| Objection Statin is the core drug for secondary prevention of coronary heart disease after percutaneous coronary intervention(PCI).There are differences between Chinese and foreign guidelines on whether to initiate intensive statin therapy in patients with coronary heart disease after PCI.Clinically,medium-dose statins(eg.atorvastatin20mg/d)are most commonly used.However,the level of low density lipoprotein cholesterol(LDL-C)still could not reach the target level in some patients after given medium-dose atorvastatin.The purpose of this study was to evaluate the short-term lipid-lowering efficacy and safety of double-dose atorvastatin(ie.40mg/d)and atorvastatin combined with ezetimibe(10mg/d)in patients with coronary heart disease after PCI who did not reach the LDL-C standard after medium-dose atorvastatin lipid-lowering therapy.Methods From October 2016 to April 2018,patients diagnosed with coronary heart disease and had a PCI surgery in Northern Jiangsu People's Hospital were selected and all of them received regular outpatient visits as required after the surgery.These patients were treated with secondary prevention of CHD according to the standard.In terms of lipid-lowering therapy,medium-dose atorvastatin was given first,and serum lipid level was reviewed three months later.If the LDL-C was still greater than1.8mmol/L or decreased by less than 50%,the lipid-lowering therapy was deemed to be substandard.According to the inclusion criteria and exclusion criteria,82 patients are selected as the research object.On the basis of simple random grouping method,divided the researchers into two groups: double-dose atorvastatin(40 mg/d,n=53)or medium-dose atorvastatin combine with ezetimibe(atorvastatin 20 mg/d and ezetimibe10 mg/d,n=29).All patients were required to be followed up in the outpatient department every 4 weeks and reexamined for blood lipids.The experiment would complete after 12 weeks.Patients' general information and baseline data were collected.At the same time,the fasting plasma glucose,liver injury indicators(more than 3 times the normal upper limit of alanine aminotransferase),serum creatinine,uric acid,creatinine kinase(CK)and other adverse events were observed and recorded.Results 1.The total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and non-high-density lipoprotein cholesterol(non-HDL-C)were significantly lower after the intensive treatment than before in both of the group(P < 0.05).Meanwhile,the triglyceride(TG)also decreased after treatment in the double-dose atorvastatin group(P < 0.05).2.According to the standard of lipid lowering treatment that the absolute value of LDL-C is lower than 1.8mmol/L or the reduction rate is at least 50%,the compliance rate of the two groups were 66% vs.57%,38% vs.35%,respectively,but there was no difference between two groups(P > 0.05).3.The basic lipid levels of patients who has achieve the therapeutic target were significantly lower than that of not achieved the target(P < 0.05),including TC,LDL-C and non-HDL-C,suggesting that the basic LDL-C of the patients was the important factor affecting the treatment efficacy.4.The incidence of adverse events of the two groups was 15%(8/53)and 7%(2/29),respectively.Although there was an increasing trend in the double-dose atorvastatin group,there was no difference between the two groups(P > 0.05).Adverse reactions were mainly manifested as mild abnormal of aminotransferase(elevated aminotransferase was less than 3 times of the upper limit of normal value),increased CK with muscle symptoms.No other adverse reactions were observed in either group.Conclusion 1.After Intensive lipid-lowering therapy,the total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and non-high-density lipoprotein cholesterol(non-HDL-C)were significantly lower than before treatment in the two groups.In addition,high-dose atorvastatin can reduce triglyceride(TG).2.According to the standard of lipid lowering treatment that the absolute value of LDL-C is lower than 1.8mmol/L or the reduction rate is at least 50%,there was no difference between the compliance rate of the two groups.3.The lower the basic LDL-C value,the easier it is to reach the target after lipid-lowering treatment.4.There were no statistically significant difference of the rate of adverse events between two groups.Adverse reactions were mainly manifested as mild abnormal of aminotransferase(elevated aminotransferase was less than 3 times of the upper limit of normal value),increased CK with muscle symptoms.No other adverse reactions were observed in either group. |
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