Stein James H, Merwood Michelle A, Bellehumeur Jennifer L, Aeschlimann Susan E, Korcarz Claudia E, Underbakke Gail L, Mays Maureen E, Sosman James M
University of Wisconsin Atherosclerosis Imaging Research Program, University of Wisconsin Medical School, Madison 53792, USA.
Am Heart J. 2004 Apr;147(4):E18. doi: 10.1016/j.ahj.2003.10.018.
Although recommended as initial therapy for patients with dyslipidemia who are taking human immunodeficiency virus protease inhibitors (HIV PIs), the effects of pravastatin on lipoproteins and arterial reactivity have not been elucidated. The purpose of this study was to determine the effects of pravastatin on lipoprotein subfractions and endothelial function in patients with dyslipidemia who are receiving HIV PIs.
This was a placebo-controlled, double-blind, crossover study comparing pravastatin (40 mg) to placebo in 20 patients who were taking HIV PIs. Lipoprotein subfractions were measured with nuclear magnetic resonance spectroscopic analysis. Flow-mediated vasodilation (FMD) of the brachial artery was evaluated with high-resolution ultrasound scanning.
At baseline, subjects had an increased concentration of low-density lipoprotein (LDL) particles (1756 +/- 180 nmol/L), which tended to be small (19.9 +/- 0.2 nm), a low concentration of large high-density lipoproteins (HDL; 0.94 +/- 0.07 mmol/L), and an increased concentration of large very low-density lipoproteins (VLDL; 1.90 +/- 0.58 mmol/L). FMD was impaired (4.5% +/- 1.1%). Compared with placebo, pravastatin resulted in a 20.8% reduction in LDL particles (P =.030), a 26.7% reduction in small LDL (P =.100), and a 44.9% reduction in small VLDL (P =.023). Total and non-HDL cholesterol levels decreased by 18.3% (P <.001) and 21.7% (P <.001), respectively. FMD tended to increase in patients receiving pravastatin (0.7% +/- 0.6%); however, the difference between treatment phases was not statistically significant (P =.080).
This is the first double-blind, placebo-controlled study of the effects of statin therapy on lipids, lipoprotein subfractions, and endothelial function in patients taking HIV PIs. Pravastatin reduced concentrations of atherogenic lipoproteins, particularly those most associated with future coronary events.
尽管普伐他汀被推荐作为正在服用人类免疫缺陷病毒蛋白酶抑制剂（HIV PIs）的血脂异常患者的初始治疗药物，但其对脂蛋白和动脉反应性的影响尚未阐明。本研究的目的是确定普伐他汀对正在接受HIV PIs治疗的血脂异常患者的脂蛋白亚组分和内皮功能的影响。
这是一项安慰剂对照、双盲、交叉研究，在20名正在服用HIV PIs的患者中比较普伐他汀（40毫克）和安慰剂。用核磁共振光谱分析测量脂蛋白亚组分。用高分辨率超声扫描评估肱动脉的血流介导的血管舒张（FMD）。
基线时，受试者的低密度脂蛋白（LDL）颗粒浓度升高（1756±180纳摩尔/升），这些颗粒往往较小（19.9±0.2纳米），大高密度脂蛋白（HDL）浓度低（0.94±0.07毫摩尔/升），大极低密度脂蛋白（VLDL）浓度升高（1.90±0.58毫摩尔/升）。FMD受损（4.5%±1.1%）。与安慰剂相比，普伐他汀使LDL颗粒减少20.8%（P = 0.030），小LDL减少26.7%（P = 0.100），小VLDL减少44.9%（P = 0.023）。总胆固醇和非HDL胆固醇水平分别下降了18.3%（P < 0.001）和21.7%（P < 0.001）。接受普伐他汀治疗的患者FMD有增加的趋势（0.7%±0.6%）；然而，治疗阶段之间的差异无统计学意义（P = 0.080）。
这是第一项关于他汀类药物治疗对正在服用HIV PIs的患者的血脂、脂蛋白亚组分和内皮功能影响的双盲、安慰剂对照研究。普伐他汀降低了致动脉粥样硬化脂蛋白的浓度，特别是那些与未来冠状动脉事件最相关的脂蛋白。
