作者:Koon K. Teo、Jeffrey R. Burton
DOI:10.2165/00003495-200262120-00001
日期:——
During the last decade, the development of the HMG CoA reductase inhibitors, commonly referred to as ‘statins’, has contributed greatly to cholesterol lowering therapy and cardiovascular risk reduction. These agents are well tolerated and efficacious. Data on nearly 30 000 patients from five long-term randomised, placebo-controlled trials of statins have clearly demonstrated that a broad range of individuals can benefit from such therapy. These include men or women, younger or older individuals, those with elevated or normal cholesterol levels, with or without myocardial infarction or symptomatic coronary heart disease, with or without hypertension or diabetes mellitus, and those who are smokers or non-smokers. Benefits include reductions in the risks for myocardial infarction, and coronary, cardiovascular and all-cause mortality, stroke and the need for coronary revascularisation. Results of the recently completed Heart Protection Trial have clearly confirmed the results of the earlier trials and support the use of statin therapy in secondary prevention. The role of statins in acute coronary syndromes is being actively evaluated and appears promising. In primary prevention, the data are not as convincing and generalisations cannot be made as to whether, and in which subgroup, drug therapy to lower low density lipoprotein (LDL) cholesterol should be initiated. There are important cost implications to consider and the use of statin therapy has to be judged on an individual basis, particularly in those with high or very high LDL cholesterol levels and/or with multiple risk factors rendering them at high short- and long-term risk of coronary heart disease. There is evidence of a ‘care gap’ in translating trial data into practice, even in secondary prevention, and this needs closing in order to improve patient outcomes.
过去十年间,HMG CoA 还原酶抑制剂(通常称为 "他汀类药物")的开发为降低胆固醇治疗和减少心血管风险做出了巨大贡献。这些药物具有良好的耐受性和疗效。他汀类药物的五项长期随机安慰剂对照试验中近 3 万名患者的数据清楚地表明,许多人都能从这种疗法中获益。这些患者包括男性或女性、年轻或年长者、胆固醇水平升高或正常者、有或没有心肌梗死或无症状冠心病者、有或没有高血压或糖尿病者、吸烟或不吸烟者。该疗法的益处包括降低心肌梗死、冠心病、心血管疾病和全因死亡率、中风以及冠状动脉血运重建需求的风险。最近完成的心脏保护试验结果明确证实了早期试验的结果,并支持在二级预防中使用他汀类药物治疗。他汀类药物在急性冠状动脉综合征中的作用正在积极评估中,似乎很有希望。在一级预防方面,数据并不那么令人信服,对于是否应该开始药物治疗以降低低密度脂蛋白(LDL)胆固醇,以及在哪个亚组中开始药物治疗,还不能一概而论。他汀类药物的使用必须根据个体情况来判断,尤其是那些低密度脂蛋白(LDL)胆固醇水平较高或非常高和/或存在多种风险因素的人群,他们在短期和长期内都面临着冠心病的高风险。有证据表明,在将试验数据转化为实践方面存在 "护理差距",即使在二级预防方面也是如此,因此需要弥补这一差距,以改善患者的治疗效果。