Clinical Research Of HbA1c Combined Telmisartan With Rosuvastatin On Stable Coronary Artery Disease Patinets

Background: Stable coronary heart disease is a chronic disease that increases aspeople age progresses, and coronary heart disease has become the first killer tohuman health. Dyslipidemia is an important risk factor leading to coronary heart disease, and lipid-lowering therapy has become an important target forprevention and treatment of coronary heart disease. Many clinical studies showthat statins can significantly reduce LDL-c level, decrease cholesterol deposition in the blood vessel wall, and delay the progress of atherosclerosis. A meta-analysis demonstrated that reduction of LDL-C level by1.0mmol/L (～40mg/L) can reduce all-cause mortality by10%, cardiovascular mortality by20%, and various groups of patients can benefit from statins by lowering LDL-C levels. It can significantly prolong life and reduce the risk of cardiac events when stains are administrated for primary prevention.. Although statins have many important clinical values, there are still a lot of side effects: liver damage, muscle injury, new-onset diabetes and other serious adverse reactions.The purpose of this clinical research is to find the effect of telmisartan on the elevated HbAlc caused by statins.Methods:80patients were taken in including both hospitalized and outpatients in the Qilu Hospital of Shandong University from March2013to January2014. Inclusion criteria were: patients conform to the SCAD diagnostic criteria according to the2012stable ischemic heart disease management guidelines of American Heart Association (AHA). Because these are all patients of stable coronary disease, according to the2012AHA guidelines for the management of stable coronary artery disease treatment, two groups require lifestyle intervention and drug therapy.Drug treatment includes: 1The anti-anginal and anti-ischemic drugs:(1) nitrates,including the short and long-term effect of nitroglycerin and isosorbide dinitrate;(2)β-blockers;(3) the calcium channel blocker (CCB);(4) metabolic drugs:Vasore;2, The prevention of myocardial infarction and death treatment:(1) antiplatelet therapy:two groups were treated with low dose of aspirin(100mg/d);(2) lipid lowering drugs:lipid lowering drugs play an important role in SCAD. For the purpose of this study, two groups were given rosuvastatin10mg/d;(3)angiotensin converting enzyme inhibitor (ACEI), ACEI can decrease mortality,cardiac events and myocardial infarction, therefore, ACEI is suitable for SCAD patients, especially for patients with LVEF<40%, diabetes and chronic renal insufficiency, patients who are ACEI-intolerant can use ARBs. The major manifestations of ACEI intolerance are angioedema, dry cough, rare allergy. Therefore, according to the guidelines, patients in two groups were given rosuvastatin10mg/d, while patients in control group administrate ACEI drugs perindopril4mg/d, and patients in experimental group who are ACEI intolerance were given telmisartan40mg/d.The other treatments and drugs are the same. Outcome measures include:the symptoms, ECG, cardiac ultrasound, HbAlc, liver function, renal function and muscle enzyme and other indicator including clinical events, major adverse reaction.ResuIts:The clinical research finally get31patients in the experimental group and37cases in the control group. HbAlc of experimental group before treatment was (5.75±0.22)%, while after six months’treatment HbAlc level was (5.85±0.18)%, and HbAlc level increased after treatment (p=0.045), there are statistical differences. Control group HbAlc level before treatment was (5.83±0.32)%, while after6months’ treatment HbAlc level was (5.99±0.31)%, and HbAlc significantly increased (p=0.040), there are statistical differences.Change of HbAlc in the experimental group and control group was1.8%and2.6%(p=0.022), then HbAlc change in the experimental group is less than the control group.Conclusions:1Rosuvastatin can elevated patients’ HbAlc levels with stabilize atherosclerotic coronary heart disease.2. Telmisartan and rosuvastatin combination can reduce the elevated influence of rosuvastatin on SCVD patients’HbAlc level.3 Telmisartan’s effect on patient’s HbAlc who use rosuvastain is better than perindopril.