The New Concept In The Era Of Statins

Introduction:Dyslipidemia is one of the main risk factors to cardiovascular system or CerebralVascular system. With the incease in morbidity and mortality from cardio-cerebro-vasculardisease, it becomes very important to control the condition. However, the surveydemonstrates that there is a high incidence of dyslipidemia, but a low rate of awareness andtreatment. All these mean it will need doctors to do a lot of work. At present, there are manykinds of lipid-lowering medications, and especially statin using a lot, like statin’s era, butthere are still so many questions to solve. Peter Jones found if we give double dose of statin,we just can reduce more LDL-C by about6%，and the maximum dose is also difficult toreduceLDL-C more than50%, which makes statin to a predicament. And we have to find thenew way to solve the problem. If a single medicine can not reach the standard, willcombination of medicines can be a good method? Furthermore, the research of Peter Jones isa big project, which is accepted widely by doctors. However, in the clinical, we found manypatients just have taken atorvastatin（20mg or40mg per day, theLDL-C has reduced morethan50%easily. Does this phenomenon exit at large or at small? So we will do furtherresearch.Objectives:To discuss the effect on the blood-lipid by different doses of atorvastatin and the differenteffect between different blood-lipid baseline and to provide new clinical and theoretical basis for thelipid-lowering therapy.Methods:Patients who need intensive lipid-lowering therapy from the outpatient orinpatient department in the second hospital of Jilin university were selected. And they areaged between50-75yeas, demistrated have athorosclersosis disease by coronary heartdisease and are divided into two groups: atorvastatin (20mg/d, called normal group),atorvastatin (40mg/d, called instensive group),60cases in each group.The dividing line ofLDL-C level is3mmol/l， The two group are divided into high baseline group（LDL-C≧3mmol/l）and low baseline group（LDL-C<3mmol/l）by the dividing line ofLDL-C level,which is3mmol/l.Also two group are divided into high baseline group（HDL-C≧1.2mmol/l）and low baseline group（HDL-C<1.2mmol/l）by the dividing line ofHDL-C level,which is1.2mmol/l.And our target is lowing the level of LDL-C to1.7mmol/l. The selected patients for at least3months are not treated with lipid-lowering drugs, weregiven lipid-lowering corresponding therapy for two months. Blood-lipid was checked everymonth, if theLDL-C≤1.7mmol/l（about70mg/dl）, the doses of statin was reduced to the halfof its original dose, if LDL-C>1.7mmol/（labout70mg/dl）, the doses of statin was the same.The cholesterol level of every group was compared.Results:1）After one month treatment, the level of TC、LDL-C of normal group and intensivegroup has decreased respectively by25.1%、32.6%and28.2%、36.2%，(P <0.01),between groups (P>0.05). The level of HDL-C has respectively decreased by3.4%and4%,intensive group (p <0.05), normal group (p>0.05) and between groups (P>0.05). The levelof TG has respectively decreased by6.7%and16.0%, intensive group (p <0.05), normalgroup (p>0.05) and between groups (P>0.05).2）In the normal group,the level of TC、LDL-C has decreased by38.3%、40.3%onemonth later,and5.8%、22.5%second month later.3）After one month treatment, in the normal group,the level of TC、LDL-C of highbaseline group（LDL-C≧3mmol/l）and low baseline group（LDL-C<3mmol/l）has decreasedrespectively by34.0%、41.5%and22.5%、27.3%，the level of TC、LDL-C of high baseline(P <0.01), the level of TC of low baseline(P>0.05)，the level of LDL-C of low baseline(P<0.05).4）After one month treatment, in the intensive group,the level of TC、LDL-C of highbaseline group（LDL-C≧3mmol/l）and low baseline group（LDL-C<3mmol/l）has decreasedrespectively by29.8%、44.3%and9.9%、22.2%，the level of TC、LDL-C of high baselinegroup (P <0.01).the level TC of low baseline (P>0.05)，the level LDL-C of low baseline(P <0.05).5）Between the high baseline of normal group and the high baseline of intensivegroup(p<0.05). Between the low baseline of normal group and the low baseline of intensivegroup(p>0.05).6）After one month treatment, in the normal group,the level of HDL-C of high baselinegroup（HDL-C≧1.2mmol/l）has decreased by20.7%，(P <0.01)，and the low baseline group（HDL-C<1.2mmol/l） raised by5.6%,(P>0.05). After one month treatment, in theintensive group,the level of HDL-C of high baseline group（HDL-C≧1.2mmol/l）has decreased by24.4%，(P <0.01)，and the low baseline group（HDL-C<1.2mmol/l） raisedby9.7%,(P>0.05).Conclusions:1. atorvastatin20mg (normal group) and atorvastatin40mg (intensive group)canreduce TC,LDL-C obviously, but there is no different between the two group.2. In the normal group and intensive group,the level of TC、LDL-C of high baseline has reducedmore than the low baseline,that is to say,if the higher of the level of bloodlipid,the more the lipid isreduced. With a positive correlation with dose. Which will supply a new concept of clinical therapy about thedoses of statins.3. In the normal and intensive group,statins did not manifest the function of raising the level ofHDL-C,but when the baseline of HDL-C is lower,there will be a tendency of raising the level ofHDL-C.How to say the problem?Maybe we still need the research of large sample.