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Atorvastatin effect on phospholipid profile and distribution between lipoprotein fractions in type 2 diabetic patients with and without CAD
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Abstracts / Atherosclerosis 263 (2017) e111ee282
Aim: The aim of the study was to investigate the effect of early administration of atorvastatin in the acute phase of acute myocardial infarction on the dynamics of systemic markers of inflammation, and lipid profile. Methods: The study included 164 patients with acute myocardial infarction aged 37-76 years who underwent myocardial revascularization. The 1st group consisted of 82 patients receiving basic therapy (atorvastatin 20 mg), in the 2 nd - 82 patients treated with a loading dose of atorvastatin (80 mg daily) appointed in the first 24 hours of the disease, regardless of lipid spectrum of blood. Results: blood lipid parameters in patients studied groups at baseline did not differ. However, on the 10th day of observation, treatment with highdose atorvastatin resulted in a significant decrease in total cholesterol (5,83±0,17) to (4,63±0,13) mmol/l) and LDL (3,56±0,17) to (2,37±0,15) mmol/l), while the treatment with atorvastatin 20 mg indicators lipid profile was not significantly different from baseline, although there was a tendency to decrease. In group 1, for 10 days of treatment total cholesterol levels decreased by only 4.9%, while in the 2 nd - by 20.6% (P <0.001), LDL respectively 13.5 and 31 7% (P <0.01). Conclusions: Thus, with the appointment of atorvastatin at a dose of 80 mg / day in the early hours of the onset of acute myocardial infarction, a marked lipid-lowering effect and helps to reduce the number of peripheral blood leukocytes and reduce the severity of increased, CRP, creatine kinase MB, thereby reducing the severity of myocardial reperfusion injury
PO444. EFFECT OF HIGH-DOSE ATORVASTATIN THERAPY ACCOMPANIED BY DISCONTINUATION OF CHOLESTEROL-RICH DIET ON COLOR-DOPPLER ULTRASONOGRAPHY PARAMETERS OF ATHEROSCLEROTIC CAROTID ARTERY 1
2
3 1
Hossein Mehrad , Manijhe Mokhtari-Dizaji , Hossein Ghanaati . Islamic Azad University, Tabriz Branch- Faculty of Basic Sciences- Department of Physics, Tabriz, Iran; 2 Tarbiat Modares University, Faculty of Medical Sciences, Department of Medical Physics, Tehran, Iran; 3 Tehran University of Medical Sciences, Imam Khomeini Hospital, Advanced Diagnostic and Interventional Radiology Research, Tehran, Iran Aim: Atherosclerosis is the underlying reason for nearly all causes of coronary artery disease and peripheral arterial disease and many cases of stroke. Carotid color-Doppler ultrasonography is a popular tool for evaluating atherosclerosis of the carotid artery. The aim of this study was to generate a rabbit model of carotid arterial atherosclerotic stenosis and the subsequent investigating the effect of high-dose atorvastatin therapy on color-Doppler ultrasonography parameters in this model. Methods: Carotid fibro-lipid plaque with severe stenosis (>70%) and neovascularization was induced at the right common carotid artery of New Zealand white rabbits by perivascular severe cold injury using liquid nitrogen before being fed a 1.5% cholesterol-rich diet. After eight weeks, the histopathology showed advanced atherosclerosis formation, resulting in vessel wall thickening and stenosis formation. The animals treated by high- dose atorvastatin (5 mg/kg/day) administration accompanied by discontinuation of cholesterol-rich diet. Different variables such as PSV (Peak Systolic Velocity), EDV (End Diastolic Velocity), MV (Mean Velocity), RI (Resistance Index), PI (Pulsatility Index), VF (Volume Flow) were studied in the treatment group compared with other groups using color-Doppler ultrasonography. Results: Results from color-Doppler ultrasonography, showed a significant reduction in the mean value for PSV, EDV, MV, RI and a significant increase VF at the stenotic region in the treatment group compared with the other groups (P< 0.05). Conclusions: Changes in color-Doppler ultrasonography parameters in the treatment group, as mentioned in the results section, show that lipidlowering therapy by high-dose atorvastatin in combination with discontinuation of cholesterol-rich diet, can cause to atherosclerotic plaque regression.
