Effect of Atorvastatin on Haemostasis, Fibrinolysis and Inflammation in Normocholesterolaemic Patients with Coronary Artery Disease A Post Hoc Analysis of Data from a Prospective, Randomized, Double-Blind Study

Background: Treatment with HMG-CoA reductase inhibitors (statins) reduces the morbidity and mortality of coronary artery disease (CAD). In addition to their lipid-lowering actions, pleiotropic effects of statins have been demonstrated. Objective: The aim of the present study was to assess if atorvastatin therapy has an impact on haemostasis, fibrinolysis and inflammation in normocholesterolaemic patients with CAD. Methods: Fifty-four patients with CAD who had received atorvastatin treatment for at least 8 weeks (mean dosage 30 mg/day) and 54 patients with CAD who had not received atorvastatin therapy were selected from a larger prospective, randomized, double-blind study for inclusion in this post hoc analysis. Patients were matched by their total cholesterol levels. All patients were normocholesterolaemic. Results: In the atorvastatin-treated patients significantly lower plasma levels of thrombin-antithrombin complexes (p<0.05), plasminogen activator inhibitor-1 activity (PAI-1) [p<0.05], soluble vascular cell adhesion molecule-1 (p<0.05), soluble platelet selectin (p<0.05) and high-sensitivity C-reactive protein (p<0.05) were measured compared with patients not on atorvastatin therapy. Additionally, a strong trend towards lower soluble intercellular adhesion molecule-1 plasma levels was detected in patients treated with atorvastatin. No differences were found in tissue-type plasminogen activator antigen, plasmin-plasmin inhibitor complexes, fibrinogen, D-dimer and activated factor XII values. Conclusion: Atorvastatin appears to have an effect on coagulation activation, fibrinolysis and inflammation in patients with CAD. Reduction in PAT-1 and reduced thrombin formation may have an impact on cardiovascular morbidity and mortality in patients with CAD.