Vasoprotective effect of effective lipid-lowering therapy in patients with ST-segment elevation myocardial infarction

Aim. To study the vasoprotective effects of atorvastatin depending on the achievement of the target level of low-density lipoprotein cholesterol (LDL-C) in patients with ST-segment elevation myocardial infarction (STEMI) within 48 weeks of follow-up.

Materials and methods. Included were 112 STEMI patients who received atorvastatin 20–40–80 mg. On days 7–9 from the onset of the disease, after 24 and 48 weeks, ultrasound examination of the carotid arteries with RF technology and applanation tonometry were performed, the lipid profile was determined. The patients were divided into groups: group 1 (n=41) of highly effective therapy (HET) – who achieved the target LDL-C after 24 and 48 weeks; group 2 (n=29) in relatively effective therapy (RET) – achieving target values at 24th or 48th week; group 3 (n=42) insufficiently effective therapy (IET) – did not reach the target LDL-C.

Results. When examining the carotid arteries in the HET group, the intima-media thickness (IMT) decreased by 10.7–13.1%, the b index – by 14.9–26.3% after 24–48 weeks. In the RET group, the IMT regression was 10.4–13.3%; b index – 23.9% by the 48th week. In the IET group, the b index decreased by the 48th week by 14.3%. According to applanation tonometry in the HET group, the central pressure did not change. In the RET group, systolic pressure in the aorta increased by 10–15.7% after 24–48 weeks, pulse pressure – by 33.9% by the end of observation. With IET, the increase was 8.6–6.8 and 19.8–25.9%, respectively. The odds ratio of developing endpoints in the RET group was 4.7 (95% CI 1.2–26.4; p=0.02), in the IET group – 3.9 (95% CI 1.1–24.8; p=0.03) compared with HET.

Conclusion. The most pronounced vasoprotective effect and a decrease in cardiovascular risk are associated with the achievement of the target LDL-C throughout the entire treatment period.