Jacobson T A
Department of Medicine, Emory University School of Medicine, Thomas K. Glenn Memorial Bldg., 69 Butler St. S.E., Atlanta, GA 30303, USA.
Curr Atheroscler Rep. 2001 Sep;3(5):373-82. doi: 10.1007/s11883-001-0075-y.
For the care of an expanding segment of the US population with multiple coronary risk factors, combination lipid-altering therapy is emerging as a treatment imperative. The most recent National Cholesterol Education Program's consensus guidelines emphasize long-term global coronary heart disease (CHD) risk status, designate patients with CHD risk equivalents (eg, diabetes, peripheral arterial disease, 20% or more 10-year absolute CHD risk) for aggressive lipid-altering therapy, and deem the metabolic syndrome (eg, obesity, insulin resistance, hypertension, elevated triglycerides, low levels of high-density lipoprotein cholesterol, small dense low-density lipoprotein particles) as a secondary target for intervention. With the advancing age of the US population and the high prevalence of diabetes, the metabolic syndrome, and CHD, increasing numbers of patients will require a more balanced metabolic attack attainable only through combination lipid-altering regimens. Many of these patients, as well as persons at heightened risk for cardiovascular disease because of a range of heritable conditions (eg, familial hypercholesterolemia, familial combined hyperlipidemia), will undoubtedly require binary or ternary regimens involving statins in concert with niacin, fibric-acid derivatives, or bile acid resins. Such approaches enable the clinician to exploit the complementary effects of these agents, allowing them to be administered at low, optimally tolerable doses that are consistent with superior efficacy and a lower risk of adverse events as compared with escalating doses of monotherapy.
为了照料美国人口中不断扩大的具有多种冠心病危险因素的群体，联合调脂治疗正成为一种必要的治疗方法。美国国家胆固醇教育计划的最新共识指南强调长期的全球冠心病（CHD）风险状况，指定患有冠心病风险等同症（如糖尿病、外周动脉疾病、10年绝对冠心病风险达20%或更高）的患者接受积极的调脂治疗，并将代谢综合征（如肥胖、胰岛素抵抗、高血压、甘油三酯升高、高密度脂蛋白胆固醇水平低、小而密的低密度脂蛋白颗粒）视为二级干预靶点。随着美国人口老龄化以及糖尿病、代谢综合征和冠心病的高患病率，越来越多的患者将需要一种更平衡的代谢治疗方案，而这只有通过联合调脂方案才能实现。这些患者中的许多人，以及由于一系列遗传性疾病（如家族性高胆固醇血症、家族性混合性高脂血症）而心血管疾病风险增加的人，无疑将需要二元或三元治疗方案，将他汀类药物与烟酸、纤维酸衍生物或胆汁酸树脂联合使用。这种方法使临床医生能够利用这些药物的互补作用，使它们能够以低的、最佳耐受剂量给药，与单药治疗剂量递增相比，这些剂量具有更高的疗效和更低的不良事件风险。
