| Objective: Nowadays,the incidence of Atherosclerotic Cardiovascular Disease(ASCVD) is increasing,statins therapy can reverse atherosclerosis. Until now, the meaning of statins on people who only have carotid artery plaques has not been fully described. This study was designed to explore early intervention of Atorvastatin on carotid atherosclerostic plaques.Methods : From June 2013 through January 2014, consecutive patients who was admitted to the First Hospital of Qinhuangdao were enrolled. Recruiting criteria:(1) Three or less risk factors of cardiovascular disease;(2)Patients who had diagnosed by Color Doppler ultrasound with low or medium echo-level carotid artery plaques. Exclusion criteria:(1) Coronary heart disease and other atherosclerostic arteries such as ischemic stroke, abdominal aortic aneurysm,peripheral arterial diseases and symptomatic carotid artery disease, etc;(2) diabetes;(3) Severe symptomatic carotid stenosis(>70%), history of carotid endarterectomy or radiation therapy in carotid artery;(4) severe liver and kidney insufficiency;(5) Systemic lupus erythematosus, rheumatoid arthritis or arteritis and disease which could be misdiagnosed;(6) Thyroid diseases, tuberculosis;(7)chronic infectious diseases,cancer;(8) A short-term regular use of lipid-lowering drugs;(9) statins allergy. Normal Low density lipoprotein cholesterol(LDL-C) level: 3.4mmol/L or less. The patients with carotid artery plaques were divided into two groups based on blood lipid level:Nomal LDL-C group(the people were divided into Group A and Group B randomly),High LDL-C group(the people were divided into Group C and Group D randomly),The four groups with therapeutic lifestyle changes and controlled risk factors such as smoking,obesity,high blood pressure,Group A and Group C were given atorvastatin 20 mg per night orally. The indexes were measured and recorded as follows:(1) Body Mass Index(BMI), systolic blood pressure(SBP),and diastolic blood pressure(DBP) before medication intervention,12 weeks treatment and 1 year treatment;(2)Total cholesterol(TC),low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C),triglyceride(TG), fasting plasma glucose(FPG), haemoglobin A1c(Hb A1c), alanine aminotransferase(ALT), aspartate amino transaminase(AST), Gamma-glutamyltransferase(GGT),serum creatinine(SCr), creatine kinase(CK) before medication intervention, 12 weeks treatment and 1 year treatment;(3) The carotid intima-media thickness(IMT) and the quantity, nature, size and thickness of carotid artery plaques were detected by Color Doppler ultrasound before medication intervention and 1 year treatment.The software of SPSS 13.0 was used in the statistic analyses, a two-sided of P-value <0.05 was defined as statistically significant.Results: 1 Baseline characteristicsA total of 140 cases were enrolled, and 131 patients were followed up successfully,34 cases in group A(24 males and 10 females, average age was 58.38 ± 9.19 years old),32 cases in group B(18 males, 14 females, average age was 58.97 ± 9.96 years old), 30 cases in group C(17 males and 13 females, average age was 58.57 ± 7.13 years old), and 35 cases in group D(17 males, 18 females, average age was 61.03 ± 7.76 years old). There were no significant differences in age, gender, BMI, SBP, DBP,history of smoking and drinking, hypertension, ischemic cardiovascular disease risk score, IMT and the quantity, nature, size and thickness of carotid artery plaques, levels of TC, LDL-C, HDL-C, TG, ALT,AST, GGT,FPG,Hb A1 c,SCr and CK between group A and B,group C and D. 2 Changes of IMT and carotid artery plaques 2.1 Normal LDL-C groupsNo significant difference were found in IMT and cross-sectional area compared with the baseline in Group A(P>0.05);the number of plaques was dcreased from 57 to 54,which indicated no significant difference(P>0.05), the number of low echo level plaques was dcreased from 21(36.8%) to 15(27.8%),they turned into medium echo level plaques,medium echo level plaques were increased from 36(63.2%) to 39(72.2%),but no significant changes were shown(P>0.05).The thickness of plaques were similar(2.01±0.60 mm vs. 1.94±0.52 mm,P=0.504). There were no statistical significances in IMT and cross-sectional area compared with the baseline in Group B(P>0.05).The number of plaques was increased from 52 to 59,the change has no statistical significance(P>0.05), the number of low echo level plaques was increased from 20(38.5%)to 28(47.5%), medium echo level plaques were decreased from 32(61.5%) to 31(52.5%), which indicated no significant difference(P>0.05). The carotid artery plaques were thicker than those in Group B compared with the baseline(2.26±0.80 mm vs. 1.98±0.63 mm,P=0.037).The nature of plaques has changed showed significant difference between the two groups after a year treatment(P<0.05). 