PO445. SAFETY OF LONG-TERM STATIN THERAPY: DATA FROM REAL-WORLD OBSERVATION IN SUBJECTS AT VERY HIGH RISK
Bela Benczur1, Bela Herczeg2. 1 'Balassa Janos' County Hospital, Dept. of Cardiology, Szekszard, Hungary; 2 'Hetenyi Geza' County Hospital, Dept. of Cardiology, Szolnok, Hungary Aim: SAMS are the main cause of poor statin-adherence leading to adverse cardiac outcome. This is particularly harmful in patients at the highest risk. SAMS are rare in RCTs but much prevalent (7-29%) in registries. To contribute to real-world data on statin-adherence we investigated retrospectively a post-infarction cohort to assess the long-term safety of statins. Methods: 232 subjects were included into this analysis (165 male, 67 female, mean age: 61.8 ys) with a mean follow-up of 33.1 months. Statin use, rate of reaching target LDL (1.8 mmol/l), potential adverse events and the change of laboratory values (CK, SGOT, SGPT, eGFR, HbA1c) were analyzed. Results: The mostly used statins were atorvastatin (48%) and rosuvastatin (36%) in moderate-high doses (63mg vs 31mg, respectively). Interestingly every subjects got intensive statin-dose at MI but dose was decreased in 40% after 3-6 months (87 pts). The real cause of dose-reduction couldn’t be identified in 79 pts. Myalgia (4 cases), liver function-elevation (2) and worsening diabetes (2) occurred as potential statin-AE (3.4%). Nobody was permanently withdrawn from statin. Although the strict target LDL-level was reached only in 19% of subjects ezetimibe was added to statins rarely (13%). Conclusions: Despite statin is the cornerstone of CV-prevention significant underdosing can be confirmed in practice. It’s essential to identify those patients who unable to take statin to find solutions to decrease their risk. In addition we have to convince both subjects and doctors regarding the need of intensive statin therapy to reduce the threat of MACE.
PO446. ATORVASTATIN EFFECT ON PHOSPHOLIPID PROFILE AND DISTRIBUTION BETWEEN LIPOPROTEIN FRACTIONS IN TYPE 2 DIABETIC PATIENTS WITH AND WITHOUT CAD Imen Askri1, Sami Kelbousi2, Mohsen Sakly1, Nabil Attia1. 1 UR11ES33, Integrated Physiology, Faculty of Sciences of Bizerte, Carthage University, Tunisia; 2 Internal Medicine Department, Regional Hospital of Bizerte, Bizerte, Tunisia Aim: Phospholipids (PL) mainly phosphatidylcholine are associated to metabolic syndrome and Coronary Artery Disease (CAD), but no data showing the statin medication effect on PL metabolism in type 2 diabetes and CAD. We aimed to examine whether the PL distribution is modulated in lipoprotein fractions after two-month atorvastatin treatment in type 2 diabetic patients with and without CAD. Methods: Ninety subjects were recruited (age, 40-70 years): 30 type 2 diabetic patients without CAD, 30 type 2 diabetic patients with CAD and 30 age- and sex-matched controls. Lipid profile and PL distribution in lipoprotein fractions were measured before and two months after atorvastatin treatment (10 mg). Lipoproteins were separated by precipitation method. Results: Apart from an altered lipid profile in patients groups compared to controls, we found a significant decrease, after atorvastatin treatment, in non-coronary diabetic patients: 19.2 % for triglycerides, 20.7 % for total cholesterol, 17.7 % for total phospholipids, 33.3 % for (VLDL+LDL)-PL and 30.1 % for LDL-C. In concomitance, the treatment enhances the HDL-C and -PL levels by 21.2 and 14.5 % respectively. These modulations by the treatment were comparable with those observed in type 2 diabetic patients with CAD. Conclusions: The PL level and distribution between lipoprotein fractions were altered in type 2 diabetic patients and atorvastatin restore such disturbance suggesting that, in type 2 diabetes mellitus, atorvastatin might promote reverse cholesterol transport via enrichment of HDL with phospholipids.
