Changes in Homocysteine Levels Affect Serum Lipid Response to Atorvastatin in Patients With Acute Coronary Syndrome: A Retrospective Observational Study.

OBJECTIVE

The present study investigated whether changes in serum homocysteine (Hcy) levels modify the effects of atorvastatin treatment on blood lipid parameters in patients with acute coronary syndrome (ACS).

METHODS

A total of 159 patients with ACS who received regular, long-term treatment with 20 mg/d atorvastatin were included. Depending on the changes in Hcy parameters, they were divided into Hcy reduction (HR) and Hcy elevation (HE) groups.

RESULTS

After long-term atorvastatin treatment, total cholesterol (TC), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), apolipoprotein (Apo) B, and Hcy levels were decreased ( < .05), and the ApoAI level was increased ( < .01). Correlation and stratified analysis showed that Hcy or hyperhomocysteinemia was correlated with blood lipids. In both the HE and HR groups, the TC, LDL-C, and ApoB levels after treatment were lower than those before treatment ( < .01), and the ApoAI level was increased compared with that before treatment ( < .05). There was no difference in the reduction of TC, LDL-C, and ApoB levels or in the increase of ApoAI level ( > .05) between the 2 groups. However, there was a clear opposite trend of the effect of atorvastatin on TG and high-density lipoprotein cholesterol (HDL-C) levels between the HR and HE groups ( < .05). In the HR group, the HDL-C level was increased ( < .05), and TGs were decreased compared with those before treatment ( < .01). Nevertheless, in the HE group, the HDL-C level was decreased ( < .05), and TGs ( < .05) were increased compared with those before treatment.

CONCLUSION

The effects of atorvastatin on TGs and HDL-C depend on changes in Hcy levels. Patients with a reduced Hcy level after atorvastatin treatment had more favorable lipid parameters.