2.2 High LDL-C groupsThere were no statistical significances in IMT and cross-sectional area compared with the baseline in Group C(P>0.05),the number of plaques was decreased from 52 to 51,the change has no statistical significance(P>0.05), the number of low echo level plaques was decreased from 27(51.9%) to 22(43.1%),they turned into medium echo level plaques,medium echo level plaques were increased from 25(48.1%) to 29(56.9%),no significant changes were shown(P>0.05). The thickness of plaques indicated no significant difference(2.07±0.62 mm vs. 1.99±0.53 mm,P=0.503).The IMT was thicker compared with the baseline in Group D after a year treatment( 1.79±0.35 mm vs.1.45±0.28 mm,P=0.000),there was no statistical difference in cross-sectional area compared with the baseline,the number of plaques was increased from 56 to 68, the change has no statistical significance(P>0.05), the number of low echo level plaques was increased from 29(51.8%) to 38(55.9%), medium echo level plaques were increased from 27(48.2%) to 30(44.1%), which indicated no significant difference(P>0.05). The thickness of plaques was thicker than baseline(2.23±0.81 mm vs. 1.94±0.48 mm,P=0.019).IMT in group D was thicker than that in Group C after a year treatment( P<0.01). 3 Changes of the levels of blood lipid 3.1 Normal LDL-C groupsAfter 12 weeks, TC,LDL-C and TG concentration were 3.85±0.69mmol/L, 2.38±0.57mmol/L,1.38±0.46mmol/L, respectively, they were decreased in Group A compared with the baseline(P<0.05);HDL-C level maintained the original level in 12-week treatment(P>0.05); After a year, the levels of TC,LDL-C and TG were3.80±0.84mmol/L,2.17±0.41mmol/L,1.23±0.53mmol/L,respectively,they were decreased significantly in Group A compared with the baseline(P<0.01);HDL-C was not changed comepared with the baseline(P>0.05).12 weeks later, the levels of TC,LDL-C,TG and HDL-C concentration were not changed in Group B compared with the baseline(P>0.05);After a year, the levels of TC,LDL-C and TG were maintained the original level in Group B(P>0.05);the level of HDL-C was decreased from 1.23±0.20mmol/L to 1.15±0.21mmol/L(P<0.01).The levels of TC and LDL-C in Group A were lower than that in Group B for two times(P<0.05),but no difference in TG and HDL-C between the two groups(P>0.05). 3.2 High LDL-C groupsAfter 12 weeks, TC,LDL-C and TG concentration were 4.79±0.94mmol/L, 2.92±0.60mmol/L,1.14±0.31mmol/L, respectively,they were decreased significantly compared with the baseline in Group C(P<0.01),HDL-C was not changed significantly(P>0.05). After a year, the levels of TC,LDL-C and TG were 4.51±0.83mmol/L,2.71±0.62mmol/L, 1.08±0.36mmol/L,these walues were decreased in Group C(P<0.01),there was no statistical difference in the change of level of HDL-C(P>0.05).After 12 weeks, TC,LDL-C,TG and HDL-C concentration were decreased compared with the baseline in Group D, there were statistical differences in the changes of TC and HDL-C(P < 0.05), After a year, TC,LDL-C,TG and HDL-C concentration were decreased consistently compared with the baseline in Group D, significant differences were found in the changes of TC and HDL-C(P<0.05).The levels of TC,LDL-C and TG in Group C were lower than that in Group D for two times(P<0.01),there was a significant difference in HDL-C between the two groups after 12-week treatment. 4 Changes of BMI,blood pressure and FPG 4.1 Normal LDL-C groupsBMI,SBP,DBPand FPG in Group A were decreased compared with the baseline after 12-week treatment and 1-year treatment, there were indicated significant differences for BMI and SBP( P<0.01), BMI,SBP,DBPand FPG in Group B were decreased compared with the baseline after 12-week treatment, there were indicated significant differences for BMI and SBP(P< 0.05), BMI,SBP,DBPand FPG were continually decreased compared with the baseline after 1-year treatment, there were indicated significant differences for BMI and SBP(P<0.01), In the two groups, no matter BMI,SBP,DBPor FPG,there were no statistical differences among different times(P>0.05). 4.2 High LDL-C groupsBMI,SBP,DBPand FPG in Group C were decreased compared with the baseline after 12-week treatment, there were significant differences in BMI and FPG(P< 0.05), a year later,these indexes were decreased constantly compared with the baseline(P<0.05).BMI,SBP,DBPand FPG in Group D were decreased compared with the baseline after 12-week treatment, there were indicated significant differences for BMI and SBP(P<0.05), BMI,SBP,DBP and FPG were continually decreased compared with the baseline after 1-year treatment(P<0.05). BMI,SBP,DBP,FPG in the two groups were no statistical differences among different times(P>0.05). 5 Safety 5.1 Normal LDL-C groupsThere were 2 cases(5.9%)of mild elevation of ALT and AST in Group A.No elevation of ALT,AST and CK were found in Group B. No statistically significant differences in the levels of ALT、AST、GGT、FPG、Hb A1c、CK、SCr in the two groups(P>0.05). 5.2 High LDL-C groupsThere were 3 cases(10%)of mild elevation of ALT and AST,1case(3.3%) of mild elevation of CK in Group C, respectively. No elevation of ALT,AST and CK were found in Group D.No differences were found in the levels of ALT、AST、GGT、FPG、Hb A1c、CK、SCr in the two groups(P>0.05).Conclusion:Early intervention of atorvastatin can stabilize the atherosclerotic plaques in carotid artery, it is effective in slowing progression of atherosclerotic plaques. |
PDF Full Text Request