Combination of statin and ezetimibe in the post-infarction period

Aim. To study the lipid-lowering and pleiotropic effects of statin monotherapy and combination with ezetimibe in patients in the postinfarction period, depending on the achievement of the target level of low-density lipoprotein cholesterol (LDL cholesterol) for 24 weeks. Materials and methods. 114 patients with myocardial infarction were included. Treatment was started with statin monotherapy, with insufficient efficacy, ezetimibe was added. After 24 weeks, the 1st group included 38 people, the 2nd – 76 patients. On 7–10th days and 24 weeks later, the lipid profile, the N-terminal fragment of the precursor of the cerebral natriuretic peptide (NT-proBNP) were determined, speckle-tracking echocardiography, ultrasound examination of the carotid arteries (CA) with RF technology were performed. Results. At week 24, the patients were divided depending on the achievement/non-achievement of the LDL cholesterol target. The highly effective therapy group (HET) included 52 patients, the insufficiently effective therapy group (IET) consisted of 62 people. The ratio of the chances of achieving LDL cholesterol with the addition of ezetimibe to a statin was 3.4 [1.8; 6.6] (p0.001). In the HET group, by the 24th week, NT-proBNP decreased by 59.6% (p=0.045); in the IET group – by 52.2% (p=0.042). According to echocardiography data, after 24 weeks in the HET group, an increase in global constructive work GCW by 9.1% (p=0.036) and the global work index GWI by 8.2% (p=0.041) was revealed without dynamics of indicators in the comparison group. In the study of the CA, the thickness of the intima-media complex in the HET and IET groups regressed by 9.5% and 6.8% respectively (p0.05). Only in the HET group did the common CA stiffness indicators improve. Conclusion. The achievement of LDL cholesterol control on the background of combined lipid-lowering therapy in patients in the postinfarction period is characterized by the most pronounced organoprotective effect.