Effect Of Atorvastatin Or Rosuvastatin Combined With Clopidogrel On Carotid Artery Plaque

?Objective?With incidence of stroke increasing,it has become one of the leading causes of death in the world.Atherosclerosis is a risk factor that can not be ignored,which can lead to the formation of unstable plaque.And it narrows the lumen of the blood vessels,resulting in inadequate perfusion of cardiovascular and cerebrovascular.Even more,it causes plaque rupture and secondary thrombosis,resulting in cardio-cerebrovascular events.Lowering blood lipids,stabilizing plaques,and reversing plaques play an important role in the prevention and treatment of cerebrovascular diseases.Statins have been confirmed that are significantly lipid-lowering and have a reversal effect on plaques,whose benefits are related to their doses.Clopidogrel is currently mainly used for antiplatelet aggregation in the treatment of cardio-cerebrovascular diseases.It has been suggested that clopidogrel can also reduce the lipid content and effectively delay the progression of atherosclerosis.However,some patients do not respond to antiplatelet aggregation after taking clopidogrel,that is,clopidogrel resistance(CR).Some analysis show that patients with CR are more likely to have atherosclerosis and the incidence of adverse events is higher.When statins are combined with clopidogrel,the benefits of lipid-lowering are often attributed to statins,and clopidogrel is ignored.For design flaws of insufficient dosage of statins,short observation time,and no exclusion of static clopidogrel resistance and so on in previous studies,we use intensive-dose statins,prolongs the observation time,and excludes patients with static clopidogrel resistance in our study,to investigate the effect of atorvastatin and rosuvastatin combined with clopidogrel on carotid artery plaque.?Methods?Patients with secondary prevention of ischemic stroke were collected in this study during March 2015 to September 2016 in Neurology Clinic of our hospital,who need to take clopidogrel 75 mg/day for one week,then detect platelet aggregation ratio(PAR)before and after taking the drug.Patients without CR could continue to be observed and 97 cases finally completed the observation,including 50 cases of Atorvastatin group(atorvastatin 40 mg/d plus clopidogrel 75 mg/d)and 47 cases of the Rosuvastatin group(rosuvastatin 20 mg/d plus clopidogrel 75 mg/d).Pre-treating with Clopidogrel(Visit 0),one-week treating with Clopidogrel(Visit 1),one-month(Visit2),three-month(Visit 3)and six-month(Visit 4)treating with Clopidogrel and Atovastatin or Rosuvasratin,detect PAR,blood lipids(TG,CHOL,LDL-C),liver and kidney function,CK and other indicators in patients after a six-month follow up.At the visit 0 and visit 4,carotid ultrasound was performed on all enrolled patients,and the changes of blood lipids and plaques were compared between the two groups.According to patients' PAR regrouped,if the patient's PAR ? 55% during follow-up,then included in the dynamic clopidogrel resistance group(DCR,n = 25),and the remaining patients included in no dynamic clopidogrel resistance group(NDCR,n=72).Compare the changes in atherosclerotic plaque between this two groups.?Results?1.In the atorvastatin group and rosuvastatin group,the plaque area was reduced after 6 months of treatment,but the difference was not statistically significant(P>0.05).However,there was a significant difference in the percentage change of plaque area between two groups,and the plaque area decreased more in atorvastatin group(P<0.05).In the rosuvastatin group,the IMT of the visit 4 was significantly smaller than that of the visit 0(P<0.05),but there was no significant difference of the IMT before and after treatment in the atorvastatin group(P>0.05).There was no significant difference in IMT between the two groups(P>0.05).2.The blood lipid levels(TG,TC,and LDL-C)in both atorvastatin and rosuvastatin groups were significantly lower than baseline(visit 0)at 1 month,3 months,and 6 months after statins were taken(P<0.05)..There was no significant difference in blood lipid levels between the two groups at the same period(P>0.05).3.In the DCR group and the NDCR group,the plaque area was reduced after treatment,but the difference was not statistically significant(P>0.05).There was no significant difference in plaque area between the two groups(P>0.05).The IMT of visit 4 in NDCR group was significantly lower than that in visit 0(P<0.05),but there was no significant difference of the IMT before and after treatment in the DCR group(P>0.05).There was no significant difference in IMT between the two groups(P>0.05).4.The blood lipid levels(TG,TC,and LDL-C)in both DCR and NDCR groups were significantly lower than baseline(visit 0)at 1 month,3 months,and 6 months after treatment(P<0.05)..There was no significant difference in blood lipid levels between the two groups at the same period(P>0.05).5.In the atorvastatin and rosuvastatin groups,the rapid decrease in PAR after taking clopidogrel was significantly lower than the baseline(visit 0)(P<0.05).At Visit 3 and Visit 4,the patient's PAR increased slightly compared with the previous period.There was no significant difference in PAR between the two groups(P>0.05).?Conclusion?1.In the short term,clopidogrel combined with atorvastatin or rosuvastatin in the treatment of secondary prevention of ischemic stroke,atorvastatin group decreased more in improving plaque area.Both this two statins can not significantly reduce the plaque area,but there is a trend of reduction.Rosuvastatin is more effective in improving IMT and patients who regularly take clopidogrel and have no resistance have a certain benefit in anti-atherosclerosis.2.Short-term use of enhanced doses of atorvastatin or rosuvastatin in the treatment of secondary prevention of ischemic stroke,patients can achieve better lipid-lowering effect and high safety.3.In patients with secondary prevention of ischemic stroke combined with clopidogrel and statins(such as atorvastatin)metabolized by CYP3A4 enzyme,the former has no effect on the antiplatelet effect of clopidogrel.