Sposito Andrei C, Chapman M John
Dyslipoproteinemia and Atherosclerosis Research Unit, National Institute for Health and Medical Research U551, Hôpital de la Pitié-Salpetriere, Paris, France.
Arterioscler Thromb Vasc Biol. 2002 Oct 1;22(10):1524-34. doi: 10.1161/01.atv.0000032033.39301.6a.
Randomized trials have established that statin treatment reduces coronary events in primary prevention and in patients with stable coronary artery disease. In unstable coronary artery disease, however, the pathophysiological background is distinct, and the potential benefits of statin therapy have not been evaluated until recently. Data from animal models and clinical studies indicate that statin treatment can influence a spectrum of molecular and cellular mechanisms that are intimately related to the pathogenesis of acute coronary syndromes; these include the reduction of circulating levels of atherogenic lipoproteins (very low density lipoprotein, very low density lipoprotein remnants, intermediate density lipoprotein, and low density lipoprotein) and thus of arterial lipid deposition and the attenuation of inflammation, modulation of thrombogenesis and thrombolysis, improvement of endothelial dysfunction, and reduction of ischemia/reperfusion injury. Indeed, findings from prospective and observational studies have demonstrated that statin treatment significantly improves clinical outcome after acute coronary syndromes. Therefore, early initiation of statin therapy after an acute coronary event not only enhances adherence to treatment but also preempts the occurrence of new events. In this review, we discuss recent important developments in our knowledge of the clinical evidence of the beneficial effects of early statin therapy in acute coronary syndromes and the biological mechanisms that underlie them.
随机试验已证实，他汀类药物治疗可降低一级预防以及稳定型冠状动脉疾病患者的冠状动脉事件发生率。然而，在不稳定型冠状动脉疾病中，病理生理背景有所不同，直到最近他汀类药物治疗的潜在益处才得到评估。来自动物模型和临床研究的数据表明，他汀类药物治疗可影响一系列与急性冠状动脉综合征发病机制密切相关的分子和细胞机制；这些机制包括降低致动脉粥样硬化脂蛋白（极低密度脂蛋白、极低密度脂蛋白残粒、中间密度脂蛋白和低密度脂蛋白）的循环水平，从而减少动脉脂质沉积，减轻炎症反应，调节血栓形成和溶栓过程，改善内皮功能障碍，以及减少缺血/再灌注损伤。事实上，前瞻性和观察性研究的结果表明，他汀类药物治疗可显著改善急性冠状动脉综合征后的临床结局。因此，急性冠状动脉事件后早期开始他汀类药物治疗不仅能提高治疗依从性，还能预防新事件的发生。在本综述中，我们讨论了近期关于早期他汀类药物治疗在急性冠状动脉综合征中有益作用的临床证据以及其潜在生物学机制的重要进展。
