Comparative effects of atorvastatin 80 mg versus rosuvastatin 40 mg on the neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and monocyte to HDL-cholesterol ratio in patients with acute myocardial infarction
Comparative effects of atorvastatin 80 mg versus rosuvastatin 40 mg on the neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and monocyte to HDL-cholesterol ratio in patients with acute myocardial infarction
Background: Previous studies have shown the association between the elevated levels of hematological markers like Neutrophilto Lymphocyte ratio (NLR), Platelet to lymphocyte ratio (PLR) and Monocyte to High density lipoprotein cholesterol (HDL-C) ratio(MHR) and increased risk of the existence of cardiovascular disease, increased risk of acute coronary syndromes and severity ofcardiovascular disease. One of the most commonly used drugs in atherosclerotic cardiovascular diseases are statins and we knowthat statins have beneficial effects in addition to LDL-lowering effects known as pleiotropic effects. However the effects of statinson the hematological markers are unclear. We performed this investigation to clarify and compare the effects of maximum-dose ofatorvastatin and rosuvastatin on hematological biomarkers in patients with acute myocardial infarction.Methods: Statin or other anti-lipid drugs naive patients with either ST-segment elevation myocardial infarction or Non-ST elevationmyocardial infarction were enrolled to our study. Biochemistry parameters, lipid parameters, blood-count parameters and NLR, PLRand MHR levels were measured at baseline and 30 days after discharge. Baseline characteristics and results of 2 groups after onemonthtreatment were compared.Results: Among the 128 statin-naive patients included, 65 patients received atorvastatin (80 mg/day) and 63 patients recievedrosuvastatin (40 mg/day). Baseline clinical characteristics of groups were similar. Atorvastatin 80 mg significantly decreased thelevels of NLR (p=0.001) and MHR (p=0.024) at the end of one-month therapy. Rosuvastatin 40 mg also significantly decreased thelevels of NLR (p=0.001) and MHR (p=0.006) at the end of one-month therapy. Both statins were ineffective on the levels of PLR.Percent and absolute changes of NLR, MHR and PLR were similar and there were no statistically significant differences between bothgroups. The percent and absolute changes of lipid parameters were also similar among both treatment arms.Conclusion: Our results showed that atorvastatin 80 mg and rosuvastatin 40 mg decreased the NLR and MHR levels significantly atthe end of one-month therapy. However, both statins have no effects on PLR levels.
___
- 1. The top 10 causes of death. http://www.who.int/
mediacentre/factsheets/fs310/en/. accessed date
07.03.2017
- 2. Furman MI, Gore JM, Anderson FA, et al. Elevated leukocyte
count and adverse hospital events in patients with acute
coronary syndromes: findings from the Global Registry of
Acute Coronary Events (GRACE). Am Heart J 2004;147:42-
8.
- 3. Horne BD, Anderson JL, John JM, et al. Which white blood
cell subtypes predict increased cardiovascular risk? J Am
Coll Cardiol 2005;45:1638-43.
- 4. Zouridakis EG, Garcia-Moll X, Kaski JC. Usefulness of the
blood lymphocyte count in predicting recurrent instability
and death in patients with unstable angina pectoris. Am J
Cardiol 2000;86:449-51.
- 5. Cho KH, Jeong MH, Ahmed K, et al. Value of Early Risk
Stratification Using Hemoglobin Level and Neutrophil-to-
Lymphocyte Ratio in Patients With ST-Elevation Myocardial
Infarction Undergoing Primary Percutaneous Coronary
Intervention. American Journal of Cardiology 2011;107:849-
56.
- 6. Azab B, Zaher M, Weiserbs KF, et al. Usefulness of Neutrophil
to Lymphocyte Ratio in Predicting Short- and Long-Term
Mortality After Non-ST-Elevation Myocardial Infarction. Am
J Cardiol. 2010;106:470-6.
- 7. Nunez J, Nunez E, Bodi V, et al. Usefulness of the neutrophil
to lymphocyte ratio in predicting long-term mortality in
ST segment elevation myocardial infarction. Am J Cardiol
2008;101:747-52.
- 8. Gul M, Uyarel H, Ergelen M, et al. Predictive Value of
Neutrophil to Lymphocyte Ratio in Clinical Outcomes of
Non-ST Elevation Myocardial Infarction and Unstable
Angina Pectoris A 3-Year Follow-Up. Clin Appl Thromb-
Hem 2014;20:378-84.
