Efeito de terapias hipolipemiantes nos lípides e esteróis plasmáticos em pacientes de alto risco com proteína c-reativa elevada

Barbosa, Simone Pinto de Melo [UNIFESP]

Efeito de terapias hipolipemiantes nos lípides e esteróis plasmáticos em pacientes de alto risco com proteína c-reativa elevada

Data

2013-11-27

Autores

Barbosa, Simone Pinto de Melo

Orientadores

Izar, Maria Cristina de Oliveira Izar

Tipo

Dissertação de mestrado

Resumo

Aims: High-risk subjects with elevated C-reactive protein (CRP) are at high risk for cardiovascular events and frequently require potent statins or combined lipid-lowering therapy to achieve lipid targets and decrease in- flammation. Our study aimed at evaluating the effects of three lipid-modifying therapies on LDL-cholesterol, CRP levels and markers of cholesterol absorption and synthesis. Main methods: A prospective intervention study was performed in high cardiovascular risk individuals receiving atorvastatin 10 mg daily for four weeks. Those with CRP ? 2.0 mg/L were randomized to another four-week treatment period with atorvastatin 40 mg, ezetimibe 10 mg or the combination of atorvastatin 40 mg / ezetimibe 10 mg. Lipids, markers of cholesterol absorption (campesterol and ?-sitosterol), and synthesis (desmosterol), as well as CRP were quantified at baseline and end of study. Key findings: One hundred and twenty two individuals were included. Atorvastatin alone or combined with ezetimibe reduced both LDL-cholesterol and CRP (P b 0.002 vs. baseline; Wilcoxon); ezetimibe did not modify CRP. Ezetimibe-based therapies reduced absorption markers and their ratios to cholesterol (P b 0.0001 vs. baseline, for all; Wilcoxon), whereas atorvastatin alone increased campesterol/cholesterol and ?-sitosterol/ cholesterol ratios (P b 0.05 vs. baseline; Wilcoxon). In addition, ezetimibe also increased desmosterol and desmosterol/cholesterol ratio (P b 0.0001 vs. baseline; Wilcoxon). Significance: These results contribute to understanding the link between cellular cholesterol homeostasis, in- flammation and lipid-modifying therapies. Our findings highlight the broader benefit of combined therapy with a potent statin and ezetimibe decreasing inflammation, and preventing increase in cholesterol biosynthesis, an effect not observed with ezetimibe alone.

Citação

BARBOSA, Simone Pinto de Melo. Efeito de terapias hipolipemiantes nos lípides e esteróis plasmáticos em pacientes de alto risco com proteína c-reativa elevada. 2013. Dissertação (Mestrado) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2013.