POSSIBILITIES OF COMBINED LIPID-LOWERING THERAPY IN patients WITH CHRONIC CORONARY HEART DISEASE AND TYPE 2 DIABETES MELLITUS

Abstract

High-atherogenic dyslipidemias are detected in patients with type 2 diabetes mellitus (DM) with a high frequency and represent a leading factor in the accelerated development of atherosclerotic cardiovascular lesions and poor prognosis. The use of lipid-lowering therapy can improve the parameters of the lipid profile, slow down the rate of progression of atherosclerotic lesions of the vascular wall and reduce cardiovascular risk. Non-statin lipid-lowering drugs are not common in wide clinical practice.
Purpose. To study the effect of combined lipid-lowering therapy using ezetimibe on the parameters of the lipid spectrum and structural and functional indicators of the vascular wall in patients with chronic coronary artery disease (CAD) in combination with type 2 DM.
Material and methods. A prospective comparative randomized trial was conducted in 68 patients with chronic CAD in combination with type 2 DM. In all patients were determined the parameters of the lipid spectrum, the thickness of the intima-media complex of the common carotid artery and the reaction of the brachial artery in a sample with reactive hyperemia. Were randomized patients with the envelope method into 2 groups. In group A (39 people), statins were used as a lipid-lowering approach, in group B (29 patients), ezetimibe 10 mg / day was prescribed in addition to statins. The duration of follow-up was 6 months. Statistical processing was carried out using the program STATISTICA for Windows/version 10 / StatSoft, Inc. (2011).
Results. In groups A and B, lipid-lowering treatment was satisfactorily tolerated. In both groups, there was a small, transient and statistically unreliable increase in alanine aminotransferase levels without the need to cancel treatment. In both groups, there were distinct favorable changes in the parameters of the lipid profile, while the degree of severity of positive changes was higher in group B in comparison with group A (all p<0.05). It is especially important that in group B, favorable shifts in the most atherogenic indicators of the lipid profile were much deeper. In both groups, there was a statistically significant decrease in the thickness of the intima-media complex of the common carotid artery and a significant improvement in the vasoreactivity of the brachial artery in a sample with reactive hyperemia (with a decrease in its resistivity index). The severity of these shifts was more significant in group B compared to group A.
When carrying out statistical processing of the material, criteria for higher effectiveness of lipid-lowering treatment in chronic CAD in combination with type 2 DM were established: age ≥60 years, prescription of diabetes ≥10 years, male sex, the presence of a previous myocardial infarction in the anamnesis, the initial level of LDL cholesterol ≥4.0 mmol/l, combined lipid-lowering treatment using ezetimibe.
Conclusion. Combined lipid-lowering therapy, including high doses of statins in combination with ezetimibe, is satisfactorily tolerated and has additional beneficial effects on lipid profile indicators and structural and functional vascular parameters. The developed criteria for predicting a higher effectiveness of lipid-lowering treatment can be used to improve treatment tactics in patients with chronic CAD and type 2 diabetes.