cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-1685Research ArticleИШЕМИЧЕСКАЯ БОЛЕЗНЬ СЕРДЦАCORONARY HEART DISEASEИзучение липидных и плейотропных эффектов розувастатина у больных острым инфарктом миокардаLipid-lowering and pleiotropic effects of rosuvastatin in patients with acute myocardial infarctionДжаианиН. А.DzhaianiN. A.stereschenko@yandex.ruИльинаЕ. В.IlyinaE. V.stereschenko@yandex.ruКочетовА. Г.KochetovA. G.stereschenko@yandex.ruТерещенкоС. Н.TereshchenkoS. N.stereschenko@yandex.ruГОУ ВПО Московский государственный медико-стоматологический университет Федерального агентства по здравоохранению и социальному развитию Российской Федерации, г. МоскваMoscow State Medico-Stomatological University, Federal Agency of Health and Social Development. Moscow200820122008779197Copyright © Джаиани Н.А., Ильина Е.В., Кочетов А.Г., Терещенко С.Н., 20082008Джаиани Н.А., Ильина Е.В., Кочетов А.Г., Терещенко С.Н.Dzhaiani N.A., Ilyina E.V., Kochetov A.G., Tereshchenko S.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1685Цель

Цель. Изучить липидные и плейотропные эффекты розувастатина у больных острым инфарктом миокарда (ОИМ).

Материал и методы

Материал и методы. Включены 47 больных Q-ОИМ в первые 24 ч: 25 (53,2% ) мужчин и 22 (46,8% ) женщины, средний возраст - 60±1,9 лет. Пациенты разделены на две группы: I(n=26) получала розувастатин (Р) 10 мг/сут. с первых суток ОИМ дополнительно к стандартной терапии, а во II группе (n=21) лечение проводили без статинов. Период наблюдения составил 10 месяцев (мес). На 21 сут и 10 мес. больным выполняли велоэргометрию (ВЭМ) и эхокардиография (ЭхоКГ). На 1, 21 сут и 10 мес. определяли липидный спектр, уровень маркеров воспаления: С-реактивный белок (СРБ), макрофагальный белок воспаления, интерлейкин-6, фактор некроза опухоли а (ФНО-а), мозговой натрийуретический пептид (МНП).

Результаты

Результаты. В I группе частота развития постинфарктной стенокардии была ниже, чем во II (61,5% vs 76,2% ) (р>0,05). По частоте развития нарушений ритма группы не отличались. Рецидивы ИМ в I группе отсутствовали, во II - имели место в 2 случаях. Прогрессирование сердечной недостаточности наблюдалось в 3,9% случаев в I группе и 9,5% во II (р>0,05). В I группе умерли 3 больных; во II-4. ФВ в I группе увеличилась на 10,3%, во II - снизилась на 5,5% (р=0,05). В I группе в отличие от II отмечен хороший гиполипидемический эффект Р. Аналогичная динамика сохраняется к 10 мес. наблюдения: СРБ в I группе снижался на 45% от исходного на 21 сут (р<0,001), к 10 мес. - на 37,0% (р<0,001) от исходного, во II группе - на 20,7% (р>0,05) и 22,6% (р>0,05), соответственно. ФНО-а в I группе в отличие от IIснижался достоверно. При анализе динамики уровня МНП между группами каких-либо различий не отмечалось.

Заключение

Заключение. Раннее применение Р при лечении ОИМ благоприятно влияет на течение постинфарктного периода, повышая толерантность к физической нагрузке, ведет к отсрочке повторных ишемических событий и летального исхода. Р помимо эффективного гиполипидемического действия снижает концентрации маркеров воспаления: СРБ, ФНО-а.

Aim

Aim. To study lipid-lowering and pleiotropic effects of rosuvastatin in patients with acute myocardial infarction (MI).

Materials and methods

Materials and methods. The study included 47 patients in the first 24 hours of Q-wave MI: 25 (53,2%) men and 22 (46,8%) women; mean age 60±1,9 years. Group I (n=26) additionally received rosuvastatin (R), 10 mg/d in the first 24 hours of MI, Group II (n=21) received standard therapy only, but no statins. Follow-up period lasted for 10 months. After 21 days and 10 months, all patients underwent veloergometry (VEM) and echocardiography (EchoCG). At Days 1 and 21 and 10 months later, lipid profile and levels of inflammatory markers (C-reactive protein, CRP, macrophage inflammatory protein, interleukin-6, tumor necrosis factor (TNF) alpha, and brain natriuretic peptide (BNP) were assessed.

Results

Results. In Group I, post-MI angina attacks were less frequent than in Group II (61,5% vs. 76,2%, р>0,05). Both groups were similar in terms of cardiac arrhythmia incidence. No recurrent MIs were registered in Group I, with 2 events in Group II. Heart failure progression took place in 3,9% and 9,5% (р>0,05), respectively. Three and 4 deaths were registered in Groups I and II, respectively. Ejection fraction increased by 10,3% in Group I, reducing by 5,5% in Group II (р=0,05). In contrast to Group II, substantial lipid-lowering effect was observed in Group I. Positive dynamics persisted by the end of the follow-up period. In Group I, CRP level reduced by 45% at day 21 (р<0,001) and by 37,0% (р<0,001) 10 months later, comparing to the baseline level; in Group II, these figures were, respectively, 20,7% (р>0,05) and 22,6% (р>0,05). TNF-alpha level significantly decreased in Group I, but not in Group II. BNP dynamics was similar in both groups.

Conclusion

Conclusion. Early R administration in acute MI improved post-MI clinical course, increased physical stress tolerability reduced the incidence of recurrent MI and death. In addition to its lipid-lowering effects, R decreased inflammatory marker levels (CRP, TNF-alpha).

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The authors declare that there are no conflicts of interest present.