Effect Of Two Different Doses Simvastatin On Serum Lipid And Matrix Metalloproteinases-1 In Patients Of Acute Myocardial Infarction In Early Stage

Objective To observe the influence of two different doses simvastatin on serum matrix metalloproteinases-1 and lipid in patients of acute myocardial infarction(AMI) in early stage. To investigate the change of serum lipid of AMI in early stage and the influence of two different doses simvastatin on lipid and stability of plaque in order to provide clinic evidence for uasage of higher dose statins in early stage of AMI. Methods 120 consecutive patients with AMI were divided into three groups randomly: group 1( n = 41) was given 40mg/d simvastatin at night, group 2 ( n = 40 ) was given 20mg/d simvastatin , control group ( n =39) was no lipid-lowering drugs. The serum levels of MMP-1 and serum lipid before and after treatment 3, 7, 14 day were detected. The cardiovascular events, heart function ,arrhythmia and drug adverse reaction were recorded.Results 1)The lipids of change in control group:compared to those before treatment, the level of serum TC decreased 3% on the 3rd day, increased respectively 1.3%,5.3% on the 7^th and 14^th day; the level of serum LDL-C decreased 3% on the 3^rd day, increased respectively 15%,21% on the 7^th and 14^th day; the level of TG increased respectively 15%,23%,26%; the level of HDL-C decreased respectively 5.8%,12%,4.1%.2) The lipids change in simvastatin 20mg/d group(group 2): compared to those before treatment, the level of serum TC decreased respectively 4.3%,4.3%,1.8% on the 3^rd ,7^th ,14^th day; the level of serum LDL-C decreased respectively 15%,10%,4.1% on the 3^rd , 7^th , 14^th day; the level of TG increased respectively 14%,10%,22%; the level of HDL-C decreased respectively4.1%,11%,4.9%.3) The lipids change in simvastatin 40mg/d group(group 1): compared to those before treatment, the level of serum TC decreased respectively 7.7%, 13%, 10% on the 3rd ,7lh ,14th day; the level of serum LDL-C decreased respectively 18%,19%,23% on the 3rd , 7lh , 14th day; the level of TG increased respectively 1.3%,9.9%,12.5%; the level of HDL-C decreased respectively 5.5%,10%,6.3%.4) Compared to those before treatment, the level of serum levels of MMP-1 increased respectively 2.5%,16%,8.8% in the control group.There was not significant difference after treatment (P > 0.05) .5) Compared to those before treatment, the level of serum levels of MMP-1 decreased respectively 21%,28%,30% in the group 2.There was significant difference after treatment (P< 0.05) .6) Compared to those before treatment, the level of serum levels of MMP-1 decreased respectively 27%,35%,40% in the group 1.There was significant difference after treatment (/><0.05) .7) Comparing with group 2 there was relatively lower levels of MMP-1 on the 7th and 14th day(P<0.05) .8) In group 2 the decrease of MMP-1 had no correlation to the percentage of TC decreased(3rd r = 0.137, P = 0.22; 7th r = 0.14, P = 0.22; 14th r = 0.104, P=0.36).9) In group 2 the decrease of MMP-1 had no correlation to the percentage of LDL-C decreased(3rd r = 0.22, P = 0.06; 7th r = 0.21, P = 0.06; 14th r = 0.104, P = 0.36). 10 ) In group 1 the decrease of MMP-1 had no correlation to the percentage of TC decreased(3rd r = 0.08, P = 0.479; 7th r = 0.21, P = 0.07; 14th r = 0.19, P = 0.09).ll) In group 1 the decrease of MMP-1 had no correlation to the percentage of LDL-C decreased(3rd r = 0.07, P= 0.56; 7th r = 0.17, P = 0.13).On the 14th day,the decrease of MMP-1 had correlation to the percentage the LDL-C had decreased(r = 0.22, P = 0.048).Conclusion 1) There is a dynamic change in the serum lipid in the patients of AMI in early stage, it seems decrease before increase. The total serum cholesterol and low density lipoprotein start decreasing soon after AMI and the lowest at 3rd day then increase slowly. The HDL-C was decreasing and the TG was increasing. 2) The use of different dose simvastatin can delay or depress the increase of LDL-C. Simvastatin 20mg/d can not depress it's increase but had lower significantly level than control group. Simvastatin 40mg/d can decrease significantly level of LDL-C and depress the decrease of HDL-C.Thedecreased level of LDL-C was associated with the dose of simvastatin. 3) The earlyuse of statins decreased significantly level of MMP-1. The level of MMP-1 decreasedhad no correlation to the level of LDL-C and TC.It was associated with the dose ofsimvastatin.4) The use of higher dose simvastatin in the patients of AMI in earlystage may modulate lipids and benefit to atherosclerotic plaque stabilization .