Effect Of Combination Therapy With Statins And Bezafibrate On Lipids And Apolipoprotein A5in Patients With Acute Coronary Syndrome

PurposeTo investigate the effect of combination therapy with statin and bezafibrate on lipids and apolipoprotein A5in patients with acute coronary syndrome(ACS).MethodsFrom February2011to February2012,52patients with ACS hospitalized in the Department of Cardiology of Second Xiangya Hospital were selected. On the basis of conventional therapy, the patients were randomly divided into2groups:(1) control group (n=26), which were given atorvastatin20mg QN or the other statin equivalent to20mg atorvastatin;(2) treatment group (n=26), which were given the same dose statin and bezafibrate200mg BID. The serum levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), lipoprotein A5(apoA5) and high sensitivity C-reactive protein (Hs-CRP) were assessed before the treatment and after6weeks and12weeks, and the side effects and adverse events were recorded.Result(1)The serum levels of TC, TG, LDL-C, Hs-CRP in two groups decreased after6weeks of treatment with further decline after12weeks and treatment group decreased more than the control group (P<0.05); HDL-C increased in6weeks after treatment, with further rise in12weeks after treatment and no significant difference between the two groups (P>0.05).(2)The serum levels of apoA5in two groups increased after therapy, rise more after12weeks than6weeks and more in the treatment group than that in the control group(P<0.05); the serum levels of Hs-CRP in two groups decreased in6weeks after treatment, with further decline in12weeks after treatment and no significant difference between treatment group and control group(P>0.05).(3)The rate reaching to target of the serum levels of LDL-C in the control group in12weeks after treatment was34.6%, on TG was65.4%, HDL-C was46.2%, the total three was2%; in the treatment group LDL-C was69.2%, on TG was88.5%, HDL-C was92.3%, the total three was46.2%; the reaching target goal of the serum levels of LDL-C, TG, HDL-C and the total three rate reaching in treatment group were higher than these in the control group.(4)Spearman rank correlation analysis showed the serum levels of apoA5had positive correlation with TG levels in patients with ACS before the treatment.(r=0.359, P<0.05), and the changes of apoA5had negative correlation with the changes of TC, TG, LDL-C in patients with ACS in12weeks after treatment (P<0.05).(5)There were no serious side effects, discontinuation and exit the research due to adverse events during the observation period in two groups. Follow-up to the12th week, there was no obvious elevation of ALT, CK and no case of myalgia or gravis. There was no significant difference between the serum levels of ALT, CK and Cr in12weeks after treatment and before treatment in two groups (P>0.05).Conclusion(1) The combined treatment of statin and bezafibrate in patients acute coronary syndrome have a synergistic effect in modulating lipids and may help ACS patients with increasing TG and (or) decreasing HDL-C to reach target goal in all lipid parameters.(2) Both Statins and bezafibrate may increase the level of apoA5, and the combination treatment has a stronger effect. (3) Before the treatment, the serum levels of apoA5had a positive correlation with TG levels in patients with ACS, which suggest that the function of apoA5is damaged. The changes of apoA5have a negative correlation with the changes of TC, TG, LDL-C in patients with ACS after the treatment, but the exact mechanism still need further study.(4) No increased adverse reactions had been observed in patients with ACS during the follow up period, which suggest that the combination treatment of statin and bezafibrate is safety.