- 9. Tanık VO, Çınar T, Velibey Y, et al. Neutrophil-to-lymphocyte
ratio predicts contrast-induced acute kidney injury in
patients with ST-elevation myocardial infarction treated
with primary percutaneous coronary intervention. J Tehran
Univ Heart Cent 2019;14:59-66.
- 10. Thaulow E, Erikssen J, Sandvik L, et al. Blood-platelet count
and function are related to total and cardiovascular death in
apparently healthy-men. Circulation 1991;84:613-7.
- 11. Iijima R, Ndrepepa G, Mehilli J, et al. Relationship between
platelet count and 30-day clinical outcomes after
percutaneous coronary interventions - Pooled analysis of
four ISAR trials. Thromb Haemostasis 2007;98:852-7.
- 12. Bian C, Wu Y, Shi Y, et al. Predictive value of the relative
lymphocyte count in coronary heart disease. Heart Vessels
2010;25:469-73.
- 13. Smith RA, Bosonnet L, Raraty M, et al. Preoperative plateletlymphocyte
ratio is an independent significant prognostic
marker in resected pancreatic ductal adenocarcinoma. Am
J Surg 2009;197:466-72.
- 14. Proctor MJ, Morrison DS, Talwar D, et al. A comparison of
inflammation-based prognostic scores in patients with
cancer. A Glasgow Inflammation Outcome Study. Eur J
Cancer 2011;47:2633-641.
- 15. Cetin EHO, Cetin MS, Aras D, et al. Platelet to lymphocyte
ratio as a prognostic marker of in-hospital and longterm
major adverse cardiovascular events in ST-segment
elevation myocardial infarction. Angiology 2016;67:336-45.
- 16. Azab B, Shah N, Akerman M, et al. Value of platelet/
lymphocyte ratio as a predictor of all-cause mortality
after non-ST-elevation myocardial infarction. J Thromb
Thrombolys 2012;34:326-34.
- 17. Kurtul A, Murat SN, Yarlioglues M, et al. Association of
platelet-to-lymphocyte ratio with severity and complexity
of coronary artery disease in patients with acute coronary
syndromes. Am J Cardiol 2014;114:972-8.
- 18. Olivares R, Ducimetiere P, Claude JR. Monocyte count: a
risk factor for coronary heart disease? Am J Epidemiol
1993;137:49-53.
- 19. Ansell BJ, Navab M, Hama S, et al. Inflammatory/
antiinflammatory properties of high-density lipoprotein
distinguish patients from control subjects better than
high-density lipoprotein cholesterol levels and are
favorably affected by simvastatin treatment. Circulation
2003;108:2751-6.
- 20. Cicek G, Kundi H, Bozbay M, et al. The relationship between
admission monocyte HDL-C ratio with short-term and
long-term mortality among STEMI patients treated with
successful primary PCI. Coronary Artery Dis 2016;27:176-
84.
- 21. Kundi H, Kiziltunc E, Cetin M, et al. Association of monocyte/
HDL-C ratio with SYNTAX scores in patients with stable
coronary artery disease. Herz 2016;41:523-9.
- 22. Tosu A, Çinar, T , Güler, A , et al. The usefulness of monocyte
to high density lipoprotein cholesterol ratio in prediction for
coronary artery ectasia. Turk J Clin Laborat 2019;10:68-73.
- 23. Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS
Guidelines for the Management of Dyslipidaemias The Task
Force for the Management of Dyslipidaemias of the European
Society of Cardiology (ESC) and European Atherosclerosis
Society (EAS) Developed with the special contribution of
the European Assocciation for Cardiovascular Prevention &
Rehabilitation (EACPR). Atherosclerosis 2016;253:281-344.
- 24. Thygesen K, Alpert JS, Jaffe AS, et al. Third Universal
Definition of Myocardial Infarction. Circulation.
2012;126:2020-
- 25. Amsterdam. 2014 ACC/AHA Guideline for the management
of patients with non-st-elevation acute coronary
syndromes: executive summary: a report of the american
college of cardiology/american heart association task force
on practice guidelines. Circulation. 2014;130:431-2.
- 26. Libby P. Inflammation in atherosclerosis. Nature
2002;420:868-74.
- 27. Aqel NM, Ball RY, Waldmann H, Mitchinson MJ. Identification
of Macrophages and smooth-muscle cells in human
atherosclerosis using monoclonal-antibodies. J Pathol
1985;146:197-204.
