Clinical Study Of LDL-C In Patients With Ultra-high Risk ASCVD Treated With Statins Combined With Non-statins

Background and Purpose:In 2018,our hospital conducted an investigation on the blood lipid compliance rate of patients with coronary heart disease who were hospitalized in the Department of Cardiology of the First Affiliated Hospital of Yangtze University and received coronary stent implantation in Jingzhou,Hubei Province from December 2016 to November 2017 in accordance with the requirements of "China Recommendations for the Prevention and Treatment of Dyslipidemia".Patients with LDL-C<1.8mmol/L were selected as the standard group,and 133 patients were enrolled.There was no statistical difference in the standard blood lipid of all patients before surgery.In February 2018,a unified reexamination of blood lipid status was conducted,and 46 patients in the group reached the standard blood lipid level,with an overall standard rate of 34.5%[1].The investigation indicated that the standard rate of blood lipid in patients with coronary artery stent implantation in this area was low,and the management of lipid-regulating treatment was poor.With the launch of ESC/EAS Guidelines for the Management of Dyslipidemia in 2019,the Chinese Expert Consensus on the Management of Dyslipidemia in Patients with Ultra High Risk Atherosclerotic Cardiovascular Disease in 2020 puts forward the ultra-high risk ASCVD(atherosclerotic cardiovascular disrase).ASCVD patients were defined,and the corresponding lipid-lowering therapy was recommended,and the secondary prevention of ultra-high-risk ASCVD patients was guided more clearly.The primary target LDL-C was reduced to less than 1.4mmol/L and decreased by more than 50%from baseline;The secondary target was non-HDL-C<2.2mmol/L[2].In the new guidelines required by the more strict control of blood lipids,have been used in our hospital moderate atorvastatin 20 mg/d of treatment,but the low density lipoprotein cholesterol,low density lipoprotein cholesterin,LDL-C)is still not up to standard of high-risk patients with ASCVD,comparative analysis of medium intensity atorvastatin joint according to fold the mab with moderate intensity atorvastatin fat will tai capsule two lipid-lowering efficacy and safety of lipid management scheme.Methods:From July 2019 to July 2020,a total of 105 patients with ultra-high risk atherosclerotic cardiovascular disease with LDL-C substandard(≥1.4mmol/L)were enrolled in Jingzhou First People’s Hospital,and all of them had been receiving atorvastatin 20mg/d for more than 4 weeks before inclusion.They were randomly divided into ezetimibe group(atorvastatin 20mg/d combined with ezetimibe 10mg/d)and libidai capsule group(atorvastatin 20mg/d combined with libidai capsule 0.96g/d).Blood lipid indexes were detected and compared before and after 8 weeks of combination therapy.Including LDL-C,high density lipoprotein cholesterol(HDL-C),triglyceride(TG),total cholesterol(TC),and non-high density lipoprotein cholesterol(non-HDL-C).Liver function indexes,including aspartate aminotransferase(AST)and alanine aminotransferase(ALT),kidney function indexes,including creatinine(CR)and various muscle enzyme indexes,were also monitored.Creatine kinase isoenzyme(CK-MB)and creatine kinase(CK)were included,and adverse cardiac events and drug reactions during treatment were recorded.Results:1.After 8 weeks of follow-up,LDL-C,TC,TG and non-HDL-C were significantly decreased and HDL-C was significantly increased in both groups(P<0.05)compared with those before the combined treatment(P<0.05);2.Follow-up at 8 weeks after adjustment of treatment regimens in both groups showed that the decrease rates of LDL-C,TC,TG and non-HDL-C in ezedemibe group were more obvious than those in Zhibitai capsule group(LDL-C:26.1%vs 15.2%,P<0.05;TC:29.3%vs 22.8%,P<0.05;TG:35.9%vs 13%,P<0.05;Non-HDL-C:47%vs 33%,P<0.05);The increase of HDL-C in ezetimibe group was significantly greater than that in Zhibitai capsule group(21.5%vs 6.5%,P<0.05);3.Follow-up at the eighth week of treatment with lipid regulation regimen in both groups showed that the LDL-C compliance rate of ezetimeibe group was higher than that of Zhibitai capsule group(43.4%vs 19.2%at<1.40mmol/L,P<0.05;<1.40mmol/L with at least 50%reduction from baseline 24.5%vs 7.7%,P<0.05);4.Follow-up at the 8th week of treatment with lipid regulation regimen showed that the non-HDL-C compliance rate of ezetimibe group and Zhibitai capsule group was similar(71.7%vs 61.5%when<2.20mmol/L,P>0.05);5.There was no statistically significant difference in the incidence of adverse cardiac events between the two groups(angina 3.8%vs 5.8%,P>0.05);6.There were no serious drug intolerance side effects and mild drug adverse reactions in the two groups(4 cases in ezetimibe group and 1 case in Zhibitai capsule group),and there was no statistically significant difference between the two groups(P>0.05).Conclusion:Atorvastatin for applied medium strength but LDL-C failed to amount to mark the atherosclerotic process in the ultra high risk of cardiovascular disease(atherosclerotic cardiovascular disrase,ASCVD)patients with moderate intensity atorvastatin combined according to fold the mab and moderate intensity joint atorvastatin fat will ty capsule both plan to further reduce LDL-C level and are safer,which according to fold the mab group have stronger lipid-lowering effect.