| Objectives: The aim of this study is to evaluate the effect of atorvastatin plus ezetimibe versus atorvastatin monotherapy on lipoprotein-associated phospholipase(Lp-PLA2)in patients with Non-ST-segment elevation acute coronary syndrome(NSTE-ACS)who underwent percutaneous coronary intervention(PCI).Methods: A total of 193 patients with NSTE-ACS undergoing elective PCI were randomly assigned to combination therapy(atorvastatin 20-40 mg and ezetimibe 10mg/day)or statin monotherapy(atorvastatin 20-40mg/day).the plasma lp-PLA2 concentrations were measured at pre-PCI and 24 h post-PCI,the primary endpoint is the change of plasma LpPLA2 and Hs-CRP concentrations,the secondary endpoint is the incidence of 30-d major adverse of cardiovascular events(MACE)and the incidence of the statin-related adverse reactions.Results: 1.There were no significant interactions between the two randomization factors,but the intensive statin therapy and the addition of ezetimibe to atorvastatin monotherapy resulted in a higher level of the change of Lp-PLA2 concentrations(P=0.045,P=0.003).2.The baseline characteristics and plasma Lp-PLA2 concentrations in all groups were similar.The plasma Lp-PLA2 obviously reduced after PCI(P<0.05).atorvastatin 20 plus ezetimibe group resulted in a lower level of Lp-PLA2 than atorvastatin 20 group after PCI(157±24.6ng/ml vs.168±31.4ng/ml,P=0.04),and atorvastatin 40 plus ezetimibe group resulted in a lower level of post-PCI Lp-PLA2 than atorvastatin 40 group.(148.9±24ng/ml vs 163±29.5ng/ml,P=0.038).The perioperative changes of Lp-PLA2 in four group were compared.The change of A40 group was higher than the A20 group(78 ± 41.8ng/ml vs.63 ± 42.1ng/ml,P<0.05);the A20 + E10 group was higer than the A20 group(84±33.9ng/ml vs.63±42.1ng/ml,P<0.05);the A40+E10 group was higher than the A40 group(90±33.5ng /ml vs.78±41.8ng/ml,P<0.05);A40+E10 group was higher than A20 group(90±33.5ng/ml vs.63±42.1ng/ml,P<0.05).However,the change were comparable in A40+E10 vs A20+E10 group and A20+E10 vs A40 group.(P>0.05)3.The hs-CRP markly increased after PCI(P<0.05).Multiple comparison analysis of hs-CRP after PCI showed that compared with A20 group,A20+E10 group can alleviate the rise of hs-CRP level after PCI(1.99(0.96-5.7)mg/L vs.2.24(1.52-9.49)mg/L,P<0.05);compared with A40 group,A40+E10 group can alleviate the rise of hs-CRP level after PCI(1.87(0.87-4.06)mg/L vs.2.05(0.78-6.37)mg/L,P<0.05);compared with A20 group,A40+E10 group can alleviate the rise of hs-CRP level after PCI(1.87(0.87-4.06)mg/L vs.2.24(1.52-9.49)mg/L).but there was no significant difference in hs-CRP between the A20 group vs A40 group and A20+E10 vs A40+E10 group(P>0.05).The change of hs-crp during perioperative period in four groups was compared.The change of hs-CRP in A20+E10 group was lower than that in the A20 group(1.99(0.96-5.7))mg/L vs.2.24(1.52-9.49)mg/L(P<0.05).And the change in A40+E10 group was lower than that in the A40 group(1.87(0.87-4.06)mg/L vs.2.05(0.78-6.37))mg/L,P<0.05).What's more,the change in A40+E10 group was lower than that in the A20 group(1.87(0.87-4.06)mg/L vs.2.24(1.52-9.49)mg/L,P<0.05).There was no statistical difference between A20 vs A40 group,A20+E10 vs A40+E10 group and A20+E10 vs A40 group.4.There was no significant difference in LDL-C levels in four groups during peri-operation.5.There was no significant correlation between the change of LDL-C,hs-CRP and LpPLA2.6.There was no statistical difference in the incidence of 30-d major adverse of cardiovascular events(MACE)and the incidence of the statin-related adverse reactions.Conclusions: Compared with statin monotherapy,ezetimibe in combination with atorvastatin resulted in a higher level of the change of plasma Lp-PLA2 concentrations.Furthermore,intensive atorvastatin therapy resulted in a higher level of Lp-PLA2.the protective effect is attributed to the anti-inflammatory function but not the change of LDLC.Lp-PLA2 is more sensitive to intensive statin therapy than hs-CRP.the intensive lipidlowing therapy is safe. |
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