Shirai Kohji
Center for Diabetes, Endocrinology and Metabolism, Sakura Hospital, Toho University, Shimoshizu, Japan.
Curr Med Res Opin. 2004 Mar;20(3):295-304. doi: 10.1185/030079903125003008.
The global burden of coronary heart disease (CHD) has led to the introduction of international guidelines to minimize the morbidity and mortality that result from this condition. These guidelines recognize the contribution of multiple risk factors to the development of CHD and advocate a multifaceted approach to treatment. Obesity, particularly visceral adiposity, contributes to the clustering of many other risk factors, such as hypertension, insulin resistance/type 2 diabetes and dyslipidemia, within individual patients. The molecular mechanisms underlying the metabolic abnormalities induced by visceral adiposity have yet to be fully elucidated; however, adipocytokines such as adiponectin, tumor necrosis factor-alpha and resistin seem to play an important role in this process. Obesity is a major modifiable CHD risk factor, and the benefits of weight loss are numerous, leading to improvements in several co-morbidities. Guidelines advocate lifestyle changes to correct excess bodyweight and improve the CHD risk factor profile. In addition, pharmacologic therapy is recommended for the management of other risk factors, such as hypertension and dyslipidemia, which may not be adequately controlled by lifestyle changes alone. Lowering low-density lipoprotein cholesterol (LDL-C) levels is the primary target for drug therapy for CHD prevention, and statins are first-line lipid-modifying therapy. The introduction of more efficacious statins with favorable effects on the lipid profile will optimize the control of dyslipidemia. Combining these new treatments with lifestyle changes and drug therapies for managing other CHD risk factors, as part of a multifaceted approach to treatment, will have benefits for CHD prevention.
冠心病（CHD）的全球负担促使国际指南出台，以尽量降低这种疾病导致的发病率和死亡率。这些指南认识到多种风险因素对冠心病发展的作用，并提倡采用多方面的治疗方法。肥胖，尤其是内脏型肥胖，会促使许多其他风险因素在个体患者中聚集，如高血压、胰岛素抵抗/2型糖尿病和血脂异常。内脏型肥胖引起代谢异常的分子机制尚未完全阐明；然而，脂联素、肿瘤坏死因子-α和抵抗素等脂肪细胞因子似乎在这一过程中发挥重要作用。肥胖是一个主要的可改变的冠心病风险因素，减肥的益处众多，可改善多种合并症。指南提倡改变生活方式以纠正超重并改善冠心病风险因素状况。此外，对于其他风险因素，如高血压和血脂异常，若仅通过改变生活方式可能无法充分控制，则建议进行药物治疗。降低低密度脂蛋白胆固醇（LDL-C）水平是冠心病预防药物治疗的主要目标，他汀类药物是一线调脂治疗药物。引入对血脂状况有良好效果的更有效他汀类药物将优化血脂异常的控制。将这些新治疗方法与改变生活方式以及用于管理其他冠心病风险因素的药物治疗相结合，作为多方面治疗方法的一部分，将对冠心病预防有益。