PO447. PLASMATIC AND PHENOTYPIC EFFECTS WITH ALIROCUMAB, A PCSK9 INHIBITOR, IN FAMILIAL HYPERCHOLESTEROLEMIA TREATMENT (FH)
Abstracts / Atherosclerosis 263 (2017) e111ee282
Aim: The aim of the study was to investigate the effect of early administration of atorvastatin in the acute phase of acute myocardial infarction on the dynamics of systemic markers of inflammation, and lipid profile. Methods: The study included 164 patients with acute myocardial infarction aged 37-76 years who underwent myocardial revascularization. The 1st group consisted of 82 patients receiving basic therapy (atorvastatin 20 mg), in the 2 nd - 82 patients treated with a loading dose of atorvastatin (80 mg daily) appointed in the first 24 hours of the disease, regardless of lipid spectrum of blood. Results: blood lipid parameters in patients studied groups at baseline did not differ. However, on the 10th day of observation, treatment with highdose atorvastatin resulted in a significant decrease in total cholesterol (5,83±0,17) to (4,63±0,13) mmol/l) and LDL (3,56±0,17) to (2,37±0,15) mmol/l), while the treatment with atorvastatin 20 mg indicators lipid profile was not significantly different from baseline, although there was a tendency to decrease. In group 1, for 10 days of treatment total cholesterol levels decreased by only 4.9%, while in the 2 nd - by 20.6% (P <0.001), LDL respectively 13.5 and 31 7% (P <0.01). Conclusions: Thus, with the appointment of atorvastatin at a dose of 80 mg / day in the early hours of the onset of acute myocardial infarction, a marked lipid-lowering effect and helps to reduce the number of peripheral blood leukocytes and reduce the severity of increased, CRP, creatine kinase MB, thereby reducing the severity of myocardial reperfusion injury
PO444. EFFECT OF HIGH-DOSE ATORVASTATIN THERAPY ACCOMPANIED BY DISCONTINUATION OF CHOLESTEROL-RICH DIET ON COLOR-DOPPLER ULTRASONOGRAPHY PARAMETERS OF ATHEROSCLEROTIC CAROTID ARTERY 1
2
3 1
Hossein Mehrad , Manijhe Mokhtari-Dizaji , Hossein Ghanaati . Islamic Azad University, Tabriz Branch- Faculty of Basic Sciences- Department of Physics, Tabriz, Iran; 2 Tarbiat Modares University, Faculty of Medical Sciences, Department of Medical Physics, Tehran, Iran; 3 Tehran University of Medical Sciences, Imam Khomeini Hospital, Advanced Diagnostic and Interventional Radiology Research, Tehran, Iran Aim: Atherosclerosis is the underlying reason for nearly all causes of coronary artery disease and peripheral arterial disease and many cases of stroke. Carotid color-Doppler ultrasonography is a popular tool for evaluating atherosclerosis of the carotid artery. The aim of this study was to generate a rabbit model of carotid arterial atherosclerotic stenosis and the subsequent investigating the effect of high-dose atorvastatin therapy on color-Doppler ultrasonography parameters in this model. Methods: Carotid fibro-lipid plaque with severe stenosis (>70%) and neovascularization was induced at the right common carotid artery of New Zealand white rabbits by perivascular severe cold injury using liquid nitrogen before being fed a 1.5% cholesterol-rich diet. After eight weeks, the histopathology showed advanced atherosclerosis formation, resulting in vessel wall thickening and stenosis formation. The animals treated by high- dose atorvastatin (5 mg/kg/day) administration accompanied by discontinuation of cholesterol-rich diet. Different variables such as PSV (Peak Systolic Velocity), EDV (End Diastolic Velocity), MV (Mean Velocity), RI (Resistance Index), PI (Pulsatility Index), VF (Volume Flow) were studied in the treatment group compared with other groups using color-Doppler ultrasonography. Results: Results from color-Doppler ultrasonography, showed a significant reduction in the mean value for PSV, EDV, MV, RI and a significant increase VF at the stenotic region in the treatment group compared with the other groups (P< 0.05). Conclusions: Changes in color-Doppler ultrasonography parameters in the treatment group, as mentioned in the results section, show that lipidlowering therapy by high-dose atorvastatin in combination with discontinuation of cholesterol-rich diet, can cause to atherosclerotic plaque regression.
