Gupta Sandeep
Department of Cardiology, Whipps Cross and St Bartholomew's Hospitals, Whipps Cross Road, Leytonstone, London E11 1NR, UK.
Int J Cardiol. 2004 Aug;96(2):131-9. doi: 10.1016/j.ijcard.2003.10.013.
There is currently intense research interest in the properties of HMG-CoA reductase inhibitors (statins) beyond their well-documented lipid-lowering action. Studies have consistently demonstrated that administration of statin therapy decreases levels of the inflammatory marker C-reactive protein (CRP), a marker associated with an increased risk of cardiovascular events. This effect appears to be independent of the extent of reduction in total or LDL-cholesterol. Statins also appear to improve endothelial dysfunction by increasing endothelium-dependent vasodilatation. There is also evidence that statins inhibit fibrin formation and thrombus development, an effect that which would be clinically beneficial following plaque fissure or rupture. Early preclinical and clinical evidence suggests that there are quantitative differences between statin regimens in terms of their cholesterol-independent properties. Trials comparing equipotent doses of different statins, based on lipid-lowering efficacy, have not reported any differences in cholesterol-independent properties. However, the current evidence base indicates that more aggressive statin regimens are associated with an enhanced anti-inflammatory effect. Intensive lipid-lowering using statin therapy generates a greater reduction in mortality than standard lipid management, and it is possible that enhanced cholesterol-independent effects may account for some of this excess benefit.
目前,除了已被充分证明的降血脂作用外,HMG - CoA还原酶抑制剂(他汀类药物)的特性也引发了强烈的研究兴趣。研究一直表明,使用他汀类药物治疗可降低炎症标志物C反应蛋白(CRP)的水平,CRP是一种与心血管事件风险增加相关的标志物。这种作用似乎与总胆固醇或低密度脂蛋白胆固醇降低的程度无关。他汀类药物还似乎通过增加内皮依赖性血管舒张来改善内皮功能障碍。也有证据表明他汀类药物可抑制纤维蛋白形成和血栓发展,在斑块破裂或撕裂后,这一作用在临床上是有益的。早期临床前和临床证据表明,不同他汀类药物治疗方案在非胆固醇相关特性方面存在数量差异。基于降脂疗效比较不同他汀类药物等效剂量的试验,尚未报告非胆固醇相关特性存在任何差异。然而,目前的证据基础表明,更积极的他汀类药物治疗方案与更强的抗炎作用相关。使用他汀类药物进行强化降脂治疗比标准降脂管理能更大程度地降低死亡率,增强的非胆固醇相关作用可能是这种额外益处的部分原因。