Abstract
BackgroundLarge observational studies have shown that small, dense LDL subfractions are related to atherosclerotic cardiovascular disease. This study assessed the effects of two highly effective lipid-lowering therapies in the atherogenic subclasses of lipoproteins in subjects with ST-segment elevation myocardial infarction (STEMI).MethodsPatients of both sexes admitted with their first myocardial infarction and submitted to pharmacoinvasive strategy (N = 101) were included and randomized using a central computerized system to receive a daily dose of simvastatin 40 mg plus ezetimibe 10 mg or rosuvastatin 20 mg for 30 days. Intermediate-density lipoprotein (IDL) and low-density lipoprotein (LDL) subfractions were analysed by polyacrylamide gel electrophoresis (Lipoprint System) on the first (D1) and 30th days (D30) of lipid-lowering therapy. Changes in LDL and IDL subfractions between D1 and D30 were compared between the lipid-lowering therapies (Mann-Whitney U test).ResultsThe classic lipid profile was similar in both therapy arms at D1 and D30. At D30, the achievement of lipid goals was comparable between lipid-lowering therapies. Cholesterol content in atherogenic subclasses of LDL (p = 0.043) and IDL (p = 0.047) decreased more efficiently with simvastatin plus ezetimibe than with rosuvastatin.ConclusionsLipid-lowering therapy with simvastatin plus ezetimibe was associated with a better pattern of lipoprotein subfractions than rosuvastatin monotherapy. This finding was noted despite similar effects in the classic lipid profile and may contribute to residual cardiovascular risk.Trial registrationClinicalTrials.gov, NCT02428374, registered on 28/09/2014.
Highlights
Effective statins alone or combined with ezetimibe have been recommended for high-risk patients, according to recent guidelines [1, 2]
The main clinical characteristics of the study population are shown in Table 1 and did not differ between groups. All patients had their first segment elevation myocardial infarction (STEMI), and the proportion of culprit coronary artery and infarct size estimated by highsensitivity troponin T were similar in both groups
The proportions of low-density lipoprotein (LDL)-C and non-HDL-C targets achieved according to the European Society of Cardiology/European Atherosclerosis Society [1] were comparable between groups
Summary
Effective statins alone or combined with ezetimibe have been recommended for high-risk patients, according to recent guidelines [1, 2]. The pattern of lipoprotein subfractions after lipid-lowering therapies seems important. In a cohort of subjects without prior cardiovascular disease conducted in Japan, small, dense LDL was associated with a higher risk of coronary heart disease [7]. A meta-analysis involving 21 studies and 30,628 individuals confirmed the positive relationship between small, dense LDL and ischaemic heart disease [8]. In China, a country with one of the highest mortality rates from stroke, small and dense subclasses of LDL particles were more prevalent in subjects with acute ischaemic stroke [9]. Large observational studies have shown that small, dense LDL subfractions are related to atherosclerotic cardiovascular disease. This study assessed the effects of two highly effective lipid-lowering therapies in the atherogenic subclasses of lipoproteins in subjects with ST-segment elevation myocardial infarction (STEMI)
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