Westerweel P E, Verhaar M C, Rabelink T J
Universitaire Medisch Centrum Utrecht, divisie Inwendige Geneeskunde en Dermatologie, afd. Vasculaire Geneeskunde, Utrecht.
Ned Tijdschr Geneeskd. 2004 Jul 17;148(29):1431-5.
Statins safely and effectively reduce the morbidity and mortality due to cardiovascular disease. In the trials conducted so far, which have been carried out predominantly on high-risk patients, the observed risk reduction is probably completely attributable to the reduction of the cholesterol level. However, statins also influence the atherosclerotic disease process in a lipid-independent way. This includes beneficial effects on the early pathogenetic components of atherosclerosis, such as endothelial dysfunction and inflammation. These effects are probably not visible in the large clinical trials that usually follow up cohorts of patients with late stages of atherosclerosis during a relatively short period of time. These cholesterol-independent effects do affect intermediate factors in the atherosclerotic process, such as endothelial dysfunction. In clinical practice, where not only short-term effects in patients with manifest vascular disease but also the prevention of the long-term complications of atherosclerosis in high-risk patients is an important goal, these so-called pleiotropic effects may contribute to risk reduction.
他汀类药物能安全有效地降低心血管疾病所致的发病率和死亡率。在迄今为止开展的试验中，主要针对高危患者进行，观察到的风险降低可能完全归因于胆固醇水平的降低。然而，他汀类药物也以不依赖脂质的方式影响动脉粥样硬化疾病进程。这包括对动脉粥样硬化早期发病机制成分的有益作用，如内皮功能障碍和炎症。这些作用在通常在相对较短时间内对动脉粥样硬化晚期患者队列进行随访的大型临床试验中可能并不明显。这些不依赖胆固醇的作用确实会影响动脉粥样硬化过程中的中间因素，如内皮功能障碍。在临床实践中，不仅对已患血管疾病患者的短期疗效很重要，而且预防高危患者动脉粥样硬化的长期并发症也是一个重要目标，这些所谓的多效性作用可能有助于降低风险。
