Gylling H
Department of Clinical Nutrition, University of Kuopio, and Kuopio University Hospital, Kuopio, Finland.
Int J Clin Pract. 2004 Sep;58(9):859-66. doi: 10.1111/j.1742-1241.2004.00351.x.
Cardiovascular diseases are the principal causes of mortality in middle-aged people and in older people. Coronary heart disease (CHD) is the most common of the cardiovascular diseases; high serum levels of cholesterol are associated with atherosclerosis and an increased risk of CHD. Cholesterol homeostasis is achieved by means of a fine balance between cholesterol intake, absorption/excretion and synthesis. All of these processes are tightly linked and a change in one of them can significantly influence the others. Results from both experimental studies and clinical trials have shown that inhibition of cholesterol synthesis with a statin increases absorption and that conversely, inhibition of cholesterol absorption increases synthesis. The tight linkage of cholesterol absorption and synthesis in maintaining cholesterol homeostasis suggests that treatment with an agent that influences only one of these two processes is likely to have distinct limits with respect to its effects on cholesterol levels. Better understanding of cholesterol homeostasis, particularly the close interrelationship between cholesterol synthesis and absorption, may result in the design of rational integrated treatment regimens that employ multiple agents with complementary actions that attack multiple mechanisms to lower cholesterol.
心血管疾病是中老年人死亡的主要原因。冠心病（CHD）是最常见的心血管疾病；血清胆固醇水平升高与动脉粥样硬化及冠心病风险增加相关。胆固醇稳态通过胆固醇摄入、吸收/排泄与合成之间的精细平衡来实现。所有这些过程紧密相连，其中一个过程发生变化会显著影响其他过程。实验研究和临床试验结果均表明，使用他汀类药物抑制胆固醇合成会增加吸收，反之，抑制胆固醇吸收会增加合成。胆固醇吸收与合成在维持胆固醇稳态方面的紧密联系表明，仅影响这两个过程之一的药物治疗在降低胆固醇水平方面可能有明显局限性。更好地理解胆固醇稳态，尤其是胆固醇合成与吸收之间的密切相互关系，可能会促成合理的综合治疗方案设计，该方案采用具有互补作用的多种药物，通过多种机制来降低胆固醇。
