Hyporesponse to statin therapy in patients with carbohydrate metabolism disorders following acute coronary syndrome

Druk I.V., Yukhina Y.Ye., Korennova O.Yu., Savchenko M.V.

ABSTRACT

The aim of the study was to investigate the frequency of hyporesponse to statin therapy among patients with impaired carbohydrate metabolism after acute coronary syndrome (ACS) in short-term follow-up.

Methods. A retrospective analysis of the medical records of 1500 patients admitted for cardiologic follow-up after ACS was performed. The data of patients who did not receive statins before the development of ACS (400 patients; mean age — 63.42±9.64 years, including 286 (71.5%) men) were included in the analysis. Carbohydrate metabolism disorders (CMD) according to WHO and Russian Association of Endocrinologists criteria were present in 124 patients (type 2 diabetes mellitus (type 2 DM) — in 71 patients; prediabetes — in 53 patients). All patients were prescribed high-dose statin therapy, namely atorvastatin (40 mg or more daily). Low-density lipoprotein (LDL) cholesterol was assessed at baseline and after 1 month of therapy. Hyporesponse to statins was defined as the percentage reduction in LDL cholesterol of <15% from baseline during 1 month of therapy. Suboptimal response was defined as an LDL reduction of less than 50% after 1 month of therapy.

Results. The frequency of hyporesponse was 26.75% (n=107). Depending on the history of carbohydrate metabolism disorders (type 2 DM, prediabetes), patients were divided into 2 groups: group 1 (CMD, n=124), group 2 (without CMD, n=276). After 1 month of follow-up in the total group, the rate of hyporesponse was 26.75%. In group 1 and group 2, the rate of hyporesponse to statin therapy was 25.81% and 27.54%, respectively (p=0.719). The frequency of suboptimal response in the CMD group was 56.45%. Patients with CMD and hyporesponse to statins were characterized by lower baseline LDL levels.

Conclusion. The absolute majority of patients with CMD after ACS do not achieve the LDL-lowering goal after 1 month of high-intensity statin therapy. Hyporesponse to statins is seen in a quarter of this group. Lower baseline LDL levels increase the likelihood of hyporesponse to statins.

Keywords: statins, hyporesponse, diabetes mellitus, prediabetes.

For citation:

Druk I.V., Yukhina Y.Ye., Korennova O.Yu., Savchenko M.V.  Hyporesponse to statin therapy in patients with carbohydrate metabolism disorders following acute coronary syndrome. International Journal of Heart and Vascular Diseases. 2024. 41(12):15-21. DOI: 10.24412/2311-1623-2023-41-17-25