Lviv clinical bulletin 2018, 1(21)-2(22): 14-19

https://doi.org/10.25040/lkv2018.01.014

The Effectiveness of the Influence of Median-Dose StatinTherapy on the Serum Lipid Profilein Patients with Stable Coronary Heart Disease, Combined with Non-Alcoholic Fatty Liver Disease at the Stage of Steatosis

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I. Vakalyuk, N. Virstyuk

Ivano-Frankivsk National Medical University

Introduction. Today, dyslipidaemia is considered one of the main risk factors for atherosclerosis and, as a consequence, cardiovascular disease. In turn, the liver plays a leading role in the onset of atherogenic dyslipidemia and at the same time serves as the target organ, which leads to the development of non-alcoholic fatty liver disease (NAFLD). The search of adequate hypolipidemic therapy is actual, which would combine sufficient effectiveness in the correction of dyslipidemia, taking intoaccount NAFLD stage and the individual tolerability of the drugs in patients with stable coronary heart disease (CHD), combined with NAFLD.

Aim. To evaluate the effectiveness of the median-dose statin therapy influence on the lipid profile of the patients with stable coronary heart disease, combined with non-alcoholic fatty liver disease at the stage of steatosis.

Material and methods. The subject of the study was 249 patients with stable CHD of II or III functional classes, who had an acute coronary syndrome more than 3 months ago. According to the results of a detailed clinical and diagnostic examination, the patients were divided according to the presence of NAFLD. In particular, among them were 160 patients without NAFLD (Group I) and 89 patients with NAFLD at the stage of steatosis (Group II). The control group consisted of 20 practically healthy persons. General clinical examination, electrocardiography, echo­cardiography, coronary angiography, evaluation of serum lipid profile were performed to all patients.

Results. It was established that the effectiveness of hypolipidemic therapy depended on the presence of NAFLD, the selected statin, its dosage and duration of treatment. In particular, after three months of treatment in patients of Group I, the advantage of hypolipidemic effect of rosuvastatinat a dose 20.0 mg/day vs. atorvastatin at a dose 40.0 mg/day was established. It was shown, that rosuvastatin at a dose 20.0 mg/day caused the achievement of the lipid metabolism target level after 3 months of treatment in 86 (87.8 %) cases with preservation of the hypolipidemic effect within 6 months, compared with atorvastatin at a dose 40.0 mg/day, which was accompanied by the achieve­ment of the target level in 51 (82.3%) cases only aftersix months of therapy in patients with stable CHD without NAFLD. In case of combination with NAFLD at the steatosis stage, there was a significant benefit of prolonged use of rosuvastatin at a dose 20.0 mg/day compared with atorvastatin at a dose of 20.0-40.0 mg/day, which was char­acterized by a decrease in LDL cholesterol level by 57.7 % after 3 months of treatment and achievement of stable target control of serum lipids profile aftersix months of treatment in 32 (84.2 %) cases.

Conclusions. It is expedient to use a long-term statin therapy with rosuvastatin at a dose 20.0 mg/day in order to provide the most effective and stable control of the serum lipid profile, especially in case of combined course with non-alcoholic fatty liver disease at the stage of steatosis in patients with stable coronary heart disease.

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