Xydakis Antonios M, Ballantyne Christie M
Division of Endocrinology and Metabolism, Baylor College of Medicine, Houston, Texas 77030, USA.
Am J Cardiol. 2002 Nov 20;90(10B):21K-29K. doi: 10.1016/s0002-9149(02)02968-5.
Patients with combined dyslipidemia are at high risk for coronary artery disease and often require combination drug therapy to achieve lipid levels recommended by the US National Cholesterol Education Program's third Adult Treatment Panel (ATP III). In addition to recommendations for low-density lipoprotein (LDL) cholesterol and triglyceride levels, ATP III established non-high-density lipoprotein (HDL) cholesterol goals for individuals with triglycerides >or=2.26 mmol/L (>or=200 mg/dL). It also introduced certain criteria for the diagnosis of the metabolic syndrome, a clustering of risk factors (abdominal obesity, elevated triglycerides, low HDL cholesterol, elevated blood pressure, impaired fasting glucose) that increases cardiovascular risk and is common in patients with combined dyslipidemia. Statin monotherapy has been shown to benefit these patients, and additional benefit may be obtained by combination therapy that provides greater reductions in both LDL cholesterol and triglycerides as well as greater increases in HDL cholesterol. However, combining a statin with either niacin or a fibrate may increase the risk for myopathy and therefore requires careful monitoring and evaluation of the risk-benefit ratio for each patient. Moreover, combination therapy may be associated with increased drug costs and decreased patient compliance. Recently developed agents that may improve the effectiveness of combination therapy include ezetimibe-a cholesterol absorption inhibitor-and a formulation that combines extended-release niacin and lovastatin in a single pill. Clinical trials are needed to determine the optimal treatment in patients with combined dyslipidemia.
合并血脂异常的患者患冠状动脉疾病的风险很高，通常需要联合药物治疗以达到美国国家胆固醇教育计划第三次成人治疗专家组（ATP III）推荐的血脂水平。除了对低密度脂蛋白（LDL）胆固醇和甘油三酯水平的建议外，ATP III还为甘油三酯≥2.26 mmol/L（≥200 mg/dL）的个体设定了非高密度脂蛋白（HDL）胆固醇目标。它还引入了代谢综合征的某些诊断标准，代谢综合征是一组危险因素（腹部肥胖、甘油三酯升高、HDL胆固醇降低、血压升高、空腹血糖受损）的聚集，会增加心血管风险，在合并血脂异常的患者中很常见。他汀类药物单药治疗已被证明对这些患者有益，联合治疗可能会带来额外益处，联合治疗能更大程度地降低LDL胆固醇和甘油三酯水平，同时更大程度地提高HDL胆固醇水平。然而，将他汀类药物与烟酸或贝特类药物联合使用可能会增加肌病风险，因此需要对每位患者的风险效益比进行仔细监测和评估。此外，联合治疗可能会增加药物成本并降低患者依从性。最近开发的可能提高联合治疗效果的药物包括依泽替米贝（一种胆固醇吸收抑制剂）以及一种将缓释烟酸和洛伐他汀组合在一粒药丸中的制剂。需要进行临床试验以确定合并血脂异常患者的最佳治疗方法。
