title: [Cardioprotective effect and mechanism of intensive lipid modulation on patients with coronary artery disease undergoing noncardiac surgery].
abstract: OBJECTIVE
  To explore the protective effect and possible mechanism of intensive lipid modulation on the perioperative period of patients with stable coronary artery disease undergoing noncardiac surgery.
  
  
  METHODS
  In the study, 60 patients with stable coronary artery disease undergoing elective noncardiac surgery were randomly divided into intensive lipid modulation group (n = 30) and conventional group (n = 30). In intensive lipid modulation group, the patients were given atorvastatin 40 mg every night before surgery, 80 mg 12 h before surgery, and 40 mg 2 h before surgery, and 40 mg every night after noncardiac surgery. In conventional group, the patients were given atorvastatin 20 mg every night before surgery and also after the surgery. The occurrence of perioperative major adverse cardiac events (including sudden cardiac death, acute myocardial infarction, unplanned revascularization) were compared in the two groups. Preoperative and 48 h postoperative changes of lipid levels and inflammatory markers were also compared in the two groups.
  
  
  RESULTS
  In conventional group, one patient suffered myocardial infarction with acute anterior ST-segment elevation and was given emergency left anterior descending artery interventional reperfusion therapy, and 7 patients suffered asymptomatic myocardial infarction. In intensive lipid modulation group, one patient suffered asymptomatic myocardial infarction, and the incidence rate of perioperative acute myocardial infarction reduced significantly compared with conventional group (P < 0.05). There was no significant difference in preoperative and postoperative changes of lipid levels in the two groups (P > 0.05), and compared with conventional group, there was significantly lower levels of inflammatory markers in intensive lipid modulation group (P < 0.05).
  
  
  CONCLUSIONS
  The intensive lipid modulation group significantly reduced the incidence of perioperative major adverse cardiac events especially asymptomatic myocardial infarction, and the inhibition of the inflammatory response may be one of the protective mechanisms, which still needs to be further confirmed by large multicenter randomized controlled clinical trials.
authors.affiliation: Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Jing-gang
authors.initials: JG
authors.lastname: Xia
authors.affiliation: Deparment of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Qu
authors.affiliation: Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Shao-dong
authors.initials: SD
authors.lastname: Hu
authors.affiliation: Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Ji
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Chun-lin
authors.initials: CL
authors.lastname: Yin
authors.affiliation: Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Xu
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000517:prevention & control; D000069059:Atorvastatin; D053840:Brugada Syndrome; D000075224:Cardiac Conduction System Disease; D003324:Coronary Artery Disease / Q000503:physiopathology*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D006329:Heart Conduction System / Q000002:abnormalities; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D008055:Lipids / Q000097:blood; D009203:Myocardial Infarction / Q000517:prevention & control*; D059035:Perioperative Period; D011758:Pyrroles / Q000627:therapeutic use*
chemical_list: D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D008055:Lipids; D011758:Pyrroles; D000069059:Atorvastatin