Highly effective lipid-lowering therapy on local vascular stiffness and symptoms of chronic heart failure in patients with postinfarction cardiosclerosis

Objective. To study the effect of achieving the target level of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL–C) on the parameters of local vascular stiffness and the development of chronic heart failure (CHF) in patients with ST-elevation myocardial infarction (STEMI).

Design and methods. The study included 80 patients with myocardial infarction with ST segment elevation (STEMI) aged 35 to 65 years. On the 7–9th day of STEMI, at the 24th and 48th weeks of treatment with atorvastatin 40–80 mg clinical symptoms of heart failure were analyzed, the lipid profile and brain natriuretic peptide (BNP) were determined. Ultrasound of the common carotid arteries using high-frequency RF signal technology was performed. Depending on the effectiveness of treatment with atorvastatin, patients were retrospectively divided into 2 groups: 40 people who reached the target level of LDL–C (highly effective therapy, HET) and 37 patients who did not reach the target level of LDL–C (relatively effective therapy, RET).

Results. In patients who reached the target LDL–С level, the initial BNP values were 115,2 pg/ml, with the regression by 34,5 % at follow-up (p = 0,03). There was no significant change in the RET group. In the HET group, a decrease in IMT, an improvement in distensibility parameters, a decrease in local PWV and stiffness index of common carotid arteries, were found. Based on the 6-minute walk test, only patients in HET group showed an increase in exercise tolerance after 24th week (p = 0,04). Also, individuals who did not reach the target LDL–С level, showed a decrease in the quality of life 27,4 % (p = 0,03). Patients in the HET group showed no negative dynamics.

Conclusion. We showed that at the long-term follow-up after STEMI, the achievement of the target LDL cholesterol values was accompanied by a significant improvement in the parameters of local rigidity of the main arteries, and a decrease in BNP level, as well as by more favorable course of CHF.

1. World Health Organization. http://www.who.int/healthinfo/globalburdendisease/estimates/en/index1.html (2015).

2. The task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Russ J Cardiol. 2018; 23(5):103–58. doi:10.15829/1560-4071-2018-5-103-158. In Russian.

3. Touboul P, Hennerici M, Meairs S, Adams H, Amarenco P, Bornstein N et al. Mannheim carotid intima-media thickness consensus (2004–2006). Cerebrovasc Dis. 2007;23(1):75–80.

4. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D. On behalf of the European Network for Non-invasive Investigation of Large Arteries. Expert consensusdocument on arterial stiffness: methodological issuesand clinical applications. Eur Heart J. 2006;27(21):2588–2605. doi:10.1093/eurheartj/ehl254

5. Russian Heart Failure Society, Russian Society of Cardiology, Russian Scientific Medical Society of Internal Medicine. Guidelines for heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(6S):8–158. doi:10.18087/cardio.2475. In Russian.

6. ЕSC/ЕАS Guidelines for the management of dyslipidaemias. Russ J Cardiol. 2017;5(145):7–77. DEUjj7mi5N 67b6LYZPApyoV8Ek8hdNL1Vy. In Russian.

7. Cholesterol Treatment Trialists’ (CTT) Collaboration, Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet. 2015;385(9976):1397–405. doi:10.1016/S0140-6736(14)61368-4

8. Cholesterol Treatment Trialists’ (CTT) Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet. 2012;380(9841):581–590. doi.org/10.1016/S0140-6736(12)62027-3

9. Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376(9753):1670–1681. doi:10.1016/s0140-6736(10)61350-5

10. Crouse J, Frohlich J, Ose L, Mercuri M, Tobert J. Effects of high doses of simvastatin and atorvastatin on high-density lipoprotein cholesterol and apolipoprotein A-1. Am J Cardiol. 1999;83(10):1476–1477.

11. Eckardstein A, Assmann G. Prevention of coronary heart disease by raising high-density lipoprotein cholesterol? Curr Opin Lipidol. 2000;11(6):627–637.

12. Okazaki S, Yokoyama T, Miyauchi K, Shimada K, Kurata T, Sato H et al. Early statin treatment in patients with acute coronary syndrome: demonstration of the beneficial effect on atherosclerotic lesions by serial volumetric intravascular ultrasound analysis duringhalf a year after coronary event: the ESTABLISH Study. Circulation. 2004;110(9):1061–1068.

13. Fox K, Dabbous O, Goldberg R, Pieper K, Eagle K, Van deWerf F et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). Br Med J. 2006;333(7578):1091–1099.

14. Lerman A, Zeiher A. Endotelial function: cardiac events. Circulation. 2005;111(3):363–368.

15. Tomiyama H, Koij Y, Yambe M, Shiina K, Motobe K, Yamada J et al. Brachial-ankle pulse wave velocity is a simple and independent predictor of prognosis in patients with acute coronary syndrome. Circ J. 2005;69(7):815–822.

16. Shahar E, Chambless LE, Rosamond WD, Boland LL, Ballantyne CM, McGovern PG et al. Plasma lipid profile and incident ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) study. Stroke. 2003;34(3):623–631.

17. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. N Engl J Med. 1998;339(19):1349–1357.

18. Greene SJ, Vaduganathan M, Lupi L, Ambrosy AP, Mentz RJ, Konstam MA et al. Prog nostic significance of serum total cholesterol and triglyceride levels n patients hospitalized for heart failure with reduced ejection fraction (from the EVEREST Trial). Am J Cardiol. 2013;111(4):574–581.

19. Myasoedova E, Crowson CS, Kremers HM, Roger VL, Fitz-Gibbon PD, Therneau TM et al. Lipid paradox in rheumatoid arthritis: the impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease. Ann Rheum Dis. 2011;70(3):482–487.

20. Yoon CH, Youn TJ, Ahn S, Choi DJ, Cho GY, Chae IH et al. Korean Heart Failure Registry. Low serum total cholesterol level is a surrogate marker, but not a risk factor, for poor outcome in patients hospitalized with acute heart failure: a report from the Korean Heart Failure Registry. J Card Fail. 2012;18(3):194–201.

21. Wierzbicki AS, Poston R, Ferro A. The lipid and non-lipid effects of statins. Pharmacol Ther. 2003;99(1):95–112.

22. May HT, Muhlestein JB, Carlquist JF, Horne BD, Bair TL, Campbell BA et al. Relation of serum total cholesterol, C-reactive protein levels, and statin therapy to survival in heart failure. Am J Cardiol. 2006;98(5):653–658.