Abstract:The “Diagnosis and Management Guidelines for Chronic Coronary Syndrome Patients in China” published in 2024 was led by the Atherosclerosis and Coronary Heart Disease Group of the Cardiology Branch of the Chinese Medical Association and the Editorial Board of the Chinese Journal of Cardiovascular Diseases, in conjunction with the Intervention Group, Intravascular Imaging and Functional Group, Cardiovascular Disease Imaging Group, and Basic Science Group. The guideline is the first in China to provide guidance for the diagnosis and management of patients with chronic coronary syndrome (CCS), comprehensively introducing the definition, diagnostic process, treatment strategies, and long-term management of CCS. The guideline aims to improve the prognosis and quality of life by providing the best diagnostic or treatment methods. This article focuses on the antithrombotic therapy, lipid-lowering therapy, and management of special populations for patients with CCS, further interpreting the updates and recommendations in the guidelines.

Abstract:Aim To investigate the change of serum small and dense low density lipoprotein cholesterol (sdLDLC) level in patients with coronary heart disease (CHD) after lipid-lowering therapy. Methods Blood samples were collected from 1065 patients with CHD and 469 healthy controls from March to July 2016. Serum low density lipoprotein cholesterol (LDLC), high density lipoprotein cholesterol (HDLC) and sdLDLC levels were measured by direct assay, and serum triglyceride (TG) and total cholesterol (TC) levels were measured by enzyme method. The reference interval of the healthy control group was established. According to the serum LDLC level of CHD patients after lipid-lowering therapy, lipid-lowering LDLC standard group and intensive lipid-lowering LDLC standard group were determined. The blood lipid indexes were compared in each group, and the changes of sdLDLC level and sdLDLC/LDLC ratio were analyzed and compared. Results (1)After lipid-lowering therapy, CHD group compared with the healthy control group, there were significant differences in TG, HDLC and sdLDLC/LDLC ratio between the two groups (P＜0.05), and there were no significant differences in the levels of TC, LDLC and sdLDLC between the two groups (P＞0.05). (2)Compared with the healthy control group, the sdLDLC/LDLC ratio increased in lipid-lowering LDLC standard group (P＜0.05), and there was no significant difference in sdLDLC level between the two groups (P＞0.05). Among the patients who had reached the standard of lipid-lowering, the sdLDLC level of 2.3% CHD patients and the sdLDLC/LDLC ratio of 7.7% CHD patients were higher than the reference interval established by this study. (3)Compared with the healthy control group, SdLDLC level reduced and sdLDLC/LDLC ratio increased in intensive lipid-lowering LDLC standard group (P＜0.05). Among the patients who had reached the standard of intensive lipid-lowering, the sdLDLC level of 0.8% CHD patients and the sdLDLC/LDLC ratio of 15.3% CHD patients were higher than the reference interval established by this study. ConclusionsIn the lipid-lowering therapy and intensive lipid-lowering therapy for CHD patients, the changes of serum sdLDLC level and sdLDLC/LDLC ratio are of great significance for risk analysis of residual cardiovascular events. Lowering sdLDLC level may be one of the important indicators that ultimately reduce the risk of CHD.

Abstract:Aim To validate the efficacy of different doses of atorvastatin for patients with symptomatic intracranial atherosclerotic stenosis （sICAS）. Methods 120 patients with sICAS were enrolled and randomly divided into three groups. Patients in the three groups were given 10 mg/d, 20 mg/d, and 40 mg/d of atorvastatin respectively, for one year. All patients were also given other aggressive medical therapy. Evaluation variables,including changes in degree of stenosis, and perfusion-related parameters derived from computed tomography perfusion （CTP） imaging from baseline to one year during the study period, were used to compare the benefits of these three statin therapies. Results After one year of atorvastatin therapy, patients in the three groups had an obvious improvement of degree of stenosis, improvement of degree of stenosis was significantly better in the 40 mg/day group. Patients in the three groups had an obvious increase in relative cerebral blood flow （rCBF） and relative cerebral blood volume （rCBV） levels at the end of one year. However, patients in the 40 mg/day group experienced a reduction in relative time to bolus peak （rTTP） at the end of one year while those in the other two groups showed an increase in rTTP. Conclusions Improvement of degree of stenosis, and perfusion-related parameters were all significantly better by long-term use of atorvastatin.

