Volume : V, Issue : V, May - 2015

HDL–Paradox and Cardiovascular Risks During Statin Therapy In Chronic Stable Angina

Tarek M Abdelrahman

Abstract :

 Background  Lipid lowering agents became the cornerstone in treatment of coronary artery diseases, however in some cases, the  good HDL–cholesterol is also reduced and described this phenomenon as "HDL–paradox". HDL–C is an independent,  negative risk factor for cardiovascular disease.  Aim of the study The aim of this study is to observe the effect of using a long term statin therapy on HDL level and its correlation to  clinical course of the disease and laboratory findings in those patients. Methods  Retrospective analysis of 210 patients known as "chronic–stable–angina" on chronic statin therapy recruited from cardiology outpatient clinic in Minia University Hospital along two years from March 2013 till April 2015. Recorded data  from all patients as regard clinical and demographic data were analyzed and correlated to their symptoms and laboratory findings after dividing them onto two groups based on their averaged serum HDL–cholesterol, (group–I) with high  HDL and (group–II) with Low HDL. Exclusion criteria were, known history of diabetes, hypertension, renal or liver disease, thyroid dysfunction and all participants were non–smokers. Also, obese patients with body mass index more than  30 were excluded and no cases are treated by diuretics. Results  In spite reduction of all Non–HDL lipoproteins in both groups, significant reduction of HDL was evident in group–II and  was associated with elevation in HBA1C, Hs–CRP, Proteinuria and creatinine levels. Also, liver enzymes were significantly  higher in low HDL arm. A significantly lower EF ad FS% was observed in low HDL–group. Data concerning complaints  and events occurred during the study period revealed that, patients of group–II having recurrent hospital admissions,  more symptoms of Lv dysfunction, increasing need for modification of treatment and need for intervention more than  group–I. A linear negative correlation was found between HDL–levels and HBA1C and hs–CRP.  Conclusion There‘s a significant reduction of HDL levels during long–term statin therapy ‘HDL–paradox‘. This is not just a laboratory observation, it‘s linked to deterioration of the clinical condition and cardiac functions in echocardiography. Also,  change in glucose metabolism in the form of elevated HBA1C that might be a factor in appearance of new onset diabetes. The risk appeared again from elevation of hs–CRP which represent a risk factor for atherosclerosis and vascular  injury. So, we advice to carefully monitoring the lipogram of all patients treated by statins and detect any significant  reduction of HDL.

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Article: Download PDF   DOI : 10.36106/ijar  

Cite This Article:

Tarek M Abdelrahman HDL–Paradox and Cardiovascular Risks During Statin Therapy In Chronic Stable Angina Indian Journal of Applied Research, Vol.5, Issue : 5 May 2015

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