The Variation Of The Cholesterol Metabolism Markers During Antilipemic Therapy In Patients With Coronary Heart Disease

Objective: In order to reveal the characteristic of cholesterol matabolism and indicate the guidence of cholesterol metabolism markers in antilipemic therapy in patients with coronary heart disease (CAD), cholesterol synthesis and aborption markers are measured in this study. According to cholesterol matabolism status reflecting by these markers, more efficiency individualized treatment will be taken. It is supposed to popularized in clinical work to measure these markers before antilipemic therapy, which is helpful for secondary prevention of coronary heart disease.Methods: Patients diagnosed as CAD through coronal artery angiography in Special Medical department of An Zhen Hospital who had not receive antilipemic therapy for 4 weeks were coutinous selected in this study. Our study involves 45 CAD patients inculding 34 males and 11 females. According to the level of LDL-C after 20 mg/d simvastatin for 4 weeks, subjects were divided into 2 groups. Subjects whose LDL-C meet the standard will keep up 20 mg/d simvastatin for next 8 weeks, and the other group will get 20 mg of simvastatin plus 10 mg of ezetimibe daily for next 8 weeks. The concentrations of lipid and cholesterol matabolism markers will be measured in baseline, 4 weeks and 12 weeks. In our study, cholesterol synthesis markers (squalene, lanthosterol and desmosterol) and absorption markers (campesterol, stigmasterol and sitosterol) are measured.Result: (1) All of 45 CAD patients were given 20mg/d simvastatin for the first 4 weeks, and the TC reduced 15.6% (p=0.000), LDL-C reduce24.6% ( p=0.000), ApoB reduced 11.4% (p=0.003), ApoA increase 8.5% (p=0.004), lanthosterol descended 18.8% ( p=0.033), sitosterol /TC increased 17.8% (p=0.017). The success rate of dyslipidemia was 62.2%.(2) Twenty-eight patients who reached the lipid goal during the first 4 weeks continued monotherapy of simvastatin to the 12th week. Increasing tendency of TC(3.85mmol/L vs 3.41mmol/L,p=0.062) and LDL-C(2.00mmol/L vs 1.88mmol/L,p=0.187) in the 12th week compared with the 4th week was observed, and there was no significance variation in cholesterol matabolism markers. The success rate of dyslipidemia of this group was 78.6% in the 12th week.(3) Seventeen patients who did not reach the lipid goal during the first 4 weeks received combination treatment of simvastatin and ezetimibe to the 12th week. TC reduced 16.5% (p=0.000), LDL-C reduced 23.2% (p=0.000), campesterol reduced 50.7% (p=0.000), sitosterol reduced 15.2% (p=0.016), sitosterol /TC reduced 41.0% (p=0.000). The success rate of dyslipidemia of this group was 76.5% in the 12th week.(4) Percentage of combination therapy from the first to the fourth quarter divided by sitosterol/TC was 41.7%, 63.6%, 27.3% and 18.2% separately.Conclusion: (1) Concentrations of TC, LDL-C and cholesterol synthesis markers in patients with CAD reduced after receiving therapy of simvastatin for 4 weeks, and cholesterol absorption markers increased for feedback.(2) Compared to simvastatin monotherapy, the combination of simvastatin and ezetimibe could further decrease circulating TC and LDL-C concentrations, and also cholesterol absorption reduced. As a result, the success rate of dyslipidemia could be improved.(3) For discriminating patients with high cholesterol absorption and giving them statin plus ezetimibe therapy to secondary prevention of coronary heart disease, cholesterol matabolism should be measured before treatment.