Comparing the Clinical Effectiveness of High-Dose and Low-Dose Statin Therapy in Patients with Atherosclerotic Coronary Artery Disease (CAD)

Clinical Effectiveness of High-Dose and Low-Dose Statin Therapy in Atherosclerotic Disease

Authors

  • Adnan Ghafoor Department of Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
  • Tanzil Ur Rehman Trainee Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
  • Maria Sarfaraz Department of Biochemistry, Rawal Institute of Health Sciences, Rawalpindi, Pakistan
  • Aslam Rind Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
  • Ali Nasir Department of Pharmacology, Ziauddin University, Karachi, Pakistan
  • Jahanzeb Kamal Khan Department of Medical Education, College of Physicians and Surgeons, Karachi, Pakistan
  • Shafqat Shahzad Department of Statistics, University of Punjab, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i10.1993

Keywords:

High Dose, Statin Therapy, Low-Density Lipoprotein Cholesterol, Artery Diseases

Abstract

Coronary artery disease is associated with the circulatory system and leading cause of death around the globe, Objective: To compare the mean changes in low-density lipoprotein cholesterol with high and low doses of statin therapy. Methods: A non-randomized controlled trial at the Department of Cardiology, Fauji Foundation Hospital Rawalpindi was conducted from January 26-2023 to July 25-2023, among patients aged 45-75 years of both genders with ST-elevation myocardial infarction or non-ST-elevation myocardial infarction. Patients were divided into groups using a convenience sampling technique. Patients in Group A were given high-dose statin therapy atorvastatin 40mg orally daily. While Group B received low-dose statin therapy atorvastatin 20mg orally daily. The low-density lipoprotein cholesterol level was repeated after 3 months. Data were entered and analyzed using SPSS version 23. Results: The mean age of Group A was 56.14 ± 8.9 years and Group B was 57.5 ± 9.7 years, as per gender distribution group A showed 57.1% and Group B 68.6%, whereas, the females in Group A, were calculated as 42.9% and in Group B 31.4%. The mean changes observed in low-density lipoprotein cholesterol were significantly higher in groups in comparison to the group with low-dose statin therapy. The changes observed were significant at 35 ± 27.8mg/dl in higher statin therapy versus 21.4 ± 20 mg/dl with a p-value of 0.024. Conclusions: It was concluded that high-dose statin causes a greater reduction in low-density lipoprotein cholesterol levels. The high-dose therapy could be a great option in treating the low-density lipoprotein in initial management.

 

References

Ishii J, Kashiwabara K, Ozaki Y, Takahashi H, Kitagawa F, Nishimura H et al. Small Dense Low-Density Lipoprotein Cholesterol and Cardiovascular Risk in Statin-Treated Patients with Coronary Artery Disease. Journal of Atherosclerosis and Thrombosis. 2022 Oct; 29(10): 1458-74. doi: 10.5551/jat.63229.

Hodkinson A, Tsimpida D, Kontopantelis E, Rutter MK, Mamas MA, Panagioti M. Comparative Effectiveness of Statins on Non-High Density Lipoprotein Cholesterol in People with Diabetes and at Risk of Cardiovascular Disease: Systematic Review and Network Meta-Analysis. British Medical Journal. 2022 Mar; 376. doi: 10.1136/bmj-2021-067731.

Sulehria SB and Athar CA. Comparative Effectiveness of Atorvastatin (Low Vs High Dose) in Lowering Low-Density Lipoprotein Cholesterol in Intermediate Risk Cardiovascular Patients. Pakistan Journal of Medical & Health Sciences. 2020 Jun; 14(2): 2020312.

Roy D, Mahapatra T, Manna K, Kar A, Rana MS, Roy A et al. Comparing the Effectiveness of High-Dose Atorvastatin and Rosuvastatin among Patients Undergone Percutaneous Coronary Interventions: A non-Concurrent Cohort Study in India. Plos One. 2020 May; 15(5): e0233230. doi: 10.1371/journal.pone.0233230.

Higuma T, Akashi YJ, Fukumoto Y, Obara H, Kakuma T, Asaumi Y et al. Residual Coronary Risk Factors Associated With Long-Term Clinical Outcomes in Patients With Coronary Artery Disease Treated With High Vs. Low-Dose Statin Therapy―REAL-CAD Sub-study. Circulation Journal. 2024 May; 88(6): 995-1003. doi: 10.1253/circj.CJ-23-0134.

Chen PY, Liu YH, Duan CY, Fan HL, Zeng LH, Guo W et al. Association of In-Hospital Intensive Statins Dosage and Death in Arteriosclerotic Cardiovascular Disease With Percutaneous Coronary Intervention: Insights of Multicentre Cohort from China. European Journal of Clinical Pharmacology. 2020 Dec; 76: 1755-63. doi: 10.1007/s00228-020-02966-1.

Yamaji T, Harada T, Kajikawa M, Maruhashi T, Kishimoto S, Yusoff FM et al. Role of Small Dense Low-density Lipoprotein Cholesterol in Cardiovascular Events in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus Receiving Statin Treatment. Journal of Atherosclerosis and Thrombosis. 2024 Apr; 31(4): 478-500. doi: 10.5551/jat.64416.

