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Tesi etd-07162018-095325

Thesis type
Tesi di specializzazione (5 anni)
Lipid-lowering and anti-inflammatory effects of atorvastatin versus rosuvastatin in patients with acute coronary syndrome
Corso di studi
relatore Prof. Pedrinelli, Roberto
Parole chiave
  • atorvastatin
  • rosuvastatin
  • inflammation
  • acute coronary syndrome
  • atherosclerosis
Data inizio appello
Secretata d'ufficio
Data di rilascio
Riassunto analitico
Background: atherosclerosis biology is founded on subintimal deposition of lipoproteins accompanied by vascular and systemic inflammatory activation. Lipid-lowering and inflammatory response reduction represent crucial therapeutic targets and clinical trials demonstrated that both lead to decline in the incidence of cardiovascular disease clinical manifestation. Looking at this therapeutic needs, statins seems to be a sort of “perfect molecules”, possessing both lipid-lowering and anti-inflammatory proprieties. Our aim in this study is to compare the effects of 80 mg daily dose of atorvastatin and 20 mg daily dose of rosuvastatin (two “high intensity” statins) on lipid profiles and the levels of inflammatory markers in acute coronary syndrome (ACS).
Methods: two hundred and thirty nine patients with ACS were enrolled in this study. The patients were randomly assigned to receive atorvastatin (80 mg/day) or rosuvastatin (20 mg/day) by using a ratio of 1:1. The levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), LDL-C, Lipoprotien(a), apolipoprotein B and apolipoprotein A1 were compared between groups after 4-week therapy and 12-week therapy. The values of hs-CRP, Interleukin-6, Interleukin-1β, Interleukin-1 RA, tumor necrosis factor-α, tumor necrosis factor receptor 1 and 2, Interleukin-8, Interleukin-10, TGF-β, ICAM1, VCAM1, MMP7, MMP9 were also compared between groups. The Student's t test was used to compare absolute and percent changes between groups, and p < 0.05 was considered as statistically significant for all tests. Mann Whitney U test was used as appropriate.
Results: after treatment in both treatment groups LDL-C, hs-CRP, IL1-RA, Interleukin-6, MMP9, TGF-β values significantly decreased according to baseline. The only difference was in ApoA1, that increase at follow-up in rosuvastatin treatment group.
Conclusion: In our study in which 80 mg daily dose of atorvastatin was compared to 20 mg daily dose of rosuvastatin in patients with ACS, it was shown that both statins have comparable effects on LDL-C and inflammatory markers, after 12-week therapy. Moreover, it was observed that rosuvastatin was more effective in terms of ability to increase ApoA1 level. Based on these findings, 20 mg daily dose of rosuvastatin may be an alternative to 80 mg daily dose of atorvastatin in patients with acute coronary syndrome. Looking at the results of our study, it would be interesting to compare atorvastatin 80 mg/day and rosuvastatin 40 mg/day in patients with ACS.