Pharmacodynamics and clinical effectiveness of clopidogrel and atorvastin in patients with acute coronary syndrome and hyperlipidaemia
Abstract
Aim. To study pharmacodynamics and clinical effectiveness of clopidogrel and atorvastatin in patients with acute coronary syndrome (ACS) and hyperlipidaemia (HLP).
Material and methods. The study included 90 patients with ACS and Type IIA or IIB HLP. Group I received clopidogrel monotherapy, Group II — a combination of clopidogrel and atorvastatin, and Group III — atorvastatin monotherapy. Blood lipid profile (LP), induced platelet aggregation (IPLA), and cytochrome P-450 3A4 isoenzyme were measured.
Results. Clopidogrel did not affect blood LP, but significantly reduced IPLA. Its effectiveness was also demonstrated in combination with atorvastatin, despite reduced activity of cytochrome P-450 3A4 isoenzyme. Lipidlowering effect of atorvastatin was observed both for monotherapy and its combination with clopidogrel. Atorvastatin monotherapy has a mild anti-aggregant effect: IPLA was reduced as early as during the third month of the treatment.
Conclusion. High effectiveness of an anti-platelet agent clopidogrel and a lipid-lowering medication atorvastatin opens a window for their wide use in cardiologic practice, in particular, for ACS patients.
About the Authors
A. S. Sivkov
I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
S. V. Paukov
“Medsantrud” City Clinical Hospital No. 23
Russian Federation
Russian Federation
Moscow
R. Sh. Balugyan
“Medsantrud” City Clinical Hospital No. 23
Russian Federation
Russian Federation
Moscow
V. G. Kukes
I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
M. V. Zhuravleva
I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
S. I. Sivkov
I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
T. N. Farafonova
I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
References
1. Карпов Р.С., Кобалава Ж.Д., Коломин Е.Ю. и др. Эффективность и переносимость Ловастатина у пациентов с гиперхолестеринемией. Кардиология 1997; 5: 52-4.
2. Козлов А.А. Эффективность Ловастатина и Симвастатина в коррекции атерогенных дислипопротеидемий, нарушений структурно-метаболических свойств тромбоцитов у больных нестабильной стенокардией (результаты 6-ме¬сячного наблюдения). Дисс канд мед наук. Тюмень 1997.
3. Кукес В.Г. Клиническая фармакология. Москва “ГЭОТАРМЕД” 2004.
4. Кукес В.Г. Метаболизм лекарственных средств: клинико-фармакологические аспекты. Москва “Рефарм” 2004.
5. Славина Н.Н., Оверков О. В., Грацианский Н.А. Нестабильная стенокардия: краткосрочное применение клопидогрела с использованием нагрузочной дозы, влияние на индуцированную аденозинфосфатом агрегацию тромбоцитов. Кардиология 2000; 12: 30-7.
6. Bacer S, Joffe B, Grundy Е, et al. Treatment of homozygous familial hypercholesterolemia with probucol. S African Med J 1982; 62: 7-11.
7. Davignon J, Montiggny M, Dufour R. HMG-GoA-reductase inhibitors: a look back and a look ahead. Can J Card 1992; 8: 843-64.
8. Darius H, Reckless JP. Accelerated inhibition of platelet activity by clopidogrel loading dose in patients folloving coronary stent implantation. Eur Heart J 1999; 20: Abstr suppl: 43А.
9. East C, Bilheimer D, Grundy S. Combination drug tgerapy for familian combined hyperlipidemia. Ann Intern Med 1988; 109: 25-32.
10. Martin G, Duez H, Blancvart C, et al. Statin-induced inhibition of the Rho-signaling pathway activates PPARalpha and induces HDL apoA - I. J Clin invest 2001; 107(11): 1423-32.
11. Mukhtar RY, Reckless JP. Statin-induced myositis: a comonly encountered or rate side eeffect? Curr Opin Lipidol 2005; 16: 640-7.
12. Pavia H, Thelen КМ, van Coster R, et al. High — dose statins and skeletal musscle metabоlism in humans: a randomized controled trial. Clin Pharmacol Ther 2005; 78: 60-8.
13. Laacsonen R. On the mechanisms of statin-induced myopathy. Clin Pharmacol Ther 2006; Е—рub.
Review
For citations:
Sivkov A.S., Paukov S.V., Balugyan R.Sh., Kukes V.G., Zhuravleva M.V., Sivkov S.I., Farafonova T.N. Pharmacodynamics and clinical effectiveness of clopidogrel and atorvastin in patients with acute coronary syndrome and hyperlipidaemia. Cardiovascular Therapy and Prevention. 2009;8(4):76-83. (In Russ.)
Views:
905
Email this article 
