Effects of Intensive Statin Therapy on Left Ventricular Function in Patients with Myocardial Infarction and Abnormal Glucose Tolerance

Abstract

Objectives: Abnormal glucose tolerance in patients with acute myocardial infarction (AMI) is associated with greater mortality and adverse cardiovascular effects. As statins possess a range of beneficial pleiotropic effects on the cardiovascular system, we sought to assess the cardioprotective effects of statins on left ventricular function in patients with AMI in relation to glycometabolic state. Methods: In a prospective, randomized trial, 140 patients with AMI were randomized to intensive statin therapy receiving statin loading with 80 mg of rosuvastatin followed by 40 mg daily or standard statin therapy. Patients were assessed with an oral glucose tolerance test and their left ventricular (LV) function was assessed with speckle-tracking echocardiography measuring regional longitudinal systolic strain (RLSS) in the infarct area. Results: Overall RLSS in the infarct area improved by a mean (±SD) of -4.22% (±5.19) in the intensive-care group and -2.48% (±4.01) in the usual-care group after 1 month (p = 0.047). In patients with abnormal glucose tolerance, RLSS improved by -5.01% (±5.28) in the intensive-care group and -2.15% (±4.22) in the usual-care group (p = 0.01). Conclusions: Early high-dose statin treatment improved RLSS in the infarct area in patients with AMI, and a trend of greater improvement was seen in patients with abnormal glucose tolerance.

Pravastatin improves risk factors but not ischaemic tolerance in obese rats

“…Data from clinical studies are less consistent, with a study by Post et al (2012) suggesting that 1 week of atorvastatin treatment prior to percutaneous coronary intervention had no impact on infarct size, while another study reported decreased troponin I levels in unstable angina patients receiving long-term high-dose statin therapy (Gordin et al, 2012). Chronic statin therapy is associated with a reduction in major adverse cardiac events in myocardial infarct patients (Piao et al, 2017), consistent with its risk reduction effects, however treatment also improved post-infarct mechanical function, suggesting potentially direct myocardial effects (Auscher et al, 2017).…”