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

Abstract

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.