (ACS) patients; these studies which were mostly smaller in the size of population or did not use contemporary recommendations for ACS management including coronary interventions have shown a decrease in total and LDLcholesterol [9,10,11,12]
At admission for ACS, blood samples were taken for examination of the baseline fasting or non-fasting serum lipid parameters: total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), and HDL-cholesterol (HDL-C); fasting lipid levels were measured every morning of hospitalization
Summary
3-hydroxy-3-methylglutaryl coenzyme A (HMGCoA) reductase inhibitors, have been for two decades successfully used in the therapy of hypercholesterolemia and stable ischemic heart disease. Analysis of the baseline data from the LUNAR study has, demonstrated in a large ACS population treated according to current guidelines that there are only clinically insignificant spontaneous changes in the lipid parameters (total cholesterol, LDLcholesterol, HDL-cholesterol, and triglycerides) in the first four days of ACS [13]. It is, still not clear whether the lipid levels in the early phase of ACS may be influenced by intensive statin treatment. The immediate influence of lipid levels by high-dose statin therapy initiated at admission in ACS patients is, not clear
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