Vivancos-Mora J, León-Colombo T, Monforte-Dupret C
Servicio de Neurología, Hospital Universitario de la Princesa, Madrid, España.
Rev Neurol. 1999;29(9):857-63.
Hypercholesterolemia has been shown to be a definite risk factor for coronary disease, although its relevance in cerebrovascular disease is more controversial. This study reviews the part played by different hypolipemic treatments in primary and secondary prevention of the complications of atherothrombotic diseases, particularly stroke.
We based our study mainly on the HMG-CoA inhibitors (3-hydroxyl 3 methyl glutaryl coenzyme A) reductase, or statins++. This group of drugs acts by inhibiting the synthesis of cholesterol and increasing the expression of LDL-c receptors, achieving a 25-35% lowering of plasma LDL-c levels. In diverse clinical trials they have been shown to have a beneficial effect in the prevention of cardiovascular disease. The results of these studies indicate that, in addition to their purely hypolipemic effect, other anti-atherothrombotic mechanisms are involved. We analyze the main studies on hypolipemic drugs in the primary and secondary prevention of coronary and cardiovascular disease.
The role of statins is clearly defined in reduction of the risk of overall and cardiovascular mortality, and also in reduction of the incidence of cardiovascular incidents in patients with a past history of coronary disease and a cholesterol level over 155 mg/dl. Reduction of the risk from cerebrovascular disease has only been observed in primary prevention studies (patients with a past history of coronary disease). Therefore, we shall have to await the results of the clinical trials currently being carried out to determine the true role of statins in the secondary prevention of cerebrovascular disease.
高胆固醇血症已被证明是冠心病的明确危险因素，尽管其在脑血管疾病中的相关性更具争议性。本研究回顾了不同降脂治疗在动脉粥样硬化血栓形成疾病并发症（尤其是中风）的一级和二级预防中所起的作用。
我们的研究主要基于HMG-CoA抑制剂（3-羟基-3-甲基戊二酰辅酶A），即他汀类药物。这类药物通过抑制胆固醇合成并增加低密度脂蛋白胆固醇（LDL-c）受体的表达来发挥作用，使血浆LDL-c水平降低25%至35%。在各种临床试验中，它们已被证明对预防心血管疾病有有益作用。这些研究结果表明，除了其单纯的降脂作用外，还涉及其他抗动脉粥样硬化血栓形成机制。我们分析了关于降脂药物在冠心病和心血管疾病一级和二级预防方面的主要研究。
他汀类药物在降低总体和心血管死亡率风险以及降低有冠心病病史且胆固醇水平超过155毫克/分升的患者心血管事件发生率方面的作用已明确界定。仅在一级预防研究（有冠心病病史的患者）中观察到了降低脑血管疾病风险的情况。因此，我们必须等待目前正在进行的临床试验结果，以确定他汀类药物在脑血管疾病二级预防中的真正作用。
