THE IMPACT OF COMBINATION LIPID-LOWERING THERAPY ON PARAMETERS OF LIPID AND MINERAL PROFILE IN PATIENTS WITH DYSLIPIDEMIA, ACUTE CORONARY SYNDROME, AND CHRONIC CORONARY SYNDROME

Highlights

• Combination lipid-lowering therapy reduces total cholesterol, low-density lipoprotein cholesterol, and triglycerides and increases high-density lipoprotein cholesterol in patients with acute coronary syndrome.
• Combination lipid-lowering therapy does not affect serum level of calciprotein particles or serum calcification propensity.
• Serum level of calciprotein particles shows a positive correlation with triglycerides and a negative correlation with high-density lipoprotein cholesterol.

Abstract

Aim. To evaluate the impact of combination lipid-lowering therapy (CLT) on parameters of lipid and mineral profile in patients with dyslipidemia and acute coronary syndrome (ACS) or chronic coronary syndrome (CCS).

Methods. We consecutively enrolled patients with ACS (n = 10) and CCS (n = 5) with low-density lipoprotein cholesterol (LDL-C) > 3,5 mmol/L. The follow-up was 4 months with monthly lipid profile checkpoints. CLT included HMG-CoA reductase inhibitors (atorvastatin 40–80 mg/day or rosuvastatin 20–40 mg/day), cholesterol absorption inhibitor ezetimibe (10 mg/day), and PCSK9 inhibitor alirocumab (300 mg/mL subcutaneously, once per month). Before and after the CLT, we have also evaluated the serum level of calciprotein particles (CPPs) and serum calcification propensity.

Results. Patients with ACS and CCS had similar total cholesterol (TC), LDL-C, and triglycerides (TG) before and after the CLT. The level of high-density lipoprotein cholesterol (HDL-C) in patients with ACS was lower than in CCS (р = 0.018 and p = 0.037 before and after the CLT, respectively). CLT reduced TH, LDL-C, and TG (p = 0.002, p = 0.002, and p = 0.019, respectively) and increased HDL-C (р = 0.018) in patients with ACS. Serum level of calciprotein particles (CPPs) in patients with ACS was higher in comparison with CCS before the treatment (р = 0.04). Serum calcification propensity did not differ between the patients with ACS or CCS.

Conclusion. CLT demonstrated safety and efficacy in patients with ACS and CCS, reducing the levels of TH, LDL-C, and TG, while not affecting serum CPP level and serum calcification propensity. Achievement of target TH and LDL-C values requires the extension of CLT, broader use of ezetimibe, and increased compliance to CLT which demands the intake of multiple drugs.

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