Higashioka M, Sakata S, Honda T, Hata J, Shibata M, Yoshida D et al. The Association of Small Dense Low-Density Lipoprotein Cholesterol and Coronary Heart Disease in Subjects at High Cardiovascular Risk. Journal of Atherosclerosis and Thrombosis. 2021 Jan; 28(1): 79-89. doi: 10.5551/jat.55350.

Huang J, Gu JX, Bao HZ, Li SS, Yao XQ, Yang M et al. Elevated Serum Small Dense Low‐Density Lipoprotein Cholesterol May Increase the Risk and Severity of Coronary Heart Disease and Predict Cardiovascular Events in Patients with Type 2 Diabetes Mellitus. Disease Markers. 2021; 2021(1): 5597028. doi: 10.1155/2021/5597028.

Campos H, Moye LA, Glasser SP, Stampfer MJ, Sacks FM. Low-Density Lipoprotein Size, Pravastatin Treatment, and Coronary Events. Journal of the American Medical Association. 2001 Sep; 286(12): 1468-74. doi: 10.1001/jama.286.12.1468.

Wang X and Ji X. Sample Size Estimation in Clinical Research: From Randomized Controlled Trials to Observational Studies. Chest. 2020 Jul; 158(1): S12-20. doi: 10.1016/j.chest.2020.03.010.

Nishikura T, Koba S, Yokota Y, Hirano T, Tsunoda F, Shoji M et al. Elevated Small Dense Low-Density Lipoprotein Cholesterol as a Predictor for Future Cardiovascular Events in Patients with Stable Coronary Artery Disease. Journal of Atherosclerosis and Thrombosis. 2014 Aug; 21(8): 755-67. doi: 10.5551/jat.23465.

Bytyçi I, Shenouda R, Wester P, Henein MY. Carotid Atherosclerosis in Predicting Coronary Artery Disease: A Systematic Review and Meta-Analysis. Arteriosclerosis, Thrombosis, and Vascular Biology. 2021 Apr; 41(4): e224-37. doi: 10.1161/ATVBAHA.120.315747.

Barter PJ. High-Versus Low-Dose Statin: Effects on Cardiovascular Events and All-Cause Death. Circulation. 2018 May; 137(19): 2013-5. doi: 10.1161/CIRCULATIONAHA.118.034407.

Bergström G, Persson M, Adiels M, Björnson E, Bonander C, Ahlström H et al. Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population. Circulation. 2021 Sep; 144(12): 916-29. doi: 10.1161/CIRCULATIONAHA.121.055340.

Liu D, Du C, Shao W, Ma G. Diagnostic Role of Carotid Intima‐Media Thickness for Coronary Artery Disease: A Meta‐Analysis. Biomed Research International. 2020; 2020(1): 9879463. doi: 10.1155/2020/9879463.

Migliorino D, Mignano A, Evola S, Polizzi G, Novo G, Corrado E et al. Correlation Between Carotid Atherosclerosis and Coronary Artery Disease: A Retrospective Study of 1067 Patients. Nutrition, Metabolism and Cardiovascular Diseases. 2017 Jan; 27(1): e28. doi: 10.1016/j.numecd.2016.11.077.

Maqsood M, Sadeeqa S, Ahmad M, Afzal H. Efficacy and Safety of Atorvastatin and Rosuvastatin in Ischemic Heart Disease Patients: A Prospective Study. Tropical Journal of Pharmaceutical Research. 2019; 18(7): 1533-8. doi: 10.4314/tjpr.v18i7.25.

Priti K, Agrawal A, Ranwa BL. High Versus Low Dose Statin Therapy in Indian Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Thrombolysis. Indian Heart Journal. 2017 Jul; 69(4): 453-7. doi: 10.1016/j.ihj.2017.05.026.

Zahid R, Asif HM, Tanveer R, Summar Z, Najib M. Recommended Guidelines and Efficacy of Statins in Case of Hyperlipidemia. RADS Journal of Pharmacy and Pharmaceutical Sciences. 2021; 9(4): 231-7.

Javed MA, Adnan F, Bukhari SN, Zaffar Z, Abid MS, Zarif A. Effectiveness of High Dose Statins among Acute Coronary Syndrome Patients Presenting at a Tertiary Care Hospital. In Medical Forum Monthly. 2021; 32(4).

Hameed I, Shah SA, Aijaz A, Mushahid H, Farhan SH, Dada M et al. Comparative Safety and Efficacy of Low/Moderate-Intensity Statin plus Ezetimibe Combination Therapy vs. High-Intensity Statin Monotherapy in Patients with Atherosclerotic Cardiovascular Disease: An Updated Meta-Analysis. American Journal of Cardiovascular Drugs. 2024 May; 24(3): 419-31. doi: 10.1007/s40256-024-00642-8.

Downloads

Published

2024-10-31
CITATION
DOI: 10.54393/pjhs.v5i10.1993
Published: 2024-10-31

How to Cite

Ghafoor, A., Rehman, T. U., Sarfaraz, M., Rind, A., Nasir, A., Khan, J. K., & Shahzad, S. (2024). Comparing the Clinical Effectiveness of High-Dose and Low-Dose Statin Therapy in Patients with Atherosclerotic Coronary Artery Disease (CAD): Clinical Effectiveness of High-Dose and Low-Dose Statin Therapy in Atherosclerotic Disease . Pakistan Journal of Health Sciences, 5(10), 105–109. https://doi.org/10.54393/pjhs.v5i10.1993

Issue

Section

Original Article

Plaudit

Most read articles by the same author(s)