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Statins for Improving Myocardial Perfusion in Patients With Nonalcoholic Fatty Liver Disease Undergoing Percutaneous Coronary Intervention

Published:November 08, 2015DOI:https://doi.org/10.1016/j.amjcard.2015.11.001
      Emre et al
      • Emre A.
      • Terzi S.
      • Celiker E.
      • Sahin S.
      • Yazici S.
      • Erdem A.
      • Ceylan U.S.
      • Asik M.
      • Yesilcimen K.
      Impact of nonalcoholic fatty liver disease on myocardial perfusion in nondiabetic patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
      report that moderate-to-severe nonalcoholic fatty liver disease (NAFLD) is independently related with impaired myocardial perfusion and with poorer in-hospital prognosis after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction. In-hospital major adverse cardiac events (MACE) occurred in 31% versus 8% (p <0.0001) of patients with moderate-to-severe and mild NAFLD, respectively.
      • Emre A.
      • Terzi S.
      • Celiker E.
      • Sahin S.
      • Yazici S.
      • Erdem A.
      • Ceylan U.S.
      • Asik M.
      • Yesilcimen K.
      Impact of nonalcoholic fatty liver disease on myocardial perfusion in nondiabetic patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
      NAFLD severity was evaluated with a semiquantitative score and was characterized as mild if the score was <3 or moderate to severe if the score was ≥3. Postprocedural myocardial perfusion was evaluated with myocardial blush grade and ST-segment resolution.
      • Emre A.
      • Terzi S.
      • Celiker E.
      • Sahin S.
      • Yazici S.
      • Erdem A.
      • Ceylan U.S.
      • Asik M.
      • Yesilcimen K.
      Impact of nonalcoholic fatty liver disease on myocardial perfusion in nondiabetic patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
      In this context, we previously reported that NAFLD is related with excess risk of cardiac events
      • Athyros V.G.
      • Tziomalos K.
      • Gossios T.D.
      • Griva T.
      • Anagnostis P.
      • Kargiotis K.
      • Pagourelias E.D.
      • Theocharidou E.
      • Karagiannis A.
      • Mikhailidis D.P.
      GREACE Study Collaborative Group
      Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis.
      • Athyros V.G.
      • Giouleme O.
      • Ganotakis E.S.
      • Elisaf M.
      • Tziomalos K.
      • Vassiliadis T.
      • Liberopoulos E.N.
      • Elisaf M.
      • Tziomalos K.
      • Vassiliadis T.
      • Liberopoulos E.N.
      for the Assessing The Treatment Effect in Metabolic Syndrome Without Perceptible diabeTes (ATTEMPT) Collaborative Group
      Safety and impact on cardiovascular events of long-term multifactorial treatment in patients with metabolic syndrome and abnormal liver function tests: a post hoc analysis of the randomised ATTEMPT Study.
      both in patients with or without established cardiovascular disease.
      • Athyros V.G.
      • Tziomalos K.
      • Gossios T.D.
      • Griva T.
      • Anagnostis P.
      • Kargiotis K.
      • Pagourelias E.D.
      • Theocharidou E.
      • Karagiannis A.
      • Mikhailidis D.P.
      GREACE Study Collaborative Group
      Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis.
      • Athyros V.G.
      • Giouleme O.
      • Ganotakis E.S.
      • Elisaf M.
      • Tziomalos K.
      • Vassiliadis T.
      • Liberopoulos E.N.
      • Elisaf M.
      • Tziomalos K.
      • Vassiliadis T.
      • Liberopoulos E.N.
      for the Assessing The Treatment Effect in Metabolic Syndrome Without Perceptible diabeTes (ATTEMPT) Collaborative Group
      Safety and impact on cardiovascular events of long-term multifactorial treatment in patients with metabolic syndrome and abnormal liver function tests: a post hoc analysis of the randomised ATTEMPT Study.
      The Incremental Decrease in End Points Through Aggressive Lipid Lowering trial (n = 8,863) confirmed these findings.
      • Tikkanen M.J.
      • Fayyad R.
      • Faergeman O.
      • Olsson A.G.
