The Effects Of Atorvastatin On Prethrombotic State In Ischemic Cardiomyopathy Patients With Heart Failure

Objective:In recent years, the morbidity and mortality of Chronic Heart Failure(CHF), especially of ischemic cardiomyopathy patients with heart failure, is developing. It- impacts the life quality of patients and the public health seriously. With the deep study of pathophysiological mechanism in CHF, people have realised the generation of Heart Failure(HF) is a series of complicated pathological process including three pathophysiological mechanism that they are mutual reasons, results and associations. They are the changes of hemodynamics, ventricular remodling and the neurocrine disorder. The abnormal hemodynamics can activate the neurocine, leads to myocardial injury. The continuous activation of neurocrine can directly injure myocardium and intensify the disorder of hemodynamics. The myocardial injury, left ventricular proceeding dilatation and the results of prostration leading into hemodynamics confusion and activation of neurocrine, so that resulting in a pathological process or state including the unbalance of the coagulation-anticoagulation , fibrinolytic system function, and vascular endothelial function abnormality. And there are often the changes of the relative factor about platelet and hemorrheology easily resulting in thrombosis in the body, that is prethrombotic State(PTS). It can lead to proceeding aggravation of the state of illness, so that increasing the rate of sudden death of patients and so on.Many studys have indicated that statins have the antithrombotic function, so decreasing the rate of thrombosis, improving the symptom and prognosis of heart failure. Until now, there is no report about the clinical intervention of atorvastatin for prethrombotic state in ischemic cardiomyopathy patients with heart failure in China. Ischemic cardiomyopathy patients with heart failure and control group were divided into three groups, for investigating the markers level of PTS. The purpose of this study is to investigate: (1)whether there is discrimination of PTS marks level between ischeroic cardiomyopathy patients with heart failure and healthy subjects. (2) whether there are effections of atorvastatin on PTS in ischemic cardiomyopathy patients with heart failure. and (3)Provide a theoretical fundation for preventing and treating ischemic cardiomyopathy patients with heart failure.Methods: Sixty-six patients with ischemic cardiomyopathy patients with heart failure were enrolled in this trial, ages from 42 years to 76 years, mean ages 65±6.2 years, corresponding to the diagnostic criterion of ischemic cardiomyopathy with heart failure. They were divided equally into two groups , treated with atorvastatin and without atorvastatin on the basic of routine treatment, respectively. 20 healthy subjects were the healthy volunteer of medical examination. The conventional therapy group were given traditional therapy to ischenic cardiomyopathy with heart failure. While the atorvastatin treating group were given atorvastatin 10 mg once night, on the basic of conventional treatment. The changes of molecular markers(Fg,vWF,GMP-140,PAI-1)in all patients have been 4 weeks after treating, and then the effects of therapy were compared in two groups. Fasting blood sample were drawm from eighty six subjects at seven to eight o'clock, anticoagulation with EDTA-Na₂ for test GMP-140 with ELISA, anticoagulation with Natrium Citricum for test Fg with solidification way and anticoagulation with Natrium Citricum for exam vWF, PAI-1 with ELISA.After K-S test,the data of gaging statistics of consistent with normal distribution were shown mean±standard (X|-±S). It was used One-Way Analysis of Variance (One-Way ANOVA) in poly groups and pairing data t test in two groups to exam the PTS markers in different groups. It was considered statistical significance by P<0. 05.Results: 1. Compared with controls, serum level of Fg,vWF,Gmp-140 and PAI-1 in ischemic cardiomyopathy patients with heart failure were remarkably higher than that in healthy subjects, there were significant difference between HF and control group (P<0. 01). And there were statistical significance on serum level of Fg,vWF,Gmp-140 and PAI-1 in every group with HF (P<0. 01). 2. It was remarkably decreased after therapy that the Fg,vWF,GMP-140 and PAI-1 in treating with atorvastatin group, and there was statistical significance (P<0. 05). And there were decreased tendency on TC,TG,and LDL in after treating with atorvastatin group, but no statistical significance (P>0. 05). There was increased tendency on HDL in after treating with atorvastatin group, but no statistical significance, too(P>0. 05). 3. There was a decreased tendency on serum level of Fg,vWF,Gmp-140 and PAI-1 in convention treating group,but there was no statistical significance(P>0.05).Conclusion: (1) The danger in ischemic cardiomyopathy patients with heart failure generating thrombosis trends is remarkably higher than that in healthy subjects. (2) Statins (Atorvastatin) reduce thrombosis formation tendency in ischemic cardiomyopathy patients with heart failure by decreasing PTS markers. And,the function of improving PTS is earlier than the function of regulation blood-fat. So, it probably is an important function of independent regulation blood-fat. (3) This trial provides potential proof for the therapy program in schemic cardiomyopathy patients with heart failure, so that statins could be considered to prevent and treat ischemic cardiomyopathy with heart failure.