- 28. Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of
cholesterol-lowering treatment: prospective meta-analysis
of data from 90,056 participants in 14 randomised trials of
statins. Lancet 2005;366:1267-78.
- 29. Almuti K, Rimawi R, Spevack D, Ostfeld RJ. Effects of statins
beyond lipid lowering: potential for clinical benefits. Int J
Cardiol 2006;109:7-15.
- 30. Pitt B, Loscalzo J, Monyak J, et al. Comparison of Lipid-
Modifying Efficacy of Rosuvastatin Versus Atorvastatin in
Patients With Acute Coronary Syndrome (from the LUNAR
Study). Am J Cardiol 2012;109:1239-46.
- 31. Aydin MU, Aygul N, Altunkeser BB, et al. Comparative
effects of high-dose atorvastatin versus moderatedose
rosuvastatin on lipid parameters, oxidized-LDL and
inflammatory markers in ST elevation myocardial infarction.
Atherosclerosis 2015;239:439-43.
- 32. Ridker PM, Danielson E, Fonseca FAH, et al. Rosuvastatin to
Prevent Vascular Events in Men and Women with Elevated
C-Reactive Protein. New Engl J Med 2008;359:2195-207.
- 33. Kinlay S, Schwartz GG, Olsson AG, et al. High-dose
atorvastatin enhances the decline in inflammatory markers
in patients with acute coronary syndromes in the MIRACL
study. Circulation 2003;108:1560-6.
- 34. Gungoren F, Besli F, Caliskan S, et al. Statin Therapy
May not Effect NLR and MPV Levels in Patients With
Hypercholesterolemia: A Retrospective Study. Angiology
2016;67:536-40.
- 35. Akin F, Ayca B, Kose N, et al. Effect of atorvastatin
on hematologic parameters in patients with
hypercholesterolemia. Angiology 2013;64:621-625
- 36. Alexandrakis MG, Passam FH, Moschandrea IA, et al. Levels
of serum cytokines and acute phase proteins in patients
with essential and cancer-related thrombocytosis. Am J
Clin Oncol-Canc 2003;26:135-40.
- 37. Yildiz A, Yuksel M, Oylumlu M, et al. The Utility of the
Platelet-Lymphocyte Ratio for Predicting No Reflow in
Patients With ST-Segment Elevation Myocardial Infarction.
Clin Appl Thromb Hemost 2015;21:223-8.
- 38. Expert Panel on Detection E, Treatment of High Blood
Cholesterol in A. Executive Summary of The Third Report
of The National Cholesterol Education Program (NCEP)
Expert Panel on Detection, Evaluation, And Treatment of
High Blood Cholesterol In Adults (Adult Treatment Panel III).
JAMA 2001;285:2486-97.
- 39. Akboga MK, Canpolat U, Yuksel M, et al. Platelet to
lymphocyte ratio as a novel indicator of inflammation is
correlated with the severity of metabolic syndrome: A single
center large-scale study. Platelets 2016;27:178-83.
- 40. Kei A, Elisaf M. Nicotinic acid/laropiprant reduces platelet
count but increases mean platelet volume in patients with
primary dyslipidemia. Arch Med Sci 2014;10:439-44.
- 41. Karatas MB, Canga Y, Ozcan KS, et al. Monocyte to highdensity
lipoprotein ratio as a new prognostic marker in
patients with STEMI undergoing primary percutaneous
coronary intervention. Am J Emerg Med 2016;34:240-4.
- 42. Canpolat U, Aytemir K, Yorgun H, et al. The role of
preprocedural monocyte-to-high-density lipoprotein ratio in
prediction of atrial fibrillation recurrence after cryoballoonbased
catheter ablation. Europace 2015;17:1807-15.
- 43. 43. Tani S, Nagao K, Anazawa T, et al. Association of
leukocyte subtype counts with coronary atherosclerotic
regression following pravastatin treatment. Am J Cardiol
2009;104:464-9.
- 44. Fildes JE, Shaw SM, Mitsidou A, et al. HMG-CoA reductase
inhibitors deplete circulating classical and non-classical
monocytes following human heart transplantation. Transpl
Immunol 2008;19:152-7.
- 45. Nissen SE, Nicholls SJ, Sipahi I, et al. Effect of very
high-intensity statin therapy on regression of coronary
atherosclerosis: the ASTEROID trial. JAMA 2006;295:1556-
65.