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 (P < .05), and the ApoAI level was increased (P < .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 (P < .01), and the ApoAI level was increased compared with that before treatment (P < .05). There was no difference in the reduction of TC, LDL-C, and ApoB levels or in the increase of ApoAI level (P interaction > .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 (P interaction < .05). In the HR group, the HDL-C level was increased (P < .05), and TGs were decreased compared with those before treatment (P < .01). Nevertheless, in the HE group, the HDL-C level was decreased (P < .05), and TGs (P < .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.

中文翻译：

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同型半胱氨酸水平的变化影响急性冠脉综合征患者对阿托伐他汀的血清脂质反应：一项回顾性观察研究。

目的 本研究调查血清同型半胱氨酸 (Hcy) 水平的变化是否会改变阿托伐他汀治疗对急性冠状动脉综合征 (ACS) 患者血脂参数的影响。方法 共纳入 159 名 ACS 患者，他们接受了 20 mg/d 阿托伐他汀的常规、长期治疗。根据Hcy参数的变化，分为Hcy降低（HR）和Hcy升高（HE）组。结果 长期阿托伐他汀治疗后，总胆固醇（TC）、甘油三酯（TGs）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白（Apo）B和Hcy水平降低（P < .05）， ApoAI 水平升高（P < .01）。相关性和分层分析表明，Hcy或高同型半胱氨酸血症与血脂相关。在 HE 组和 HR 组中，TC、治疗后LDL-C、ApoB水平较治疗前降低（P < .01），ApoAI水平较治疗前升高（P < .05）。两组间 TC、LDL-C 和 ApoB 水平的降低或 ApoAI 水平的升高（P 交互作用 > .05）没有差异。然而，在 HR 组和 HE 组之间，阿托伐他汀对 TG 和高密度脂蛋白胆固醇 (HDL-C) 水平的影响存在明显相反的趋势（P 相互作用 < .05）。HR组与治疗前相比，HDL-C水平升高（P < .05），TG降低（P < .01）。然而，在 HE 组中，与治疗前相比，HDL-C 水平降低（P < .05），TGs 水平（P < .05）升高。结论 阿托伐他汀对 TGs 和 HDL-C 的影响取决于 Hcy 水平的变化。阿托伐他汀治疗后 Hcy 水平降低的患者具有更有利的血脂参数。