The Short-term Effects Of Statins On The Liver Function For Patients With ACS

Objective: With the improvement of our living standards, the incidenceof coronary heart disease is increasing year after year and has become one ofthe major causes for death and disabling in China. Acute coronary syndrome isa group of acute clinical syndrome, which of pathology foundation is based oncoronary atherosclerotic plaque rupture, and secondary incomplete orcomplete occlusive thrombosis. Lipid-lowering therapy can stabilize andprevent the occurrence of atherosclerotic plaques. Latest trials havedemonstrated that more intensive lowering of low-density lipoproteincholesterol, can not only reduce the incidence of coronary events, but alsoprevent the development of coronary atherosclerotic plaques or even reversedit for patients with ACS. Intensive lipid-lowering therapy is a new treatmentoptionsin in the patients with ACS.Statins can lower cholesterol levels by inhibiting the formation ofHMG-CoA reductase and cholesterol biosynthesis in liver. Statins also reducelow density lipoprotein (LDL) by increasing the receptor of low densitylipoprotein (LDL) in liver cell surface and enhancing the uptake andmetabolism of LDL. A lot of trials have demonstrated that the patients withcoronary heart disease can benefit from statin therapy. The statins caneffectively reduce mortality, improve the prognosis of patients with ACS onthe acute phase by lowing lipid, stabling arterial atherosclerotic plaque,improving endothelial function, inhibiting inflammation and plateletaggregation.Liver is the main place of form cholesterol synthesis. Clinicians pay moreand more attention on the damage for the liver function by statins. The liverdamage mainly includes cell degeneration, necrosis, increased membranepermeability, and then alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which exist in the liver cells, release into the blood.The determination of serum ALT and AST is the main method to diagnose thedamage of liver function. The level of ALT and AST often associated withseverity parallel, more than three times the upper limit of normal is exaltation.Clinical studies have found that: there are1%of patients who taking statinshas the transaminase index>3ULA. This situation often occurred in themedication the first1³months, and this effect related to the metabolicpathways and dose of statin. The researches about short-term impact on liverfunction about statin and related risk factors is few. The purpose of this study:To observe the short-term effects on the liver function on different metabolicpathways and different doses of statins, for the patients with ACS. Analysistaking statin drugs transaminase trends and liver dysfunction risk factors toguide clinical him statins selection.Methods: We chose110patients who were diagnosed ACS in TheSecond Hospital of HeBei Medical University from2010.11to2011.11, whichincluding75male cases,35female cases. The patients were27⁸6years old.Recorded the patient's age, sex, BMI, abdominal circumference, the history ofdrinking, smoking, and fatty liver. We divided the patients into six groups:simvastatin20mg (group1),40mg (group2), atorvastatin20mg (group3),40mg (group4), rosuvastatin5mg (group5),10mg (group6). The liverfunctions of the patients were examined before taking drugs(T0),3⁵days(T₁),7¹0days(T2),15²0days(T3) after taking drug. Statin was suspendedwhen hepatic enzymes of the patients rise to3times over normal referencelimit. Exclusion criteria: Patients with active liver disease, liver and kidneydysfunction, obvious abnormal liver function before taking medicine (alanineaminotransferase ALT, aspartate aminotransferase AST>3ULA), myopathy,have been use statin in last month, and those allergy to statins or the patientswith other definite taboo. The data were analyzed by SPSS13.0statisticalsoftware. The measurement data were expressed by mean±standard deviation(x±SD) and the enumeration data were expressed by absoluter frequency. Themeasurement data satisfied normality and homogeneity of variance condition were analyzed by completely randomized design's analysis of variance, andthe measurement data not satisfied normality and homogeneity of variancecondition were analyzed by nonparametric test(Kruskal-Wallis H), theenumeration data were analyzed by Chi-square test. The analyze of the riskfactor of abnormal liver function about statin was analyzed by Logisticregression. P<0.05was considered as significance.Result: The ratios of ALT and AST in plasma increased to3ULA werenot significantly different in the six groups, in the same time after takemedicine (P>0.05). The ratios of ALT and AST in plasma increased to3ULAwere not significantly different in group, in the different times after takemedicine. By analysis the patients who's transaminase did not rise to3ULA,we fund, the levels of ALT and AST in plasma in difference time, werenot significantly different in group (P>0.05). The levels of ALT and AST inplasma were not significantly different in the time of before taking drugs and3⁵days,15²0days after taking medicine in the groups (P>0.05). The levelsof AST in plasma after taking medicine7¹0days were different (P<0.05), thelevels of AST in plasma who taking atorvastatin20mg or40mg, higher thansimvastatin40mg. The levels of ALT in plasma after taking drugs7¹0dayswere not significantly different (P>0.05). The risk factors about statins effecton liver function are drinking and fatty liver. The odds ratio of drinking is2.03and fatty liver is2.743.Conclusion: The short-term impact on liver function not significantlydifferent in different metabolic pathways and different doses of statins, whenused initial and moderate dose. Drinking and fatty liver are the risk factor ofabnormal liver function about statin.