Application Of Statin Combined With Ezetimibe In Elderly Patients With Coronary Heart Disease Complicated With Dyslipidemia

Objective:To explore the efficacy and safety of statin combined with ezetimibe in elderly patients with coronary heart disease(CHD)complicated with dyslipidemia,and to compare the difference between elderly patients and non-elderly patients.Methods:CHD with dyslipidemia patients with completed clinical data were enrolled from November 2009 to November 2018 in Beijing Hospital.Outpatient database was used to screen the participants.The patients were divided into the elderly group(≥65 years old)and non-elderly group(<65 years old)according to the age.All patients were followed up by two cardiologists.The diagnosis of CHD was based on clinical diagnosis.LDL-C>1.8mmol/L was considered as dyslipidemia.The risk factors of CHD and laboratory data before and after treatments were recorded.Paired sample rank sum test was used to compare the changes of total cholesterol(TC),low density lipid cholesterol(LDL-C),high density lipid cholesterol(HDL-C),triglyceride(TG),aspartate transaminase(AST),alanine transaminase(ALT),creatine kinase(CK)before and after the combination.Independent sample rank sum test was used to analyze the difference between the two groups.Change of LDL-C was compared by independent sample t test.Chi-square test was used to compare the LDL-C success rate between two groups.Results:A total of 182 patients were finaly enrolled in the present study.106 were elderly patients and 76 were non-elderly patients.158 patients were stable angina,while 24 of them were acute coronary syndrome(ACS).50 patients complicated with diabetes mellitus(DM)and 151 patients with hypertension.The longest follow-up period was 6 months and the mean follow-up time was 3.7 months.The levels of TC,LDL-C and TG after combination decreased than those before the combination(p<0.05).There was no significant change in HDL-C level.ΔLDL-C level was-0.78(-1.26,-0.55)mmol/L in the elderly group and-0.83(-1.17,-0.42)mmol/L in the non-elderly group without statistical difference between two groups(p>0.05).Decreased percentage of LDL-C was 30.9%in elderly group and 27.5%in non-elderly group without statistical difference(p>0.05).There was no significant differences in TC[3.60(3.13,4.13)vs 3.57(3.15,4.38)mmol/L],LDL-C[1.93(1.57,2.39)vs 1.97(1.62,2.53)mmol/L]and TG[1.15(0.87,1.52)vs 1.36(0.91,1.82)mmol/L]level compared between elderly group and non-elderly group withp>0.05.ΔHDL-C level was 0.00(-0.09,0.11)mmol/L in the elderly group and 0.02(-0.05,-0.10)mmol/L in the non-elderly group without statistical difference between two groups(p>0.05).In terms of safety,AST and ALT level increased after combination than that before combination in the elderly group[AST:24(20,29)vs 22(19,26)U/L,ALT:22(17,29)vs 18(14,23)U/L,p<0.05],but all within the normal range.AST[AST:27(21,33)vs 25(21,32)U/L]and ALT[29(21,43)vs 27(19,38)U/L]after combination did not significant change than that before combination in non-elderly group.The level of AST and ALT was not different between the two groups(p>0.05).Besides,CK levels between the two groups before and after the combination did not show significant change(p>0.05).Conclusion:Adding ezetimibe to a moderate-intensity statin could significantly reduce LDL-C levels and increase LDL-C success rate in elderly CHD patients with dyslipidemia.Combined lipid-lowering therapy do not cause liver enzymes and muscle enzymes to increase significantly,and have good safety.There was no statistically significant difference in the efficacy and safety of statin plus ezetimibe between elderly and non-elderly patients.