The Analysis Of Polypharmacy Status And Adverse Reactions Of Statins With Different Metabolic Characteristics In Elderly ACS Patients

Aims: To observe the status of polypharmacy in elderly patients suffered from acute coronary syndrome(ACS)and underwent percutaneous coronary intervention(PCI).And to explore the effects on the elderly ACS patients received coadministration of different statins and a variety of cytochrome P-450 enzymes 3A4(CYP3A4)or P-glycoprotein(P-gp)substrates / inhibitors.Methods: We enrolled 246 elderly patients(≥65 years old)suffered from ACS and underwent PCI in department of geriatric cardiology in the First Affiliated Hospital of China Medical University from January 2014 to June 2017.The status of polypharmacy was described and the main factors were analyzed,and the effects of drugs number on renal function,liver function and fasting blood glucose in the patients were also explored.The patients were divided into atorvastatin(metabolized by CYP3A4 and transported by P-gp)group and rosuvastatin(almost not metabolized by CYP3A4 nor transported by P-gp)group.The level change of the blood creatine kinase,liver function,kidney function,fasting blood glucose and blood lipids profiles were compared between the two groups at admission and one month follow-up.And we also explored the influence relating to statin-associated adverse effects when the patients received coadministration of different statins and various CYP3A4 or P-gp substrates /inhibitors.Results: Two hundred and thirty-seven patients(96.34%)were prescribed with five or more drugs after PCI treatment,and the main factors affecting polypharmacy were hypertension(p=0.005)and diabetes(p=0.021).Compared with the level of fasting blood glucose at admission,the level at one month follow-up increased slightly in atorvastatin group,5.73(5.15,6.72)mmol/L and 5.85(5.34,6.52)mmol/L respectively,p=0.006.However,there was no significant difference between the two groups.When statins were prescribed together with three or more CYP3A4 or P-gp substrates / inhibitors,the level of fasting blood glucose further increased in atorvastatin group than rosuvastatin group,0.39(-0.13,0.75)mmol/L and-0.04(-0.49,0.32)mmol/L respectively,p=0.047.Conclusion: The incidence of polypharmacy was high in the elderly ACS patients after interventional therapy.Hypertension and diabetes are diseases affecting polypharmacy.Compared with rosuvastatin,the level of fasting blood glucose is more likely to have a slight elevation after atorvastatin prescribed together with three or more CYP3A4 or P-gp substrates / inhibitors.