Changes in Homocysteine Levels Affect Serum Lipid Response to Atorvastatin in Patients With Acute Coronary Syndrome: A Retrospective Observational Study

OBJECTIVE: The present study investigated whether changes in serum homocysteine (Hcy) levels modify the effects of atorvastatin treatment on blood lipid parameters in patients with acute coronary syndrome (ACS). METHODS: A total of 159 patients with ACS who received regular, long-term treatment with 20 mg/d atorvastatin were included. Depending on the changes in Hcy parameters, they were divided into Hcy reduction (HR) and Hcy elevation (HE) groups. RESULTS: After long-term atorvastatin treatment, total cholesterol (TC), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), apolipoprotein (Apo) B, and Hcy levels were decreased (P < .05), and the ApoAI level was increased (P < .01). Correlation and stratified analysis showed that Hcy or hyperhomocysteinemia was correlated with blood lipids. In both the HE and HR groups, the TC, LDL-C, and ApoB levels after treatment were lower than those before treatment (P < .01), and the ApoAI level was increased compared with that before treatment (P < .05). There was no difference in the reduction of TC, LDL-C, and ApoB levels or in the increase of ApoAI level (P (interaction) > .05) between the 2 groups. However, there was a clear opposite trend of the effect of atorvastatin on TG and high-density lipoprotein cholesterol (HDL-C) levels between the HR and HE groups (P (interaction) < .05). In the HR group, the HDL-C level was increased (P < .05), and TGs were decreased compared with those before treatment (P < .01). Nevertheless, in the HE group, the HDL-C level was decreased (P < .05), and TGs (P < .05) were increased compared with those before treatment. CONCLUSION: The effects of atorvastatin on TGs and HDL-C depend on changes in Hcy levels. Patients with a reduced Hcy level after atorvastatin treatment had more favorable lipid parameters.