The Effects Of Different Doses Of Atorvastatin Calcium On The Levels Of Homocysteine And Uric Acid In Patients With Unstable Angina Pectoris

Objective:This study is designed to explore the effects of different doses of atorvastatin calcium on levels of homocysteine (Hcy) and uric acid (UA) in patients with unstable angina pectoris, and to explore its clinical significance.Methods:A total of123patients who were diagnosed of unstable angina pectoris with moderately elevated levels of Hcy and UA in the2nd hospital of Hebei Medical University from December2011to June2011were enrolled. After routine treatments, all the patients were divided into40mg group (patients were administered to atorvastatin calcium40mg per night) and20mg group (patients were administered to atorvastatin calcium20mg per night). The levels of Hcy and UA before treatment, lweek,1month, and6months after treatment were measured in both groups. The safety and efficacy of atorvastatin calcium were followed up6months after treatment. The efficacies of atorvastatin calcium were including the recurrence angina, major adverse cardiac and cerebral events, and levels of blood lipid. The safety of atorvastatin calcium included xerostomia, dizziness, skin rash, constipation, nausea, abdominal distension myalgia. The levels of Alanine aminotransferase (ALT),Aspartate aminotransferase (AST), Creatine kinase (CK) and the Creatinine (SCr) were examined one week and six months after treatment. The drugs which could lower or affect the metabolism of Hcy and UA were not used during the study. Analyses were done using SPSS for Windows16.0. A two-sided of P-value<0.05was defined as statistically significant.Results:1Baseline characteristics:there were no statistical differences between two groups of in gender, age, body mass index, and the risk factors of coronary heart disease which were including diabetes, hypertension, hyperlipidemia, smoking history, family history of coronary artery disease, and the history of cerebrovascular disease. No significant differences were found in the baseline levels of Hcy and UA (P>0.05). The index of myocardium enzymes, transaminase and SCr were similar between the two groups (P>0.05).2Changes of the levels of Hcy and UA during the study:After a week, both Hcy and UA concentration were decreased in the two groups compared with baseline data, and Hcy and UA in40mg group was significantly lower than those of20mg group (P<0.01). After one-month therapy, Hcy and UA levels decreased significantly, which were significantly lower in40mg group (P<0.05). The levels of Hcy and UA levels in the two groups after six-month follow-up were lower than those after one-month treatment, and they were significantly lower in40mg group (P<0.05).3Blood lipid:After6months of treatment, the levels of TC, TG, and LDL-C in the two groups were decreased compared with baselinelevels(P<0.05), and those were much lower in40mg group(P<0.05); while the levels of HDL-C was increased compared with baseline (P>0.05).4Follow-up of major adverse cardiovascular events:There were113patients out of123patients were followed up successfully, and the average rate of follow-up was91.1%. There were62cases and51cases that finished follow-up in20mg group and40mg group, respectively. The occurrence of recurrence angina in40mg group was significantly lower than that in20mg group (25.5%vs.43.5%,P<0.05). There was no statistically significant difference between the two groups in the occurrence of nonfatal myocardial infarction (5.9%vs.11.3%,P>0.05). No statistically significance of cerebrovascular disease was found in the two groups (2.0%vs.4.8%, P>0.05). No all-cause death, heart failure, and cardiac arrhythmias happened during follow-up. The incidences of major adverse cardiac and cerebral events were similar (P>0.05).5Follow-up of side effects:There were one case of dizziness,3cases of constipation, and10cases of moderate elevation of AST and ALT in40mg group, respectively. There were2cases of constipation and9cases of moderate elevation of AST and ALT in20mg group, respectively. No dry mouth, nausea, abdominal distention, myalgia, rash and abnormal renal function were found in the two groups. No statistically significant differences in the levels of ALT and CK in the two groups, as well as the levels of AST and SCr (P>0.05).6Six months later, the levels of AST, ALT, Scr, and CK were not changed significantly in the two groups compared with baseline data(P>0.05), and no differences were found between the two groups (P>0.05).Conclusion:1There were dose and time dependence of atorvastatin calcium on reduction of levels of Hcy, UA and blood lipid.2Although no reduction of adverse cardiac and cerebrovascular events was found, there was a better effect of large dose of atorvastatin calcium improving myocardial ischemia, and do not increase the incidence of adverse events.