Clinical Efficacy Of Atorvastatin On Patients With Acute Cerebral Infarction And Its Lipid Lowering Activity Association With ABCA1 Gene R219K Polymorphism

Objective The study would to investigate the clinical efficacy, safety and early prognosis of atorvastatin in patients with acute cerebral infarction, and the present study was to examine the effects of the R219Kpolymorphism of ABCA1 on serum lipid levels on responses to atorvastatin therapy in Chinese patients with acute cerebral infarction.Methods (1) Totally 70 patients with acute cerebral infarction were randomly divided into control group and atorvastatin group. The patients in the control group received conventional therapy, while those in the atorvastatin group was administrated orally with 20mg of Atorvastatin. The indices of total cholesterol (TC), triglyceride (TG), lowerdensity lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), C-reactive protein (CRP),and carotid artery ultrasound were compared respectively in the groups before and after treatment of the first month and the third month,and noted the score of the National Institutes of Health Stroke Scale (NIHSS) and the activities of daily living Scale (ADL),Six months were followed up and taken these indicators to statistical analysis and the sub-group analysis. The patients were followed up for six months, the results were analyzed and sub-group analysis. (2) we selected 125 hospitalized patients with acute cerebral infarction and R219K polymorphism genotyping were determined by PCR-RFLP,so as to divided into groups of RR,RK,KK,each group were treated with conventional therapy and atorvastatin (20 mg / d), continuous treatment for 3 months.Fasting serum lipids were determined before and after 3 months of treatment. Results (1) After 1 month treatment, the atorvastatin group reduced LDL-C and CRP levels compared with before treatment (P<0.01), and CRP also decreased in the control group (P<0.05),but the atorvastatin group significantly lower(P <0.05).After 3 months treatment in the atorvastatin group,TC and LDL-C and CRP reduced compared with before treatment and after 1 month treatment (P<0.05),TC and LDL-C were significant lower than the control group (P<0.01),but CRP was no significant difference after 3 month treatment in two groups. (2) There was no significant difference on IMT and Crouse score in the two groups before treatment (P>0.05), but after 3 months treatment in the atorvastatin group,the IMT and Crouse score decreased(P<0.05), and IMT and Crouse score in the atorvastatin group were lower than the control group (P< 0.05);Plaque area was no significant difference in the two groups (P>0.05). (3) ADL score was higher and NIHSS score was lower in patients of atorvastatin group after six months treatment compaered with the control group (P<0.05). (4) There were no significant differences in TC, TG, LDL-C and HDL-C concentrations among patients in the three genotype groups prior to treatment.RR and RK genotype were more than KK genotype.After atorvastatin treatment,KK genotype in patients increased HDL-C levels compared with RR genotype,the difference was statistically significant(P <0.05), and TC,TG,LDL-C levels were no significant difference among the groups.Conclusion (1) Atorvastatin had early lipid-lowering and antiinflammatory effects in patients with acute cerebral infarction, and could stabilize or reverse the carotid artery plaque and improve the early prognosis. (2) ABCA1 gene R219K polymorphism RR and RK genotype were more than KK genotype in patients with cerebral infarction, lipid levels in patients may be no associated with R219K polymorphism, but ABCA1 gene R219K polymorphism and response of atorvastatin may be related. Further studies with larger sample sizes are needed to confirm these findings.