Effect of high-dose rosuvastatin loading before percutaneous coronary intervention in Chinese patients with acute coronary syndrome: A systematic review and meta-analysis

Effect of timing of administration on lipid-lowering efficacy of statins-meta-analysis

BACKGROUND

To investigate the effect of timing of statin administration on lipid-lowering efficacy.

METHODS

Computer searches of Pubmed, Embase, Cochrane Library, and Web of Science databases from 1986 to 2023. The impact of administration time on the lipid-lowering efficacy of statin drugs was investigated. Following a series of screenings, a funnel plot was constructed to assess its symmetry, and Egger and Beggar tests were conducted using StataMP-64 to evaluate publication bias. Meta-analysis was performed using RevMan 5.3 to combine MD values.

RESULTS

Fifteen papers (1352 participants) met and included the criteria. The results of the meta-analysis showed that the effect of morning and evening administration time on plasma triglycerides (TG) (P > 0.05) and plasma high-density lipoprotein cholesterol (HDL-C) (P > 0.05) was not statistically significant. There were significant reductions in total cholesterol (TC) (MD: 0.15 mmol/L, 95% CI: 0.06-0.23, P < 0.01) and low-density lipoprotein cholesterol (LDL-C) (MD: 0.10 mmol/L, 95% CI: - 0.00-0.20, P < 0.01) in the night group. According to the analysis results of the half-life of statins, only short half-life statins showed that nocturnal administration reduced LDL-C (MD: 0.21 mmol/L, 95% CI: 0.09-0.33, P < 0.01) and TC (MD: 0.32 mmol/L, 95% CI: 0.18-0.46, P < 0.01) levels and was better than morning administration. Long half-life statins did not show significant differences. In addition, the administration time of short half-life statins also showed that night administration tended to reduce TG (MD: 0.16 mmol/L, 95% CI: 0.02-0.30, P < 0.05) levels. In subgroup analysis according to clinical factors in patients aged < 55 years, there was no significant difference in the timing of administration between the two groups; the efficacy of statins in lowering lipids in patients aged ≥ 55 years was significantly different in the TC group (P < 0.01) and LDL-C group (P < 0.01). The administration time of the TC group (P < 0.05) and LDL-C group (P < 0.05) in the Americas, Europe, and Asian groups was significantly different for statins. In addition, the American group also showed that the administration time of the two groups was significantly different from the TG group (P < 0.05).

CONCLUSION

The efficacy of administering short half-life statin drugs at night in reducing plasma levels of TC, LDL-C, and TG surpasses that of morning administration. However, this study did not determine the impact of timing of statin administration in patients taking long half-life statins on the efficacy of the medication. Therefore, it is recommended to consider patient adherence when. The study was registered on PROSPERO (International Prospective Register of Systematic Reviews) as CRD42022372105 (available at https://www.crd.york.ac.uk/prospero/ ).

Intensive vs non-intensive statin pretreatment before percutaneous coronary intervention in Chinese patients: A meta-analysis of randomized controlled trials

BACKGROUND

The results of intensive statin pretreatment before percutaneous coronary intervention (PCI) is inconsistent between Chinese and Western populations, and there are no corresponding meta-analyses involving hard clinical endpoints in the available published literature.

AIM

To evaluate the efficacy and safety of high-dose statin loading before PCI in Chinese patients through a meta-analysis.

METHODS

Relevant studies were identified by searching the electronic databases of PubMed, Embase and Cochrane’s Library to December 2019. The outcomes included an assessment of major adverse cardiovascular event (MACE), non-fatal myocardial infarction (MI), cardiac death, target vessel revascularization (TVR), myalgia /myasthenia and abnormal alanine aminotransferase (ALT) in all enrolled patients. Random effect model and fixed effect model were applied to combine the data, which were further analyzed by χ² test and I² test. The main outcomes were then analyzed through the use of relative risks (RR) and its 95% confidence interval (95%CI).

RESULTS

Eleven studies involving 3123 individuals were included. Compared with patients receiving placebo or no statin treatment before surgery, intensive statin treatment was associated with a clear reduction of risk of MACE (RR = 0.44, 95%CI: 0.31-0.61, P < 0.00001). However, compared with the patients receiving moderate-intensity statin before surgery, no advantage to intensive statin treatment was seen (RR = 1.04, 95%CI: 0.82-1.31, P = 0.74). In addition, no significant difference was observed between intensive statin therapy and non-intensive statin therapy on the incidence of TVR (RR = 0.43, 95%CI: 0.18-1.02, P = 0.06) , myalgia /myasthenia (RR = 1.35, 95%CI: 0.30-5.95, P = 0.69) and abnormal alanine aminotransferase (RR = 1.47, 95%CI: 0.54-4.02, P = 0.45) except non-fatal MI (RR = 0.54, 95%CI: 0.33-0.88, P = 0.01).

CONCLUSION

Compared with placebo or no statin pretreatment, intensive statin before PCI displayed reduced incidence of MACE. However, there was no significant benefit between high and moderate-intensity statin. In addition, no significant difference was observed between intensive statin therapy and non-intensive statin therapy on the incidence of TVR, myalgia/myasthenia and abnormal alanine aminotransferase except non-fatal MI.

