Efficacy and safety comparison of different statins in elderly patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the efficacy and safety of atorvastatin, rosuvastatin and xuezhikang capsule in elderly.</p><p><b>METHODS</b>A total of 314 60-to-94-year-old (average (73.6 ± 7.9) years old) patients who were given different doses and types of statins were divided into three groups: the atorvastatin group (108 patients), the rosuvastatin group (104 patients) and the xuezhikang capsule group (102 patients). The serum TG, TC, LDL-C, HDL-C,ALT and CK were examined before and after the treatment which lasted for at least 4 weeks. All patients were divided into moderate risk group (13, 12 and 21 patients respectively in 3 groups); high risk group (40, 44 and 48 patients respectively in 3 groups) and very high risk group (55, 48 and 33 patients respectively in 3 groups ) according to guidelines on prevention and treatment of dyslipidemia in chinese adults (2007 version). The rate of reaching target goal and the dose when reaching target levels in different risk stratification groups were calculated and compared.</p><p><b>RESULTS</b>Serum TC, LDL-C and non-HDL-C were significantly reduced after the 4-week-treatment in all the three groups (P < 0.01). Serum LDL-C level before and after treatment were (3.14 ± 0.78)mmol/L vs. (2.14 ± 0.65)mmol/L in atorvastatin group (the arevage dose was (16.4 ± 4.8)mg/d), (2.92 ± 0.77)mmol/L vs. (1.96 ± 0.55)mmol/L in rosuvastatin group (the arevage dose was (8.7 ± 3.0) mg/d), and (2.70 ± 0.62)mmol/L vs. (2.16 ± 0.61) mmol/L in xuezhikang capsule group (the arevage dose was (0.9 ± 0.3) g/d ). Among all the three groups of patients, the cases of reaching target levels of LDL-C were 13, 11 and 20 in patients at moderate risk, were 38(95.0%), 38(86.4%) and 40 (83.3%) in patients at high risk, and were 22(40.0%), 30(62.5%) and 17(51.5%) in patients at very high risk. There were no statistical differences in the rate of reaching target levels of LDL-C, non-HDL-C and TC in the three groups and at different risks (P > 0.05). One patient in the atorvastatin group showed ALT level elevation >3 times of the upper limit of normal value, there was no patient with CK level elevation >5 times of the upper limit of normal value.</p><p><b>CONCLUSION</b>Atorvastatin, rosuvastatin and xuezhikang capsule at low dose and/or standard dose are effective and safety in elderly patients.</p>

The clinical features of gastrointestinal bleeding complicating aortic stenosis / 中华内科杂志

Objective To deepen the understanding about Heyde's syndrome by investigating the clinical characteristics and prognosis of the patients with aortic valve stenosis complicating with gastrointestinal bleeding.Methods Patients with aortic valve stenosis and gastrointestinal bleeding coincidently admitted to our hospital from 2001 to 2011 were retrieved and analyzed.Results In all the 443 157 in-patients,474 patients were diagnosed with aortic valve stenosis (0.11％,474/443 157) and 14 patients (9 males and 5 females,aged 53-87 years old) with gastrointestinal bleeding coincidently (2.95 ％,14/474).Among the 14 patients,3 were moderate aortic valve stenosis,11 severe aortic valve stenosis.The aortic valve peak flow velocity was 324-709 (480.54 ± 188.25) cm/s and the mean aortic valve pressure gradient was 21.04-91.56 (56.93 ± 29.90) mm Hg (1 mm Hg =0.133 kPa).Heavy gastrointestinal bleeding was manifested in all the 14 patients with 1 of haematemesis and 13 of hematochezia.Hemoglobin (Hb) and red blood cell (RBC) count were significantly lower than the normal range [(69 ±28) g/L and (2.71 ±2.04) × 1012/L,P ＜0.05].Their mean corpuscular volume(MCV),mean corpuscular hemoglobin (MCH),mean corpuscular hemoglobin concentration (MCHC),platelet (PLT) count,prothrombin time (PT) and international normalized ratio (INR) were in normal range [(90.21 ± 2.94) r,(29.39 ± 1.99) pg,(327.57 ± 14.82) g/L,(185.13 ±22.55) × 109/L,(11.4 ± 1.04) s and 1.22 ±0.44,respectively].Among all the 14 patients,13 were over 65 years old and they all accepted gastrointestinal imaging (13/14).Vascular malformation of intestine was found in 6 patients with 4 lesions located in descending colon and 2 located in sigmoid colon.Hemorrhage foci were found in 2 patients with one of colon cancer,and another of duodenal ulcer,while no definite hemorrhage foci were found in the other 11 patients.A total of 6 patients with severe aortic valve stenosis underwent aortic valve replacement (AVR) successfully (6/11) and no recurrent gastrointestinal bleeding was ever found.Conservative treatment was performed in the other 5 patients with severe aortic valve stenosis (5/11) and resulted in sudden death in 2 patients (2/5).Conclusions Prompt echocardiography and gastrointestinal endoscopy should be performed in the elderly patients with obscure gastrointestinal bleeding to facilitate the early diagnosis and treatment of Heyde's syndrome.AVR is a fundamental procedure to improve the prognosis of Heyde's syndrome.