Spieker L E, Noll G, Hannak M, Lüscher T F
Department of Cardiology, University Hospital, Zürich, Switzerland.
J Cardiovasc Pharmacol. 2000 Mar;35(3):361-5. doi: 10.1097/00005344-200003000-00003.
Hyperlipidemia is an important cardiovascular risk factor. Lipid-lowering therapy has been shown to decrease morbidity and mortality in these patients. Combination therapy with a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor and a fibric-acid derivative has been reported to be more efficacious to reduce low-density lipoprotein (LDL) cholesterol and triglycerides but may be associated with an increased risk of myositis. The aim of this study was to investigate the efficacy and tolerability of fluvastatin, an HMG-CoA reductase inhibitor, alone and in combination with bezafibrate, a fibric-acid derivative. In a randomized controlled trial with 454 hypercholesterolemic patients (mean cholesterol, 8.6 +/- 1.6 mM), fluvastatin (20 mg/day) significantly lowered total plasma cholesterol levels (-12.5%; p < 0.0001 vs. placebo), LDL cholesterol (-14%; p < 0.0001), and triglycerides (-4%; p = 0.05). A small increase in high-density lipoprotein (HDL) cholesterol levels (3%, NS) also was observed. Combination therapy with fluvastatin and bezafibrate (400 mg/day) in 71 patients with persistent hypertriglyceridemia during treatment with the statin resulted in a more pronounced reduction in triglyceride (-47%; p < 0.0001) and total cholesterol levels (-15%; p < 0.0001) than did fluvastatin alone. Furthermore, the additional bezafibrate significantly increased HDL cholesterol (+5%; p < 0.001). No significant increases in creatine phosphokinase levels or in frequency of myalgia were observed. In summary, fluvastatin decreases both cholesterol and triglyceride levels. In patients with persistent hypertriglyceridemia, combination therapy with fluvastatin and bezafibrate may be safely used to lower triglyceride and cholesterol levels more efficiently.
高脂血症是一种重要的心血管危险因素。降脂治疗已被证明可降低这些患者的发病率和死亡率。据报道，3-羟基-3-甲基戊二酰辅酶A（HMG-CoA）还原酶抑制剂与纤维酸衍生物联合治疗在降低低密度脂蛋白（LDL）胆固醇和甘油三酯方面更有效，但可能会增加肌炎风险。本研究的目的是调查HMG-CoA还原酶抑制剂氟伐他汀单独使用以及与纤维酸衍生物苯扎贝特联合使用的疗效和耐受性。在一项针对454例高胆固醇血症患者（平均胆固醇水平为8.6±1.6 mM）的随机对照试验中，氟伐他汀（20 mg/天）显著降低了总血浆胆固醇水平（-12.5%；与安慰剂相比，p<0.0001）、LDL胆固醇（-14%；p<0.0001）和甘油三酯（-4%；p = 0.05）。还观察到高密度脂蛋白（HDL）胆固醇水平略有升高（3%，无统计学意义）。在71例他汀类药物治疗期间持续性高甘油三酯血症的患者中，氟伐他汀与苯扎贝特（400 mg/天）联合治疗导致甘油三酯（-47%；p<0.0001）和总胆固醇水平（-15%；p<0.0001）的降低比单独使用氟伐他汀更为显著。此外，额外使用苯扎贝特显著提高了HDL胆固醇水平（+5%；p<0.001）。未观察到肌酸磷酸激酶水平或肌痛发生率有显著升高。总之，氟伐他汀可降低胆固醇和甘油三酯水平。在持续性高甘油三酯血症患者中，氟伐他汀与苯扎贝特联合治疗可安全有效地降低甘油三酯和胆固醇水平。
