A retrospective examination : The effects of hyperlipidemia treatment on coronary lesions on long term follow-up

Hyperlipidemia treatment is very well known to reduce cardiovascular events and mortality in patients with coronary artery disease or at high risk of cardiovascular disease. Besides lowering low-density lipoprotein (LDL)cholesterol, statins have pleiotropic effects such as improved endothelial function, reduced inflammation, and reduced thrombus formation. Statins have favourable effects on the vascular system. However, few data are available regarding the effect of these drugs on patients undergoing percutaneous coronary intervention. In this study, it was aimed to examine presence and severity of coronary lesions in patients who underwent coronary angiography at least twice for ischemic heart disease, and to evaluate the changes in coronary artery stenosis with statin therapy. Our study was carried out with 125 patients who underwent coronary angiography for ischemic heart disease between January 2010 and March 2020 and had a control angiography at least 1 year follow up. Age, BMI, lipid profile, complete blood count, biochemical results, inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein(CRP), monocyte/HDL ratio between two coronary angiography, comorbid diseases, statin treatments and medical treatments used other than statin were recorded. Coronary angiography reports were examined. The pathologies in main coronary arteries observed in left anterior descending artery (LAD), right coronary artery (RCA), circumflex artery (CX), diagonal branch, obtus marginalis (OM), left main coronary artery (LMCA) and the percentage of vascular stenosis were recorded. The mean age of the patients was 65,8 ± 9,8 years and the mean time between two coronary angiographies was 3,4 ± 1,2 years. While the pathologies observed in coronary angiography increased in 51,2% of the patients (n = 64), no increase was observed in 48,8% (n = 61). LDL-cholesterol (p <0,001) and total cholesterol level (p = 0,025) during the last angiography were significantly higher in those who had increased coronary artery pathology than those who did not. Coronary arteries with pathology during the first coronary angiography were LAD (47,2%), RCA (32,8%), CX (22,4%), diagonal branch (16,8%), OM (12%), and LMCA (1,6%), respectively. Coronary arteries with pathology in the last coronary angiography were LAD (57,6%), RCA (44,8%), CX (34,4%), diagonal branch (23,2%), OM (17,6%), LMCA (%4), respectively. In the first coronary angiography, 62,1 ± 27,7% stenosis in LAD, 56,0 ± 27,4% in RCA, 60,8 ± 24,9% in CX, 60,4 ± 23,9% in diagonal branch.was observed. In the last coronary examinations, 70,1 ± 26,7% stenosis in LAD, 62,5 ± 27,5% in RCA, 66,7 ± 23,4% in CX, 63,2 ± 22,4% in diagonal branch, 72% in OM 72,5 ± 20,2, 58,0 ± 25,8% in LMCA was observed. The percentage of stenosis observed in LAD, RCA and CX in the last angiography of the patients was significantly higher than the first angiography (p=0,019, p=0,019, p=0,044, respectively). The LDL-cholesterol and HDLcholesterol levels of the patients during the last angiography were significantly higher than LDL-cholesterol level observed in the first angiography (p=0,037, p<0,011, respectively). CRP level was observed higher during the last angiography (p=0,011). The degree of coronary artery stenosis observed in both the first angiography and the last angiography correlated with the lipid profile parameters. Total cholesterol level was higher in patients with LAD, RCA, CX or diagonal branch pathology in the last coronary angiography.There was no significant difference in the frequency of pathology observed in the main coronary arteries observed in both first and last coronary angiography in patients using and not using statin therapy. In patients who underwent coronary angiography for ischemic heart disease, the lesions and lesion severity in the coronary vessels may increase in parallel with the increase in LDL-cholesterol level despite the use of statin. Our findings suggested that the increase in coronary lesions may be related to lipid profile and inflammation. Key words: ischemic heart disease, statin, koronary lesions, angiography, stenosis, lipid profile.