Plana J C, Jones P H
Section of Atherosclerosis and Lipid Research, Baylor College of Medicine, 6565 Fannin, RM B564, M.S. B501, Houston, TX 77030-2707, USA.
Curr Atheroscler Rep. 2001 Sep;3(5):355-64. doi: 10.1007/s11883-001-0073-0.
Lipid-lowering drugs, in particular statin treatments, have been shown to reduce the incidence of initial and recurrent coronary heart disease (CHD) events within several years of initiating therapy. This effect can be clinically detected within the first 1 to 2 years in randomized trials. Recent observational and clinical trial data suggest that lipid-lowering therapy initiated at the time of an acute coronary event can reduce recurrent events, and possibly all-cause mortality, in a much shorter period of time. The possible mechanisms by which this benefit occurs include the effect of reduced lipoprotein levels, as well as an independent effect of statins on endothelial function. Statins improve endothelial-dependent flow-mediated vasodilation by increasing the bioavailability of nitric oxide. They stabilize the plaque by modulating the inflammatory response within the vessel wall. They also decrease clot formation by decreasing the adherence of platelets to the ruptured plaque and by acting on the extrinsic coagulation cascade pathway. This review examines these effects of statins and lipoproteins on vascular function, as well as the clinical evidence supporting early treatment in acute coronary syndromes.
降血脂药物，尤其是他汀类治疗药物，已被证明在开始治疗后的几年内可降低初次和复发性冠心病（CHD）事件的发生率。在随机试验中，这种效果可在最初1至2年内通过临床检测到。最近的观察性和临床试验数据表明，在急性冠脉事件发生时开始的降脂治疗可在更短的时间内降低复发性事件，并可能降低全因死亡率。这种益处产生的可能机制包括脂蛋白水平降低的作用，以及他汀类药物对内皮功能的独立作用。他汀类药物通过增加一氧化氮的生物利用度来改善内皮依赖性血流介导的血管舒张。它们通过调节血管壁内的炎症反应来稳定斑块。它们还通过减少血小板与破裂斑块的粘附并作用于外源性凝血级联途径来减少血栓形成。本综述探讨了他汀类药物和脂蛋白对血管功能的这些影响，以及支持急性冠脉综合征早期治疗的临床证据。
