Hippokratia 2002, 6(4):186-192
Ap Efthimiadis, D Psirropoulos, I Efthimiadis, N Lefkos
It has been established that the use of statins and application of a healthy modified diet and way of life have a favorable influence upon lipids, fibrinogen, PAI-l, t-PA, and C-reacting protein (CRP) in hyperlipidaemic patients with angina manifestations.We studied 206 hyperlipidaemic patients (phenotypes IIa and IIb, according to Fredricson) of both sexes (M=116, F=90, mean age 51.7+6.8 years) hospitalized in our department with angina manifestations. Group A consisted of 65 patients, 44 with stable angina (M=31, F=13) and 21 with unstable angina (M=12, F=9), treated with pravastatin 20 mg daily while Group Β consisted of 141 patients, 112 with stable angina patients (M=62, F=60) and 29 with unstable angina (M=13, F=16), treated with fluvastatin 40 mg daily. Patients with conditions affecting the acute inflammatory proteins were excluded from the study. All patients followed a specific diet for three months at the same time as antilipidaemic treatment was administered. At the end of the three months period, all patients underwent the same clinical, biochemical and electrocardiographic estimation as at baseline.The concurrent application of our healthy modified model of diet and living and antilipidaemic drug treatment for three months resulted to: 1) A statistically significant reduction of total-ch, triglycerides, LDL-ch levels and significant elevation of LDL-ch compared to those at baseline. 2) A reduction of fibrinogen levels: 7.9% in the fluvastatin group (p<0.05) and 4.8% in pravastatin group. 3) A statistically significant reduction of PAI-1 levels and a statistically significant elevation of t-PA levels compared to those at baseline. 4) A statistically significant elevation (p<0.001) of CRP levels at baseline in patients with unstable angina compared to those with stable angina and with normal values. 5) A greater reduction (p<0.05) of CRP levels after three months treatment with pravastatin compared to those with fluvastatin. 6) A good long-term outcome for all patients. Thirty-two patients from the group with unstable angina had a positive for CAD exercise test (Ex) performed one month after discharge whilst the remaining 8 had an uncertain or negative Ex. 24 of them underwent coronary angiography with stenotic lesions < 50% in one or two arteries. Drug treatment was continued and an appointment after six months was recommended. 7) A non-statistically significant elevation within normal levels of SGPT, SGOT, CpK-MB. The levels of serum glucose and the other biochemical parameters were not influenced. 8) Gastroenteritis in six patients which was managed without interruption in the administration of the antilipidaemic drug.The combination of a hypolipidaemic diet, regular exercise, cessation of smoking, loss of body weight and hydrophilic statins seems to act favorably on hyperlipidaemic coronary patients improving clinical status and anatomic lesions. This action is achieved by functionally improving the endothelium, suppressing the inflammation, reducing the thrombogenesis, supporting the fibrinolysis and decreasing the lipid levels.