Effect of 2 Different Dosages of Rosuvastatin on Prognosis of Acute Myocardial Infarction Patients with New-Onset Atrial Fibrillation in Jinan, China

BACKGROUND Atrial fibrillation (AF) often occurs in patients with acute myocardial infarction (AMI). This study aimed to observe the influence of different dosages of rosuvastatin on the prognosis of AMI patients with AF. MATERIAL AND METHODS We performed an observational, retrospective cohort study in Jinan, China, in which 323 AMI patients were recruited. All patients were randomized to receive optimal medication treatment and 10 mg or 20 mg of rosuvastatin. Holter monitor results, serum lipid levels, and heart function were recorded. We used multivariate Cox and Kaplan-Meier analyses to assess the independent factors and differences in AF and ischemia events and safety of rosuvastatin administered at different dosages. RESULTS TC, LDL-C, and TG at 1 and 12 months were significantly lower compared with those observed prior to treatment in both groups. The heart function of both groups was significantly improved after 12 months of treatment, especially in the 20 mg group. Multivariate Cox analysis showed that different dosages of rosuvastatin, age, smoking, drinking alcohol, and diabetes are independent factors related to the occurrence of AF and ischemic events. In addition, according to Kaplan-Meier analysis, no significant difference in adverse clinical events existed at different dosages of rosuvastatin. CONCLUSIONS Treatment with rosuvastatin can reduce the serum lipid level and improve cardiac function. Different dosages of rosuvastatin, age, smoking, drinking alcohol, and diabetes are independent risk factors for AF and ischemia events. The results suggested it is safe to use 20 mg rosuvastatin in the 12 months after hospital admission.

Statin loading in cardiovascular surgery: never too early to treat

PURPOSE OF REVIEW

The effects of statin loading before, during or after vascular interventions on cardiovascular and renal outcomes are discussed. Furthermore, the selection of optimal statin type and dose, according to current evidence or guidelines, is considered. The importance of treating statin intolerance and avoiding statin discontinuation is also discussed.

RECENT FINDINGS

Statin loading has been shown to beneficially affect cardiovascular outcomes, total mortality and/or contrast-induced acute kidney injury, in patients undergoing vascular procedures such as percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), carotid endarterectomy (CEA), carotid artery stenting, endovascular aneurysm repair, open abdominal aortic aneurysms (AAA) repair and lower extremities vascular interventions. High-dose statin pretreatment is recommended for PCI and CABG according to current guidelines. Statin discontinuation should be avoided during acute cardiovascular events and vascular interventions; adequate measures should be implemented to overcome statin intolerance.

SUMMARY

Statin loading is an important clinical issue in patients with cardiac and noncardiac vascular diseases, including carotid artery disease, peripheral artery disease and AAA, undergoing vascular interventions. Cardiologists and vascular surgeons should be aware of current evidence and implement guidelines in relation to statin loading, discontinuation and intolerance.

Baseline Serum Uric Acid Levels Are Associated with All-Cause Mortality in Acute Coronary Syndrome Patients after Percutaneous Coronary Intervention

Background

Whether serum uric acid (UA) is associated with all-cause mortality in patients with acute coronary syndrome (ACS) following percutaneous coronary intervention (PCI) remains unclear.

Methods

We performed a retrospective cohort study of 2296 patients with ACS. Curve-fitting and Cox proportional-hazard regression models with a hazard ratio (HR) and 95% confidence interval (CI) were used.

Results

During a mean follow-up of 246.31 ± 49.16 days, 168 (7.32%) patients died from all causes. Patients were divided into two groups [the high-UA group (n = 566) and the low-UA group (n = 1730)] based on the serum UA threshold value (5.6 mg/dl) identified through curve fitting. Fifty-three (9.36%) patients died in the high-UA group, and 115 (6.65%) patients died in the low-UA group. The difference between groups was statistically significant (P = 0.031). Univariate analysis showed that the risk of all-cause mortality in the high-UA group was significantly greater than that in the low-UA group (HR = 1.45, 95% CI: 1.03 to 2.04). This difference persisted after adjustment for baseline characteristics, medical history, and medication history (HR = 1.42, 95% CI: 1.05 to 1.87).

Conclusions

Our study demonstrated that elevated serum UA (>5.6 mg/dl) is associated with all-cause mortality in ASC patients after PCI.

Reduction of Vascular Inflammation, LDL-C, or Both for the Protection from Cardiovascular Events?

BACKGROUND

Low density lipoprotein cholesterol (LDL-C) and low grade arterial inflammation are key pathogenic factors for atherosclerosis and its manifestation, cardiovascular disease (CVD).

OBJECTIVE

In this narrative review we assessed if decreasing LDL-C levels or inflammation or both is more effective in reducing CVD events.

RESULTS

In the Scandinavian Simvastatin Survival Study (4S), all statin trials of the 90s' and the Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk (FOURIER) the benefit came from the LDL-C reduction. In the GREak and Atorvastatin Coronary heart disease Evaluation (GREACE), the Treating to New Targets (TNT), and the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trials both mechanisms in combination produced significant benefits. In the Atorvastatin for Reduction of MYocardial Damage during Angioplasty (ARMYDA) trials and the Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS) with a human antibody targeting IL-1β with no lipid lowering effect, the reduction in arterial inflammation played the only beneficial role because there was no change in lipids levels.

CONCLUSION

Both LDL-C and inflammation reduction are beneficial to the reduction of CVD risk. However, canakinumab is a very expensive drug that only induced a 15% reduction in CVD events, thus drastically reducing the possibility for it to be used in clinical practice. Besides, canakinumab is associated with increased infections, some fatal. A potent statin with anti-inflammatory effects is probably the best choice for the majority of those needing hypolipidaemic drug therapy.