Endothelial function improvement associated with the new European Society of Cardiology LDL target levels in STEMI patients

Type of funding sources: None.

According to current guidelines, statin therapy is indicated for all ACS patients regardless of the initial cholesterol level. However, the effects of different lipid-lowering regimes on endothelial function in patients after STEMI have been insufficiently studied.

The study involved 135 STEMI patients admitted an average of 4.5 hours after symptoms onset and treated with primary PCI. Lipid-lowering treatment was prescribed immediately after admittance. Patients were randomly assigned to one of two patients groups – 50 pts with intermediate (atorvastatin 10 mg /ezetimibe 10 mg or atorvastatin 40 mg), and 85 pts with high intensity treatment (atorvastatin 40 mg/ ezetimibe 10 mg or atorvastatin 80 mg). Endothelial function assessment by flow-dependent vasodilation (FDV) was performed on the 1st, 10th days of the hospital period and within the 90th day of onset of the disease.

The average level of low-density lipoprotein cholesterol (LDL) on the 90th day in patients was 1,66 ± 0.11 mmol /l. On that time frame the growth of the diameter of the brachial artery and FDV were increased by 66.2% in patients who reached LDL cholesterol <1.8 mmol/l and 85% in patients with LDL cholesterol <1.4 mmol/l versus 26.8% in patients with LDL cholesterol ≥1.8 mmol/l, p<0.05. Growth in the diameter of the brachial artery according to the results of the test with FDV more than 10% was statistically significant and more frequently observed in patients who reached the level of LDL less than 1.4 mmol /l on the 90th day (Fig.1).

Patients with STEMI who achieved a reduction in LDL cholesterol <1.4 mmol/l on the 90th day of follow-up were more likely to have a complete recovery of endothelial function. It may be dependent on early initiation of high intensity lipid-lowering treatment.