| Background: Low-density lipoprotein cholesterol(LDL-C)is an important risk factor for atherosclerotic cardiovascular disease(ASCVD).Lowering LDL-C can reduce the incidence of major adverse cardiovascular events and mortality in patients with ASCVD.Based on numerous medical evidence,both Chinese and foreign guidelines emphasize for the lower target values of LDL-C in patients with ASCVD.The recommended target value for LDL-C in very-high-risk ASCVD patients is less than 1.4mmol/L or 50%reduction from the baseline LDL-C level.Statins are the cornerstone drugs for lowering LDL-C.Foreign guidelines recommend early initiation of high-intensity statin therapy to quickly achieve the target level of LDL-C.However,in China the current clinical practice due to the potential side effects of high-intensity statin therapy on the muscles,liver,central nervous system,as well as the "6% effect of statins”,that is,doubling dose of statins will only increase LDL-C reduction by 6%,Chinese ASCVD patients mainly receive mild to moderate intensity statin therapy.Mild and moderate-intensity statin therapy may not reduce LDL-C to the target values recommended by the guidelines in the early stage,and due to the delayed effect of statins,mild and moderate-intensity statin therapy cannot meet the requirements of early risk reduction of adverse cardiovascular events in patients with ASCVD.Therefore,early combination with another lipid-lowering drug to reduce LDL-C to the recommended target value has a potential benefit to Chinese ACS patients.Objective: To compare the efficacy of early application of different blood lipid lowering drug combination strategies in patients with coronary heart disease undergoing percutaneous coronary intervention(PCI)in the First Affiliated Hospital of Dalian Medical University.Methods: Patients diagnosed with coronary heart disease and underwent PCI in the First Affiliated Hospital of Dalian Medical University from January 2018 to June 2022 were selected randomly and assigned into three groups named group A,B and C according to the lipid-lowering strategy.Patients in group A were assigned to(Atorvastatin calcium tablets 20 mg once every night or Rosuvastatin 10 mg once every night combined with Ezetimibe 10 mg once every night),group B were given(Atorvastatin calcium tablet 20 mg once every night or Rosuvastatin 10 mg once every night combined with Evolocumab 140 mg once every 2 weeks subcutaneous injection),and those in group C were given(Atorvastatin calcium tablet 20 mg once every night or Rosuvastatin Statin 10 mg once every night,Ezetimibe 10 mg once every night combined with Evolocumab 140 mg subcutaneous injection once every2 weeks).The three groups of patients were matched by propensity,and the same number of patients who had no statistical difference in gender,age,TC,and LDL-C were included in this study.The general clinical data of the selected patients were recorded,and the biochemical indicators of the patients at baseline,1 month and 6months were collected.Total cholesterol,(TC),lipoprotein a(LP(a)),Low density lipoprotein cholesterol(LDL-C),triglyceride(TG),and high-density lipoprotein cholesterol(HDL-C)their changes in serum concentrations before and after medication were recorded.Results: Through propensity matching,a total of 219 patients were included in this study,73 patients in each group and the results were as follows:1.Comparison of the general information of the three groups of research objectsThere were no statistical significant differences among the three groups in age,sex,smoking history,and previous medication history(P>0.05).The HDL-C levels of the three groups of patients before treatment had a statistically significant difference,while the remaining LDL-C,HDL-C,TC,TG,Lp(a),and Apo B had no significant differences statistically.2.Comparison of blood lipid changes after 1 monthDuring the follow-up period at first month of treatment,the levels of LDL-C in all three groups decreased significantly compared to the baseline,and the difference was statistically significant.The LDL-C level of group A patients was significantly higher than that of groups B and C [1.49(1.17,1.80),0.81(0.56,1.18)and 0.83(0.49,1.34)],and the difference was statistically significant(P<0.001),but there was no statistical difference in LDL-C between group B and C.The proportion of patients with LDL-C less than 1.4mmol/L and 50% LDL-C reduction from the baseline in group A was lower than that in group B and C(43.8%,79.4%,and 80.3%)respectively,and the difference was statistically significant(p<0.001),group B and C there was no statistical difference between the two groups.In terms of other blood lipids,total cholesterol(TC)among group A,group B,and group C decreased from baseline 5.42mmol/L,5.17mmol/L,5.79mmol/L to3.23mmol/L、2.29mmol/L、2.47mmol/L respectively.This decrease was statistically significant(p<0.001),however there was no statistical difference between groups B and C.Apoprotein B(Apo B)decreased from 1.03mmol/L,0.97mmol/L,1.15mmol/L to0.61mmol/L,0.36mmol/L,0.40mmol/L respectively,the difference was statistically significant(p<0.001),but there was no statistical difference between group B and C.There was no statistical difference in TG and Apo A1 among the three groups.3.Comparison of blood lipid changes after 6 monthsAt 6-month follow-up,the level of LDL-C in group A patients were significantly higher than that of groups B and C [1.55(1.21,2.03),1.06(0.64,1.44)and 1.09(0.78,1.57)]respectively,this difference was statistically significant(p <0.001).There was no statistical difference between groups B and C.The proportion of patients with LDL-C less than 1.4mmol/L and 50% lower than the baseline in group A was also lower than that in groups B and C(36.9%,60.9%,58.7%),and the difference was statistically significant(p<0.001),but B and C there were no statistical difference between the two groups.In terms of other blood lipids,total cholesterol(TC)decreased from baseline5.42mmol/L,5.17mmol/L,5.79mmol/L to 3.37mmol/L,2.77mmol/L,2.65mmol/L among group A,group B,and group C respectively,the decrease was statistically significant(p<0.01),but there was no statistical difference between groups B and C.Apo B decreased from 1.03mmol/L,0.97mmol/L,1.15mmol/L to 0.58mmol/L,0.41mmol/L,0.40mmol/L respectively,the difference was statistically significant(p<0.001),but there was no statistical difference between group B and C.High density lipoprotein(HDL-C)increased from baseline 0.92mmol/L,0.99mmol/L,1.04mmol/L to 1.08mmol/L,1.16mmol/L,1.10mmol/L respectively,and the difference was statistically significant(p <0.01).4.SafetyAllergies and muscle pain did not occur in all the three groups of patients.Only one patient in all groups had MACE event and underwent emergency revascularization treatment,no recurrent myocardial infarction or death occurred.Conclusion: In patients with coronary heart disease undergoing percutaneous coronary intervention(PCI),early initiation of combined lipid-lowering drugs can significantly reduce the level of LDL-C and increase the rate of achieving LDL-C target.Among the three combination therapy,Statin combined with Evolocumab has the largest reduction in LDL-C and the highest rate of compliance,moreover the effect of Evolocumab combined with Statins and Ezetimibe in reducing LDL-C is inferior to that of statins combined with Evolocumab. |
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