Comparação dos efeitos de duas estratégias hipolipemiantes sobre subclasses de lipoproteínas em pacientes com infarto agudo do miocárdio

• Autor(a) principal: Pinto, Leticia Carolinni Dos Santos [UNIFESP]
• Data de Publicação: 2020
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9923899; https://hdl.handle.net/11600/64621
• topic: Lipid Lowering Therapies; Lipoproteins; Myocardial Infarction; LDL-Cholesterol; Hipolipemiantes; Lipoproteínas; Infarto Do Miocárdio; LDL-Colesterol

BACKGROUND: Increased levels of low density lipoprotein-cholesterol (LDL-C) are related to cardiovascular disease. Prospective, randomized and controlled studies showed that statin treatment may decrease morbidity and mortality from atherosclerosis, specially from coronary disease. However, similar values of LDL-C can be distributed on many subclasses of LDL and intermediate lipoproteins (IDL) with possible implications for the residual cholesterol risk. OBJECTIVES: This study aimed to compare the effects of two highly effective lipid-lowering strategies on lipoprotein subclasses in subjects with acute myocardial infarction. In addition, associations between lipoprotein subclasses and the amount of myocardial infarction mass, as well as left ventricular function were evaluated by cardiac 3T magnetic resonance imaging (cMRI). METHODS: Prospective, randomized, open label study with blinded endpoints included 101 subjects with ST segment elevation myocardial infarction (STEMI) from nine hospitals of the city of São Paulo. All patients received tenecteplase in the first 6 h of STEMI and were hospitalized in the Hospital São Paulo of the Universidade Federal de São Paulo, in the first 24 h for coronary angiography (pharmacoinvasive strategy). At the hospital arrival, a written informed consent was obtained and the patients were randomized to receive a daily dose of rosuvastatin 20 mg or the combined simvastatin 40 mg/ezetimibe 10 mg. Blood samples were collected at admission and after 30 days of STEMI. Subclasses of lipoproteins were examined by polyacrylamid gel electroforesis. cMRI parameters were performed after 30 days of STEMI. RESULTS: Study population was composed predominantly by overweight males, smokers, and hypertensives. The two groups of patients had comparable coronary angiography with higher prevalence of the left anterior descending as culprit artery. After 30 days, cMRI revealed similar findings for both groups. The classical lipid profile (cholesterol, LDL-C, HDL-C, non-HDL-C, and triglycerides) was comparable between groups at baseline and after 30 days. Furthermore, both lipid-lowering strategies promoted similar changes on IDL and LDL subclasses. However, their effects were more pronounced on the less atherogenic lipoproteins (LDL 1-2), not changing the profile of small dense LDL particles (LDL3-7). There was an improvement with both therapies on the pattern of IDL subclasses. Finally, there was an association between baseline IDL subclasses and the amount of infarcted mass, especially IDL type C. CONCLUSIONS: Despite expressive decrease in the LDL-C levels, and improvement of IDL particles, both treatments did not improve the pattern of more atherogenic LDL particles. The infarcted myocardial mass seems related to the most atherogenic IDL subclass.