Streja Dan
Sections of Endocrinology and Cardiology, VA Medical Center of West Los Angeles, Los Angeles, CA 90073, USA.
Curr Opin Investig Drugs. 2004 Mar;5(3):306-12.
Statins have been proven to reduce cardiovascular risk, and guidelines for cardiovascular prevention recommend statin therapy in a wide range of patients. However, in spite of the dramatic success in large randomized clinical trials, two thirds of patients administered statins are not protected against cardiovascular events. This has prompted a search for additional targets for therapy. The pandemic of metabolic syndrome and type 2 diabetes has led to a dramatic increase in the prevalence of dyslipidemia. This, in turn, has prompted a resurgence of the search for drugs and algorithms that favorably affect high-density lipoprotein (HDL) and very low-density lipoprotein (VLDL) metabolism and function. Fibrates are the best-studied class of agents to be used as an addition to statins since they have also been proven to reduce clinical events as a monotherapy. However, there is a need for large safety trials of statin-fibrate combination therapy. Statin-niacin combination therapy has proven to be safe and effective in altering lipoprotein pattern. Randomized clinical trials and more research on the mechanism of action of niacin are necessary. Inhibitors of cholesterol ester transfer protein and HDL therapy drugs are in early developmental stages, and are the most promising potential additions to the current arsenal.
他汀类药物已被证明可降低心血管疾病风险，心血管预防指南建议在广泛的患者群体中使用他汀类药物治疗。然而，尽管在大型随机临床试验中取得了巨大成功，但接受他汀类药物治疗的患者中有三分之二并未得到心血管事件的预防。这促使人们寻找其他治疗靶点。代谢综合征和2型糖尿病的流行导致血脂异常患病率急剧上升。这反过来又促使人们重新寻找对高密度脂蛋白（HDL）和极低密度脂蛋白（VLDL）代谢及功能有积极影响的药物和算法。贝特类药物是作为他汀类药物辅助使用的研究最为充分的一类药物，因为它们作为单一疗法也已被证明可减少临床事件。然而，需要对他汀类药物与贝特类药物联合治疗进行大规模安全性试验。他汀类药物与烟酸联合治疗已被证明在改变脂蛋白模式方面是安全有效的。需要进行随机临床试验并对烟酸的作用机制进行更多研究。胆固醇酯转移蛋白抑制剂和HDL治疗药物正处于早期研发阶段，是目前治疗手段中最有前景的潜在补充药物。
