| Objectives:Investigate the effects of atrovastatin 20mg/day,rosuvastatin 10mg/day,pitavastatin 2mg/day on the level of residual lipoprotein cholesterol and short-term prognosis in patients with intermediate coronary artery lesion.Methods:A total of 312 patients with intermediate coronary artery lesion.diagnosed by coronary angiography in the Department of Cardiology of Jiangsu Subei People’s Hospital from November 2019 to November 2021 were selected as the study group,and 221 patients with coronary artery disease excluded by angiography were selected as the control group.General and surgical data as well as the levels of total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),apolipoprotein A-1(ApoA-1),Apolipoprotein B(Apo B),and lipoprotein a(Lp(a)were collected in 2 groups.Residual lipoprotein cholesterol(RLP-C)levels were calculated according to the formula,and Gensini scores were calculated to measure the degree of coronary artery lesions and compared.Then,patients in the study group were randomly divided into atorvastatin group,rosuvastatin group and pivastatin group according to the type of statin used.Patients were followed up for 1 year through outpatient visits,telephone calls,readmission and other forms.Postoperative medication,blood lipid and RLP-C levels before and after treatment,adverse drug events and major cardiovascular adverse events(MACEs)were collected for statistical analysis.Results:1.Comparison of general information and blood lipid levels between the control group and the research group:There were no significant differences in age,diabetes history,alcoholism history,ejection fraction and body mass index(BMI)between the two groups(P>0.05).The proportion of males in the study group,hypertension history and smoking history,and the levels of fasting TG,TC,LDL-C,Lp(a),Apo B and RLP-C in the first time after admission were significantly higher than those in the control group.The levels of HDL-C,Apo A-1 and ApoA-1/Apo B were significantly lower than those of control group(P<0.05).2.Correlation analysis between RLP-C level and Gensini score of coronary artery:RLP-C was positively correlated with Gensini score of patients with critical coronary artery disease(r=0.546,P<0.001).3.Logistic regression analysis of the factors influencing critical coronary artery disease:smoking history,hypertension history,TC,LDL-C,RLP-C increased levels were independent risk factors for critical coronary artery disease;Elevated HDL-C level was an independent protective factor for critical coronary.4.ROC curve of RLP-C level for predicting critical coronary artery lesions:the optimal cut-off value of RLP-C for predicting critical coronary artery lesions was 0.434,the area under ROC curve was 0.798(95%CI(0.760,0.835),P<0.001),the sensitivity was 0.705,and the specificity was 0.729.5.Comparison of general information and blood lipid levels before taking statins:there were no statistical differences in male proportion,age,BMI,smoking history,alcoholism history,hypertension history,diabetes history,Gensini score and postoperative medication in Rosuvastatin group,atorvastatin group and Pivastatin group(P>0.05);There were no significant differences in the levels of TG,TC,LDL-C,Lp(a),ApoA-1,Apo B,ApoA-1/Apo B and RLP-C among three groups before medication(P>0.05).6.Comparison of serum lipid levels before and after statin treatment among the three groups:Intra-group comparison:TG,TC,LDL-C and RLP-C levels of the three groups were decreased after treatment,while HCL-C,Lp(a),ApoA-1 and ApoA-1/Apo B were increased compared with that before treatment(P<0.05);There was no statistical significance compared with before treatment(P>0.05).There was no significant difference in Apo B level among the three groups compared with before treatment(P>0.05).Comparison between groups:There were no significant differences in the levels of TG,TC,LDL-C,Lp(a),Apo B and ApoA-1/Apo B among three groups after treatment(P>0.05).After treatment,the RLP-C level in Pivastatin group was significantly lower than that in the other two groups(P<0.05),and the HDL-C and ApoA-1 levels were higher than those in the other two groups(P<0.05).7.Comparison of the incidence of MACEs and adverse drug reactions among the three groups during treatment:During the follow-up period,the incidence of aggravated coronary heart disease(emergency visit or readmission,ACS,revascularization)in the Pivastatin group was 4.21%,which was lower than that in the other two groups(7.14%and 11.24%),but there was no statistical difference(P>0.05).There was no overall difference in the incidence of MACEs among the three groups(P>0.05).There was no difference in the incidence of adverse drug reactions among three groups(P>0.05).8.Comparison of the incidence of adverse drug reactions among the three groups during treatment:The total incidence of adverse drug reactions was 14.61%in rosuvastatin group,14.29%in atorvastatin group,and 12.63%in pitvastatin group.There was no difference in the incidence of adverse drug reactions among the three groups(P>0.05),and no serious adverse drug reactions occurred.Conclusions:1.Smoking history,hypertension history,elevated levels of TC,LDL-C and RLP-C were independent risk factors for intermediate coronary artery lesion.Elevated HDL-C level was an independent protective factor for critical coronary artery disease.2.There is a certain correlation between the level of RLP-C and the degree of coronary artery disease in patients with intermediate coronary artery lesion;When RLP-C>0.434mmol/L,the risk of critical coronary artery disease increased.3.Compared with atorvastatin 20mg/day and rosuvastatin 10mg/day,Pivastatin 2mg/day can significantly reduce the level of RLP-C in patients with intermediate coronary artery lesion,significantly improve the level of HDL-C and ApoA-1 in patients with intermediate coronary artery lesion,and may reduce the risk of disease exacerbation in patients with coronary artery disease. |
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