Comparative Study of Rosuvastatin as Monotherapy Versus Rosuvastatin with Ramipril in Dyslipidemia and Their Effects on Atherosclerosis

Objective: To evaluate the effect of Rosuvastatin as monotherapy versus combination therapy of Rosuvastatin with Ramipril on the Intimo-Media Thickness (IMT) of the carotid arteries in patients of dyslipidemia. Background: Statins have shown to improve the lipid profile in dyslipidemic patients. These have anti-oxidative and anti-inflammatory actions. The statins may have also antiatherosclerotic action. Angiotensin converting enzyme (ACE) inhibitors have shown to prevent the development of atherosclerosis in animal models. This antiatherosclerotic effects of ACE inhibitors is due to their multitask actions viz. ACE inhibition, antiproliferative action as well as inhibitory to the smooth muscle cell accumulation at the site of atherosclerotic lesion. Method: 88 patients of newly diagnosed dyslipidemia, aged 30-70 years, were randomized into two groups. Group I, was allocated Rosuvastatin (as monotherapy) and Group II, Rosuvastatin with Ramipril (Combination therapy). Patients were assessed at baseline, 6 weeks and 12 weeks for carotid arteries for IMT and plaque size by B-mode ultrasound, and other parameters were also assessed. Results: In group I and group II, mean percentage change in TC, LDL, TG and HDL was highly significant (p<0.001) in both the groups while no significant change was seen between the groups at 12 weeks. Mean percentage change in mean IMT and plaque size were +0.01224% (p>0.05) versus 0.0704% (p>0.05) and +0.006% (p>0.05) versus -4.554% (p>0.05) respectively in group I and group II at 12 weeks while these changes were statistically insignificant between both the groups. Mean IMT and Plaque size reduction were more in group II. Conclusion: Both the therapies effectively improved the lipid profile in dyslipidemic patients. But combination therapy of Rosuvastatin with Ramipril reduces IMT and plaque size more than the rosuvastatin monotherapy. This shows that antiatherosclerotic action of combination therapy occurs due to its action on different risk factors of atherosclerosis.