Clinical Study Of The Escape Phenomenon On The Treatment Of Statins In Patients With Coronary Heart Disease

Objective To investigate the incidence and influence factors of the escape phenomenone of statins in patients with coronary heart disease.Method 180 patients with coronary heart disease from the department of cardiology in Qilu Hospital of Shandong University and the third Hospital of Jinan were enrolled from October 2011 to October 2013.They were randomly divided into two groups.One group(n=76)was given simvastatin 40mg per day,another group(n=77)was given rosuvastatin 10mg per day.The follow-up period was 10 months.Patients' gender,age,medical history(hypertension,diabetes,PCI,number of stents,smoking),oral medication(including aspirin,clopidogrel,nitrates,beta blockers,ACEI/ARB,CCB)were inquired.The serum cholesterol,triglyceride,high density lipoprotein cholesterol,low density lipoprotein cholesterol(LDL-C),glycosylated hemoglobin,high sensitive C reactive protein were acquired at baseline and during follow-up at 2 months and 4 months,6 months,8 months and 10 months.Statins escape phenomenon was defined as increament of LDL-C level more than 15%compared to that at 2 months during follow-up.And this phenomenon served as the main observation end point.The secondary end point was the incidence of new cardiovascular events,including angina,myocardial infarction,stroke,revascularization,and sudden death.Result At last,151 patients entered the statistical analysis.Escape phenomenon occurred in 26 cases(34.2%)with simvastatin and in 20 cases(25.9%)with rosuvastatin.Total incidence rate of statins escape phenomenon was 30.5%.The escape group and non-escape groups did not differ significantly as for gender,age,BMI,history of smoking,hyperlipidemia,hypertension,myocardial infarction,PCI and the number of stents implanted and oral medication(P>0.05).Neither did serum panels.The escape phenomenon did not occur in both groups until 6 months after the treatment.From the 6th months,escape phenomenon appeared and the LDL-C level rose slowly.At the end of follow-up,LDL-C level increase 16.9%compared to the benchmark value,while the LDL-C level remain relatively steady in the non-escape group.There was significant difference in the history of diabetes mellitus,oral clopidogrel,and HbAlC levels between the two groups(P<0.05).Logistic regression analysis revealed that these three factors hold the prognostic value of statin escape phenomenon(P<0.05).During the follow-up,11 cases of new onsets of cardiac and cerebral events(6 cases of angina pectoris,3 cases of mocardial infarction,1 case of stroke,1 case of revasculariztion)occurred in the statin escape group,whereas only;6 cases of major adverse events(4 cases of angina pectoris,1 cases of myocardial infarction,1 case of stroke)occurred in the non-escape group(P<0.01).Conclusion The prevalence of statin escape phenomenon in patients taking statins was affected by oral clopidogrel,history of diabetes mellitus and especially HbA1C>7%.The occurrence of escape phenomenon contributes to major adverse events significantly.