      • Wun C.C.
      • Laskey R.
      • Kastelein J.J.
      • Holme I.
      • Pedersen T.R.
      IDEAL Investigators
      Effect of intensive lipid lowering with atorvastatin on cardiovascular outcomes in coronary heart disease patients with mild-to-moderate baseline elevations in alanine aminotransferase levels.
      Post hoc analyses of the previously mentioned studies
      • Athyros V.G.
      • Tziomalos K.
      • Gossios T.D.
      • Griva T.
      • Anagnostis P.
      • Kargiotis K.
      • Pagourelias E.D.
      • Theocharidou E.
      • Karagiannis A.
      • Mikhailidis D.P.
      GREACE Study Collaborative Group
      Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis.
      • Athyros V.G.
      • Giouleme O.
      • Ganotakis E.S.
      • Elisaf M.
      • Tziomalos K.
      • Vassiliadis T.
      • Liberopoulos E.N.
      • Elisaf M.
      • Tziomalos K.
      • Vassiliadis T.
      • Liberopoulos E.N.
      for the Assessing The Treatment Effect in Metabolic Syndrome Without Perceptible diabeTes (ATTEMPT) Collaborative Group
      Safety and impact on cardiovascular events of long-term multifactorial treatment in patients with metabolic syndrome and abnormal liver function tests: a post hoc analysis of the randomised ATTEMPT Study.
      • Tikkanen M.J.
      • Fayyad R.
      • Faergeman O.
      • Olsson A.G.
      • Wun C.C.
      • Laskey R.
      • Kastelein J.J.
      • Holme I.
      • Pedersen T.R.
      IDEAL Investigators
      Effect of intensive lipid lowering with atorvastatin on cardiovascular outcomes in coronary heart disease patients with mild-to-moderate baseline elevations in alanine aminotransferase levels.
      reported that high-dose atorvastatin was safe in patients with abnormal liver tests, probably because of NAFLD, reduced transaminase levels, and also reduced MACE twice more in these patients compared with those with normal liver biochemistry.
      • Athyros V.G.
      • Tziomalos K.
      • Gossios T.D.
      • Griva T.
      • Anagnostis P.
      • Kargiotis K.
      • Pagourelias E.D.
      • Theocharidou E.
      • Karagiannis A.
      • Mikhailidis D.P.
      GREACE Study Collaborative Group
      Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis.
      • Athyros V.G.
      • Giouleme O.
      • Ganotakis E.S.
      • Elisaf M.
      • Tziomalos K.
      • Vassiliadis T.
      • Liberopoulos E.N.
      • Elisaf M.
      • Tziomalos K.
      • Vassiliadis T.
      • Liberopoulos E.N.
      for the Assessing The Treatment Effect in Metabolic Syndrome Without Perceptible diabeTes (ATTEMPT) Collaborative Group
      Safety and impact on cardiovascular events of long-term multifactorial treatment in patients with metabolic syndrome and abnormal liver function tests: a post hoc analysis of the randomised ATTEMPT Study.
      • Tikkanen M.J.
      • Fayyad R.
      • Faergeman O.
      • Olsson A.G.
      • Wun C.C.
      • Laskey R.
      • Kastelein J.J.
      • Holme I.
      • Pedersen T.R.
      IDEAL Investigators
      Effect of intensive lipid lowering with atorvastatin on cardiovascular outcomes in coronary heart disease patients with mild-to-moderate baseline elevations in alanine aminotransferase levels.
      Recently, we reported that monotherapy with rosuvastatin 10 mg/day ameliorated liver histology in biopsy-proved nonalcoholic steatohepatitis, an advanced/severe form of NAFLD, and resolved metabolic syndrome within 12 months.
      • Kargiotis K.
      • Athyros V.G.
      • Giouleme O.
      • Katsiki N.
      • Katsiki E.
      • Anagnostis P.
      • Boutari C.
      • Doumas M.
      • Karagiannis A.
      • Mikhailidis D.P.
      Resolution of non-alcoholic steatohepatitis by rosuvastatin monotherapy in patients with metabolic syndrome.
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