Abstract:Aim To observe clinical effect and explore preliminary mechanism of Oleanolic acid strengthening atorvastatin lipid-lowering in patients with hyperlipidemia. Methods 107 cases of patients with hyperlipidemia were divided into atorvastatin therapy group or combination therapy group of atorvastatin and oleanolic acid, and the course of therapy was 3 months. The concentration of serum TC, LDLC , TG, HDLC were detected before and after treatment. The changes in serum lipid levels before and after treatment were compared between the two groups. Serum PCSK9 concentrations were detected by ELISA before and after treatment. Results General data including TC, LDLC, TG, HDLC were matched between atorvastatin therapy group and combination therapy group of atorvastatin and oleanolic acid. There were no significant difference in all compared data between two groups. All of two therapy protocols achieved remarkable results. Compared with the same group before treatment, TC and LDLC and TG were significantly decreased after treatment in two groups, and the difference was statistically significant （P<0.05） Compared with atorvastatin therapy group, TC and LDLC decreased more obviously in combination therapy group of atorvastatin and oleanolic acid, the difference was statistically significant （P<0.05）. The initial serum PCSK9 concentration difference was not statistically significant （72.4 ± 4.2 μg/L vs 71.1 ± 3.9 μg/L, P>0.05） in two groups. After treatment, in atorvastatin therapy group, serum PCSK9 concentration increased by about 30%, the difference was significant （72.4 ± 4.2 μg/L vs 95.1 ± 3.7 μg/L, P<0.01） compared with before treatment in combination therapy group, atorvastatin and oleanolic acid serum PCSK9 concentrations was slightly higher （71.1 μg/L± 3.9 vs 77.6 ± 4.4 μg/L） compared with before treatment, the difference was non-significant But in atorvastatin therapy group serum PCSK9 concentrations were significantly higher than combination therapy group with atorvastatin and oleanolic acid, the difference was significant （95.1 ± 3.7 μg/L vs 77.6 ± 4.4 μg/L, P<0.05）. Spearman correlation analysis was performed among the patients’ plasma total cholesterol, HDL cholesterol,TG, and LDL cholesterol and their circulating PCSK9 concentrations. PCSK9 correlated positively and significantly with both total cholesterol （r0.76, P0.001） and LDL cholesterol （r 0.72, P0.001）, but not with HDL cholesterol or TG （data not shown）. Conclusion Oleanolic acid can enhance atorvastatin lipid-lowering effect in hyperlipidemic patients, which may relate to oleanolic acid inhibiting PCSK9 expression.

Abstract:Aim To compare the effects of morning versus evening intake of simvastatin on lipid profile and high-sensitivity C-reactive protein(hs-CRP) in patients with combined hyperlipidemia.Methods103 patients were randomly assigned to receive 20 mg simvastatin orally each morning(n=52) or evening(n=51).The treatment period lasted 6 months.Lipid profiles,physical and laboratory investigations for adverse effects,and hs-CRP were assessed.ResultsSerum total cholesterol(TC),low density lipoprotein cholesterol(LDLC) and triglyceride(TG) levels decreased significantly in both treatment groups,while simvastatin in the morning administration resulted in larger reductions in TG than dose evening administration(38% vs 19%,P=0.035).Moreover,morning administration reduced TC and LDLC by 21% and 31%,respectively.The success rates of TG and all three together(TC,LDLC and TG) were 51% and 36% in the morning administration,which were superior to the drug given in the evening(33% and 29%,respectively).Although serum hs-CRP levels decreased significantly from baseline in both morning and evening administration,similar hs-CRP reductions were observed between the two treatment groups(p<0.05).And the effects were cholesterolindependent.There were no adverse events during the treatment periods,and simvastatin was well tolerated in the morning or evening administration.ConclusionsThe results demonstrated that TG lowering effects of simvastatin in the morning administration were superior to that of evening administration.There is no diurnal variation in anti-inflammatory effects of this drug,therefore,morning or evening administration is equally effective in decreasing hs-CRP.