| ObjectiveTo compare the efficacy of different lipid-lowering regimens based on statins on low-density lipoprotein cholesterol and carotid plaque in patients with hyperlipidemia and carotid plaque.MethodsFrom January 2021 to January 2022,360 patients were selected from the Department of Cardiology,the Third Affiliated Hospital of Guangzhou Medical University.According to the inclusion criteria and exclusion criteria,360 patients were screened and randomly divided into four groups.Group A(statin 20 mg / d orally),group B(statin 10 mg / d orally + ezetimibe 10 mg / d orally),group C(statin 10 mg /d orally + alixiumab 75 mg / 2 weeks subcutaneous injection),group D(statin 10 mg /d orally + ezetimibe 10 mg / d orally + alixiumab 75 mg / 2 weeks).The baseline data of the selected patients were collected,including gender,age,basic disease,glycosylated hemoglobin,body mass index,blood lipid profile,liver and kidney function related indicators,inflammatory indicators,carotid plaque area,carotid intima-media thickness,and carotid neovascularization.From the first day of treatment to the 24 th week and 48 th week of treatment,the patients were required to return to the hospital for reexamination twice,and the time of return to the hospital should not exceed the specified time > 2 weeks.Glycosylated hemoglobin,body mass index,blood lipid profile,liver and kidney function,inflammatory index,carotid plaque,adverse events,loss of follow-up,and withdrawal for various reasons were recorded.During the follow-up period,7 patients were lost to follow-up due to factors such as self-withdrawal,replacement of medication regimen,and withdrawal due to adverse reactions.Finally,353 effective patients were included,including 89 in group A,88 in group B,89 in group C,and 87 in group D.The main outcome indicators were the percentage of low-density lipoprotein cholesterol decreased at week 24 and the percentage of carotid plaque area decreased at week 24.The secondary outcome indicators were the rate of low-density lipoprotein reaching the standard at week 24 and week 48,the ratio of patients with carotid plaque area decreased,the ratio of patients with carotid plaque neovascularization improved,and the remaining blood lipid indicators,liver and kidney function.Results1.After 24 weeks of treatment,the four groups could reduce TC and LDL-C(P< 0.05),and the percentage of early reduction was different(P < 0.05).The percentage of decrease in group C and D was higher than that in group A and B,and there was no significant difference between group C and D(P > 0.05).2.At 48 weeks,the percentage of TC and LDL-C reduction in the four groups was more significant(P < 0.05),and the percentage of reduction was different(P <0.05).The percentage of TC reduction in groups C and D was higher than that in groups A and B,and there was no significant difference between groups C and D(P > 0.05).The percentage of LDL-C reduction in groups C and D was higher than that in groups A and B,and the percentage of LDL-C reduction in group D was higher than that in group C(P < 0.05).3.After 24 weeks of treatment,TG decreased and HDL-C increased in groups C and D(P < 0.05),and TG decreased and HDL-C increased in group B at 48 weeks(P < 0.05).4.At 48 weeks of treatment,uric acid decreased in groups B,C and D group(P< 0.05),the decrease percentage of group D > group B and group C(P < 0.05).5.The area of carotid plaque was reduced in group C and D at 24 weeks of treatment(P < 0.05),and the percentage of plaque area reduction in group D was greater than that in group C(P < 0.05).At 48 weeks,plaque reduction was also observed in group B(P < 0.05).At 48 weeks,the percentage of plaque area reduction in group D was greater than that in group C and group B(P < 0.05).6.The carotid intima-media thickness was decreased in groups B,C and D at 48 weeks of treatment,the decrease percentage of carotid intima-media thickness in group D was higher than that in group B and C(P < 0.05).7.The LDL-C compliance rate at 24 weeks and 48 weeks and the proportion of patients with plaque area reduction at 24 weeks in group C and D were higher than those in group A and B(P < 0.05).The proportion of patients with plaque area reduction in group B,C and D at 48 weeks was greater than that in group A(P <0.05),and the proportion of patients with plaque area reduction in group D was greater than that in group B and C(P < 0.05).8.All the four groups showed the reversal of plaque stability and the improvement of plaque neovascularization in the early stage(P < 0.05).At 48 weeks,the proportion of patients with plaque stability reversal and neovascularization improvement in group C and D was higher than that in group A and B(P < 0.05).9.The compliance rate of low density lipoprotein cholesterol was related to time,group,BMI and hypertension(P < 0.05),which was significantly related to time and group(P < 0.001).Comparison of the compliance rate of the four groups : group D >group C > group B > group A;the longer the treatment time,the higher the compliance rate;the higher the compliance rate of patients with hypertension;the lower the body mass index,the higher the compliance rate.10.The proportion of patients with bilateral carotid plaque area reduction was significantly correlated with time,group and plaque neovascularization(C group > B group > A group;the longer the treatment time,the higher the plaque area reversal rate;the better the improvement of plaque neovascularization,the higher the plaque area reversal rate.11.Apo B,Lp(a),Apo E and(Lp-PLA2)were decreased in group C and D at24 weeks(P < 0.05).The percentage reduction of Apo B,Lp(a)and Apo E in group D was higher than that in group C(P < 0.05).There was no significant difference in the percentage of(Lp-PLA2)decrease between group C and group D.Conclusion1.The dual and triple regimens combined with PCSK9 inhibitors can more effectively reduce TC and LDL-C levels in the early stage,and there is no difference between the two in reducing blood lipid levels in the early stage.With the prolongation of treatment time,the triple regimen combined with PCSK9 inhibitor can further reduce LDL-C than the double regimen.2.The dual and triple regimens combined with PCSK9 inhibitors have a reduction in carotid plaque area at an early stage,and the triple regimen combined with PCSK9 inhibitors can further reduce the carotid plaque area after long-term medication than the dual regimen;the lipid-lowering regimen of statins combined with ezetimibe needs to reduce the area of carotid plaque after long-term medication;single use of statins is not effective in reducing carotid plaque area.3.The four lipid-lowering regimens can improve the stability of carotid plaque and the neovascularization of carotid plaque in the early stage,but there was no significant difference between the four groups in the early stage.After long-term treatment,the combination of PCSK9 inhibitor dual and triple regimens is more effective in stabilizing carotid plaques and improving plaque neovascularization,but there is no difference between the two. |
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