The Effect Of Ezetimize Plus Small Doses Of Atorvastatin Calcium On Glucose Metabolism In Patients With Acute Coronary Syndrome

Objective: To observe the effect of Ezetimibe- selective cholesterol absorption inhibitor, plus small doses of Atorvastatin calcium on glucose metabolism in patients with Acute Coronary Syndrome(ACS).Methods:183 ACS patients hospitalized at the Cardiology department of Yan’an University Affiliated Hospital from January 2013 to December 2014 were randomly assigned into 3 groups, Group A: 10 mg Ezetimibe + 10 mg Atorvastatin calcium(n=61); Group B: 20 mg Atorvastatin calcium(n=61); Group C: 40 mg Atorvastatin calcium(n=61). All patients were followed up in the 3rd, 6th, 12 th month during the treament. The levels of Low-Density Lipoprotein Cholesterol(LDL-C), total cholesterol(TC), triglyceride(TG), High-density lipoprotein cholesterol(HDL-C),Fasting Blood Glucose(FBG), Hemoglobin A1c(HA1c), C-peptide, and safety evaluation among the treatment groups were statistically analyzed.Results:1. Comparison of average level of LDL-C after 12-month treatment: Group A-(1.10± 0.41)mmol/L, Group B-(1.78 ± 0.28)mmol/L, Group C(1.21 ± 0.51)mmol/L. Comparison between experiment groups and two control groups: PAB=0.033, indicates there is no statistical significant between Group A(10mg Ezetimibe + 10 mg Atorvastatin calcium) and Group B(20mg Atorvastatin calcium)(P>0.05), PAC=0.058, Indicates there is no statistical significant between Group A(10mg Ezetimibe + 10 mg Atorvastatin calcium) and Group C( 40 mg Atorvastatin calcium)(P<0.05).2. Comparison of average level of FBG after 12-month treatment: Group A-(6.10±1.74)mmol/L, Group B-(6.25 ± 2.12)mmol/L, Group C(6.89 ± 1.87)mmol/L. Comparison between experiment groups and two control groups: PAB=0.057, indicates there is no statistical significant between Group A(10mg Ezetimibe + 10 mg Atorvastatin calcium) and Group B(20mg Atorvastatin calcium)(P>0.05), PAC=0.025, Indicates there is no statistical significant between Group A(10mg Ezetimibe + 10 mg Atorvastatin calcium) and Group C( 40 mg Atorvastatin calcium)(P<0.05).3. Comparison of average level of Hb A1 c after 12-month treatment: Group A-(5.4±0.6)mmol/L, Group B-(5.6±0.6)mmol/L, Group C(6.3±1.87)mmol/L. Comparison between experiment groups and two control groups: PAB=0.059, indicates there is no statistical significant between Group A(10mg Ezetimibe + 10 mg Atorvastatin calcium) and Group B(20mg Atorvastatin calcium)(P>0.05), PAC=0.033, Indicates there is no statistical significant between Group A(10mg Ezetimibe + 10 mg Atorvastatin calcium) and Group C( 40 mg Atorvastatin calcium)(P<0.05).4. Comparison of average level of insulin after 12-month treatment: Group A-(10.02±0.55) U/ml, Group B-(10.12±0.63) U/ml, Group C(15.50±0.57) U/ml. Comparison between experiment groups and two control groups: PAB=0.055, indicates there is no statistical significant between Group A(10mg Ezetimibe + 10 mg Atorvastatin calcium) and Group B(20mg Atorvastatin calcium)(P>0.05), PAC=0.047, Indicates there is no statistical significant between Group A(10mg Ezetimibe + 10 mg Atorvastatin calcium) and Group C( 40 mg Atorvastatin calcium)(P<0.05).5. Comparison of average level of C-peptide after 12-month treatment: Group A(1.28 ± 0.26) ng/ml, Group B(1.27 ± 0.19) ng/ml, Group C(1.54 ± 0.24) ng/ml. Comparison between experiment groups and two control groups: PAB=0.058, indicates there is no statistical significant between Group A(10mg Ezetimibe + 10 mg Atorvastatin calcium) and Group B(20mg Atorvastatin calcium)(P>0.05), PAC=0.042, Indicates there is no statistical significant between Group A(10mg Ezetimibe + 10 mg Atorvastatin calcium) and Group C( 40 mg Atorvastatin calcium)(P<0.05).6. Safety evaluation: no statistical significance. Comparison of side effects besides glucose metabolism between experiment groups and two control groups: occurrence of elevated liver enzyme PAB=0.057, PAC=0.028, occurrence of myalgia- PAB=0.053,PAC=0.042, There is no statistical significant in the aspect of liver damage and myalgia between Group A(10mg Ezetimibe + 10 mg Atorvastatin calcium) and Group B(20mg Atorvastatin calcium)(P>0.05), Indicates there is tatistical significant between Group A(10mg Ezetimibe + 10 mg Atorvastatin calcium) and Group C( 40 mg Atorvastatin calcium)(P<0.05).Conclusion:1. Ezetimibe plus small doses of atorvastatin can control LDL-C level and lower the risk of impaired glucose metabolism on ACS patients.2. Large doses of atorvastatin can effectively reduce LDL-C level while increase the risk of impaired glucose metabolism on ACS patients.3.Regular doses of atorvastatin don’t increase the risk of impaired glucose metabolism yet can not control LDL-C level is satisfied.4.The side effects differences(eg. myolysis, elevated liver enzyme) were not significant between the Ezetimibe plus small doses of Atorvastatin and Atorvastatin alone.