Impact of early initiation and intensive statin therapy on gut microbiota,complication risk and adverse events in patients with acute coronary syndrome
ZHU Feng-juan
WANG Yao-hua
LIANG Jing
HU Ying-ying
LIU Ya-nan
ZHANG Hai-yan
ZHOU Guo-wei
Abstract：Objective To investigate the impact of early initiation and intensive statin therapy on gut microbiota,complication risk and adverse events in patients with acute coronary syndrome(ACS).Methods A total of 216 ACS patients were enrolled at Wangjing Hospital,China Academy of Chinese Medical Sciences,from January 2020 to December 2024.According to whether they received intensified statin therapy within 24 hours after admission,patients were divided into two groups:the early initiation with intensive statin group(n=156)and the non-early initiation group(n=60).Among the early initiation group,patients were further categorized into the low-dose subgroup(n=84)and the high-dose subgroup(n=72)based on the intensity of statin therapy.The lipid profiles,vascular function,cardiac function,inflammatory markers and gut microbiota composition were compared among the groups.The incidences of the complications and adverse events were also analyzed.Results The adverse reactions increased significantly across the non-intensified,low-dose and high-dose groups,while the complication rates decreased in the same order[18(30.00%)vs.16(19.05%)vs.8(11.11%),P<0.05].The high-dose group also showed a marked reduction in major adverse cardiovascular events[25(41.67%)vs.25(29.76%)vs.10(13.89%),P<0.05].The baseline lipid profiles,vascular and cardiac function,inflammatory markers and the intestinal barrier parameters were comparable across the groups(P>0.05)before the treatment.After the treatment,all these improved significantly(P<0.05),with the greatest gains in the high-dose group,followed by the low-dose group,and minimal changes in the non-intensified group.The serum diamine oxidase(DAO)decreased significantly post-treatment only in the high-and low-dose groups(14.77±0.52)U/L vs.(10.32±1.74)U/L,(14.78±0.61)U/L vs.(11.88±1.56)U/L,all P<0.05).The gut microbiota analysis revealed reduced Enterobacteriaceae and Enterococcus and increased Bifidobacterium after the treatment(P<0.05),with the most pronounced shifts in the high-dose group(P<0.05).Early statin initiation was negatively correlated with the complications,and both were significantly associated with improvements in lipids,vascular and cardiac function,inflammation,intestinal barrier integrity and gut microbiota composition(P<0.05).Multivariate regression analysis identified early statin initiation and the post-treatment levels of total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),vascular endothelial growth factor(VEGF),left ventricular ejection fraction(LVEF),high-sensitivity C-reactive protein(hs-CRP),longitudinal measurements of Enterobacteriaceae,Enterococcus,Bifidobacterium,diamine oxidase(DAO)and D-lactate as the independent predictors of the complication occurrence(P<0.05).Conclusion Early initiation combined with intensive statin therapy can significantly reduce the incidence of the complications and major adverse cardiovascular events in ACS patients,while markedly improving the lipid profiles,vascular and cardiac function,inflammatory status,intestinal barrier function and gut microbiota composition.However,this approach is accompanied by a moderate increase in adverse events,suggesting that clinical decision-making should carefully balance the efficacy and safety,tailoring treatment strategies to individual patient characteristics.
Keywords：Acute coronary syndromeEarly initiation and intensive statin therapyGut microbiotaComplicationsAdverse events
Publication Date：2025-11-20
Online Publishing Date：2025-12-05(First online date of this platform, not the publication date of the document)
Pages：9( 1011-1019 )