Effects of different doses of rosuvastatin on ventricular remodeling in elderly patients with hypertension and chronic heart failure with preserved ejection fraction

Abstract:

Objective：To investigate the effects of different doses of rosuvastatin on ventricular remodeling in elderly patients with hypertension and chronic heart failure with preserved ejection fraction（HFpEF）. Methods：A total of 128 elderly patients with hyper－tension and HFpEF were randomized into two groups，the low-dose group（64 cases，10 mg/d） and the high-dose group（64 cases，20 mg/d），based on conventional treatment for heart failure，both groups were given rosuvastatin at night，and the treatment period of both groups was 6 months. Before and 6 months after treatment，we monitored changes in the levels of left ventricular remodeling related indexes in patients including left ventricular end-diastolic posterior wall thickness（LVPWT），interventricular septum thickness （IVST），and left ventricular mass index（LVMI），left ventricular diastolic function related indicators including isovolumetric relaxation time（IVRT），deceleration time（DT），left atrial volume index（LAVI），and E/E'，cardiac function related indicators including Tei index，N-terminal-pro-B-type natriuretic peptide（NT-proBNP），and 6 minute walking test（6-MWT），myocardial fibrosis related indicators including galectin-3（Gal-3），soluble ST2（sST2），connective tissue growth factor（CTGF），and transforming growth factor-β1（TGF-β1） and inflammatory response indicators including hyper-sensitive C-creative protein（hs-CRP），matrix metallopro－teinase-9（MMP-9），interleukin-6（IL-6） and tumor necrosis factor-α（TNF-α）. Major cardiac adverse events and adverse drug reactions were recorded within 6 months of treatment. The number of patients with atrial fibrillation at each time point before and after treatment was recorded in both groups. Results：Six months after treatment，left ventricular remodeling in patients（LVPWT，IVST，LVMI），left ventricular diastolic function related indicators（IVRT，DT，LAVI，E/E’），cardiac function related indicators（Tei index，NT-proBNP，6-MWT），myocardial fibrosis related indicators（Gal-3，sST2，CTGF，TGF-β1） and inflammatory response indicators（hs-CRP，MMP-9，IL-6，TNF-α） were significantly better than those before treatment（all P＜0.01），the improvement was more significant in the high-dose group（all P＜0.05）. The incidence of major adverse cardiac events in the high-dose group was lower than that in the low-dose group（χ2=4.195，P=0.041）. There was no significant difference in the incidence of adverse drug reactions between two groups（χ2=1.888，P=0.169），and in the existence rate of atrial fibrillation between two groups at each time point after treatment（all P＞0.05）. Conclusion：Compared with the low dose，the high dose of rosuvastatin can effectively improve the ventricular remodeling，ventricular diastolic function and cardiac function in HFpEF patients，and reduce the incidence of major adverse cardiac events without increasing adverse reactions. The anti-inflammatory and anti-myocardial fibrosis of rosuvastatin may be one of its mechanisms.