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[Relationship Between Lipid Lowering and Changes of Hemostasis and Inflammation During Use of Statins in Non-ST
E V Pokrovskaia1, N A Gratsianskiĭ, N A Vaulin
1Research Institute for Physicochemical Medicine, Center of Atherosclerosis; ul. Malaya Pirogovskaya, 1a, 119828 Moscow, Russia.
Insights
Statin therapy in non-ST elevation acute coronary syndrome (NSTEACS) patients rapidly altered hemostasis parameters, with lipid-lowering degree, particularly for von Willebrand factor, being key. These changes occurred irrespective of the specific statin used.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Biochemistry
Background:
- Non-ST elevation acute coronary syndrome (NSTEACS) requires management of lipid levels and cardiovascular risk.
- Statins are crucial for lipid-lowering, but their effects on hemostasis and inflammation need further elucidation.
- Comparative studies of pravastatin and atorvastatin offer insights into differential biological effects.
Purpose of the Study:
- To analyze the relationship between lipid level changes and hemostasis/inflammation parameters.
- To investigate these relationships in patients with NSTEACS treated with pravastatin or atorvastatin.
- To determine if statin-induced lipid changes correlate with markers of coagulation and inflammation.
Main Methods:
- Ninety NSTEACS patients were randomized to pravastatin or atorvastatin (10 or 40 mg/day).
- Measurements included thrombin-antithrombin complex (TAT), prothrombin fragments 1+2 (F1+2), D-dimer, von Willebrand factor (vWF), C-reactive protein (CRP), and platelet aggregation at baseline, day 7, and day 14.
- Spearman correlation and quartile analysis were used to assess relationships between lipid changes and other parameters.
Main Results:
- Both LDL and total cholesterol decreased significantly, with atorvastatin showing greater efficacy.
- Atorvastatin, unlike pravastatin, increased F1+2 and TAT, and decreased vWF.
- Lowering of total and LDL cholesterol correlated positively with vWF decrease; this effect was most pronounced with significant LDL reduction.
- Negative correlations were observed between total cholesterol changes and TAT, and CRP and HDL cholesterol changes.
Conclusions:
- Rapid changes in hemostasis parameters during statin therapy in NSTEACS patients are linked to the degree of lipid lowering.
- The observed relationships between lipid changes and hemostasis markers, particularly vWF, appear to be largely statin-independent.
- These findings highlight the complex interplay between lipid modification and thrombotic/inflammatory pathways in acute coronary syndromes.
Aim:
To analyze relationship between changes of lipid levels and parameters of hemostasis and inflammation in a previously reported comparative study of some biological effects of pravastatin and atorvastatin in patients with non ST elevation acute coronary syndrome (NSTEACS).
Methods:
Ninety aspirin and heparin treated patients with NSTEACS were randomized to open pravastatin 40 mg/day (n=31) and atorvastatin 10 (n=30) or 40 mg/day (n=29). At baseline, on days 7 and 14 we measured levels of thrombin-antithrombin complex (TAT), prothrombin fragments 1+2 (F1+2), D-dimer, von Willebrand factor (vWF) and C-reactive protein (CRP) and assessed platelet aggregation. Spearman correlation coefficients were calculated for mean deltas of all parameters {[(baseline - day 7) + (baseline - day 14)]/2} for all patients. The patients were divided into quartiles according to absolute LDL CH lowering by day 14.
Results:
Levels of LDL and total CH significantly decreased in all groups (atorvastatin 40 mg/day >> atorvastatin 10 mg/day > pravastatin). Contrary to pravastatin the use of atorvastatin was associated with increases of F 1+2, TAT, and decrease of vWF. Platelet aggregation decreased only in atorvastatin 40 mg/day group (p<0.05) and CRP decreased in combined atorvastatin group (p<0.05). Most pronounced relationship existed between changes of lipid levels and vWF. Lowering of total and LDL CH correlated positively with decreases of vWF (r=0.25, p=0.018, and r=0.23, p=0.032, respectively) and quartile analysis showed that vWF decreased only in patients with marked LDL CH lowering (quartiles 3, 4). Negative correlation was found between changes of total CH and those of TAT (r=-0.22, p=0.039), and between changes of CRP and HDL CH (r=-0.24, p=0.03). TAT and F 1+2 levels significantly increased in those patients in whom LDL CH level <2.5 mmol/l was achieved by day 14 and tended to decrease in other patients. No relationship was found between changes of lipids and platelet aggregation.
Conclusion:
Rapid (in 14 days) changes of some parameters of hemostasis occurring during treatment of patients with NSTEACS with various statins were related to degree of lipid lowering possibly irrespective of a statin used. Most evident was relationship between changes of lipids and von Willebrand factor.
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