Comparison of anti-inflammatory effect of atorvastatin with rosuvastatin in patients of acute coronary syndrome

Sushant Khurana, Surabhi Gupta, HiraLal Bhalla, Shefali Nandwani, Varad Gupta, Sushant Khurana, Surabhi Gupta, HiraLal Bhalla, Shefali Nandwani, Varad Gupta

Abstract

Objectives: To compare anti-inflammatory effect of atorvastatin and rosuvastatin in patients of acute coronary syndrome.

Materials and methods: The study was a prospective, open-labeled, randomized and single-center study conducted on 100 patients of acute coronary syndrome. Patients were assigned to atorvastatin 40 mg daily or rosuvastatin 20 mg daily for 4 weeks. C-reactive protein (CRP) levels, lipid profiles, erythrocyte sedimentation rate (ESR) and adverse effects were measured at beginning and at the end of 4 weeks.

Results: Baseline parameters and clinical profile did not differ between the two groups. CRP levels significantly decreased from beginning to the end of 4 weeks in both atorvastatin and rosuvastatin groups (from 35.48 to 23.07 mg/l and from 35.88 to 19.91 mg/l respectively, both P < 0.001). However, there was significant difference between the levels of CRP in patients of the rosuvastatin group as compared to the atorvastatin group (19.91 ± 6.32 vs 23.07 ± 7.47, P < 0.05). In addition, both the drugs were associated with a reduction in total cholesterol, LDL levels and ESR at the end of 4 weeks as compared to the beginning (P < 0.001 for all comparisons).

Conclusion: Both atorvastatin (40 mg) and rosuvastatin (20 mg) are effective in decreasing CRP and LDL cholesterol levels even in a short duration of 4 weeks. Rosuvastatin was found to be more effective in decreasing CRP levels.

Keywords: Acute coronary syndrome; inflammation; statins.

References

    1. Park K. 21st ed. Jabalpur: Banarsidas Bhanot; 2011. Park's Textbook of Preventive and Social Medicine; pp. 300–2.
    1. Papathanasiou AI, Pappas KD, Korantzopoulos P, Leontaridis JP, Vougiouklakis TG, Kiriou M, et al. An epidemiological study of acute coronary syndromes in northwestern Greece. Angiology. 2004;55:187–94.
    1. Maseri A. Inflammation, atherosclerosis and ischemic events - Exploring the hidden side of the moon. N Engl J Med. 1997;336:1014–6.
    1. Yudkin JS, Juhan-Vague I, Hawe E, Humphries SE, di Minno G, Margaglione M, et al. HIFMECH Study Group. Low-grade inflammation may play a role in the etiology of the metabolic syndrome in patients with coronary heart disease: The HIFMECH study. Metabolism. 2004;53:852–7.
    1. Ridker PM, Rifai N, Pfeffer MA, Sacks FM, Moye LA, Goldman S, et al. Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events (CARE) Investigators. Circulation. 1998;98:839–44.
    1. Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;432:836–43.
    1. Ridker PM, Rifai N, Clearfield M, Downs JR, Weis SE, Miles JS, et al. Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events. N Engl J Med. 2001;344:1959–65.
    1. Danesh J, Wheeler JG, Hirschfield GM, Eda S, Eiriksdottir G, Rumley A, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2004;350:1387–97.
    1. Sposito AC, Chapman MJ. Statin therapy in acute coronary syndromes: Mechanistic insight into clinical benefit. Arterioscler Thromb Vasc Biol. 2002;22:1524–34.
    1. Ray KK, Cannon CP. The potential relevance of the multiple lipid-independent (pleiotropic) effects of statins in the management of acute coronary syndromes. J Am Coll Cardiol. 2005;46:1425–33.
    1. Koenig W, Sund M, Fröhlich M, Fischer HG, Löwel H, Döring A, et al. C-reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: Results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Ausberg cohort study, 1984 to 1992. Circulation. 1999;99:237–42.
    1. Ridker PM, Glynn RJ, Hennekens CH. C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction. Circulation. 1998;97:2007–11.
    1. Balk EM, Lau J, Goudas LC, Jordan HS, Kupelnick B, Kim LU, et al. Effects of statins on nonlipid serum markers associated with cardiovascular disease: A systematic review. Ann Intern Med. 2003;139:670–82.
    1. Jialal I, Stein D, Balis D, Grundy SM, Adams-Huet B, Devaraj S. Effect of hydroxymethyl glutaryl coenzyme a reductase inhibitor therapy on high sensitive C-reactive protein levels. Circulation. 2001;103:1933–5.
    1. Kinlay S, Timms T, Clark M, Karam C, Bilodeau T, Ridker PM, et al. Vascular Basis Study Group. Comparison of effect of intensive lipid lowering with atorvastatin to less intensive lowering with lovastatin on C-reactive protein in patients with stable angina pectoris and inducible myocardial ischemia. Am J Cardiol. 2002;89:1205–7.
    1. Macin SM, Perna ER, Farías EF, Franciosi V, Cialzeta JR, Brizuela M, et al. Atorvastatin has an important acute anti-inflammatory effect in patients with acute coronary syndrome: Results of a randomized, double-blind, placebo-controlled study. Am Heart J. 2005;149:451–7.
    1. Kuznetsova MA, Vaulin NA, Masenko VP, Gratsianskiĭ NA. Non-ST-elevation acute coronary syndrome. Comparison of effects of atorvastatin and rosuvastatin on blood levels of lipids and markers of inflammation. Kardiologiia. 2010;50:21–5.
    1. Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM, Jr, Kastelein JJ, et al. JUPITER Study Group. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359:2195–207.
    1. Weitz-Schmidt G, Welzenbach K, Brinkmann V, Kamata T, Kallen J, Bruns C, et al. Statins selectively inhibit leukocyte function antigen-1 by binding to a novel regulatory integrin site. Nat Med. 2001;7:687–92.
    1. Albert MA, Danielson E, Rifai N, Ridker PM. PRINCE Investigators. Effects of statin therapy on C-reactive protein levels. The pravastatin inflammation/CRP evaluation (PRINCE): A randomized trial and cohort study. JAMA. 2001;286:64–70.
    1. Rauch U, Osende JI, Chesebro JH, Fuster V, Vorchheimer DA, Harris K, et al. Statins and cardiovascular diseases: The multiple effects of lipid-lowering therapy by statins. Atherosclerosis. 2000;153:181–9.
    1. Bersot TP. Drug Therapy for hypercholesterolemia and dyslipidemia. In: Burton LL, Chabner BA, Knollman BC, editors. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 12th ed. New York: McGraw Hill; 2011. pp. 877–908.
    1. Schwartz GG, Olsson AG, Ezekowitz MD, Ganz P, Oliver MF, Waters D, et al. Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study Investigators. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: The MIRACL study: A randomized controlled trial. JAMA. 2001;285:1711–8.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