PO445. SAFETY OF LONG-TERM STATIN THERAPY: DATA FROM REAL-WORLD OBSERVATION IN SUBJECTS AT VERY HIGH RISK
Bela Benczur1, Bela Herczeg2. 1 'Balassa Janos' County Hospital, Dept. of Cardiology, Szekszard, Hungary; 2 'Hetenyi Geza' County Hospital, Dept. of Cardiology, Szolnok, Hungary Aim: SAMS are the main cause of poor statin-adherence leading to adverse cardiac outcome. This is particularly harmful in patients at the highest risk. SAMS are rare in RCTs but much prevalent (7-29%) in registries. To contribute to real-world data on statin-adherence we investigated retrospectively a post-infarction cohort to assess the long-term safety of statins. Methods: 232 subjects were included into this analysis (165 male, 67 female, mean age: 61.8 ys) with a mean follow-up of 33.1 months. Statin use, rate of reaching target LDL (1.8 mmol/l), potential adverse events and the change of laboratory values (CK, SGOT, SGPT, eGFR, HbA1c) were analyzed. Results: The mostly used statins were atorvastatin (48%) and rosuvastatin (36%) in moderate-high doses (63mg vs 31mg, respectively). Interestingly every subjects got intensive statin-dose at MI but dose was decreased in 40% after 3-6 months (87 pts). The real cause of dose-reduction couldn’t be identified in 79 pts. Myalgia (4 cases), liver function-elevation (2) and worsening diabetes (2) occurred as potential statin-AE (3.4%). Nobody was permanently withdrawn from statin. Although the strict target LDL-level was reached only in 19% of subjects ezetimibe was added to statins rarely (13%). Conclusions: Despite statin is the cornerstone of CV-prevention significant underdosing can be confirmed in practice. It’s essential to identify those patients who unable to take statin to find solutions to decrease their risk. In addition we have to convince both subjects and doctors regarding the need of intensive statin therapy to reduce the threat of MACE.
PO446. ATORVASTATIN EFFECT ON PHOSPHOLIPID PROFILE AND DISTRIBUTION BETWEEN LIPOPROTEIN FRACTIONS IN TYPE 2 DIABETIC PATIENTS WITH AND WITHOUT CAD Imen Askri1, Sami Kelbousi2, Mohsen Sakly1, Nabil Attia1. 1 UR11ES33, Integrated Physiology, Faculty of Sciences of Bizerte, Carthage University, Tunisia; 2 Internal Medicine Department, Regional Hospital of Bizerte, Bizerte, Tunisia Aim: Phospholipids (PL) mainly phosphatidylcholine are associated to metabolic syndrome and Coronary Artery Disease (CAD), but no data showing the statin medication effect on PL metabolism in type 2 diabetes and CAD. We aimed to examine whether the PL distribution is modulated in lipoprotein fractions after two-month atorvastatin treatment in type 2 diabetic patients with and without CAD. Methods: Ninety subjects were recruited (age, 40-70 years): 30 type 2 diabetic patients without CAD, 30 type 2 diabetic patients with CAD and 30 age- and sex-matched controls. Lipid profile and PL distribution in lipoprotein fractions were measured before and two months after atorvastatin treatment (10 mg). Lipoproteins were separated by precipitation method. Results: Apart from an altered lipid profile in patients groups compared to controls, we found a significant decrease, after atorvastatin treatment, in non-coronary diabetic patients: 19.2 % for triglycerides, 20.7 % for total cholesterol, 17.7 % for total phospholipids, 33.3 % for (VLDL+LDL)-PL and 30.1 % for LDL-C. In concomitance, the treatment enhances the HDL-C and -PL levels by 21.2 and 14.5 % respectively. These modulations by the treatment were comparable with those observed in type 2 diabetic patients with CAD. Conclusions: The PL level and distribution between lipoprotein fractions were altered in type 2 diabetic patients and atorvastatin restore such disturbance suggesting that, in type 2 diabetes mellitus, atorvastatin might promote reverse cholesterol transport via enrichment of HDL with phospholipids.
PO447. PLASMATIC AND PHENOTYPIC EFFECTS WITH ALIROCUMAB, A PCSK9 INHIBITOR, IN FAMILIAL HYPERCHOLESTEROLEMIA TREATMENT (FH)