Wierzbicki Anthony S
Department of Chemical Pathology, St. Thomas' Hospital, London, UK.
Curr Med Res Opin. 2005 Feb;21(2):299-306. doi: 10.1185/030079905X26216.
The critical importance of high-density lipoprotein cholesterol (HDL-C) as an independent and predictive factor for coronary heart disease (CHD) has been increasingly recognised in treatment guidelines for prevention and treatment of cardiovascular disease. The association of low HDL-C with an increased incidence of CHD implies a critical role for raising HDL-C in protection against atherosclerotic disease. HDL-C appears to exert this effect via a number of mechanisms. HDL-C is involved in reverse cholesterol transport, prevents endothelial dysfunction and has anti-inflammatory, anti-oxidant and antithrombotic properties. Therapeutic interventions that increase HDL-C include statins, fibrates and nicotinic acid. Of these, nicotinic acid raises HDL-C more effectively than either statin or fibrate therapy and has been proven to reduce cardiovascular events in monotherapy studies. Preliminary clinical studies have shown that addition of nicotinic acid to primary statin therapy is safe, has proven beneficial effects on atherosclerosis and may also reduce the incidence of major coronary events. The available clinical evidence suggests that addition of nicotinic acid to primary lipid-lowering therapy has an important atheroprotective role in patients with or at risk of developing CHD.
在心血管疾病防治指南中，高密度脂蛋白胆固醇（HDL-C）作为冠心病（CHD）的独立预测因子的至关重要性已得到越来越多的认可。HDL-C水平低与冠心病发病率增加之间的关联意味着提高HDL-C在预防动脉粥样硬化疾病中起着关键作用。HDL-C似乎通过多种机制发挥这种作用。HDL-C参与逆向胆固醇转运，预防内皮功能障碍，并具有抗炎、抗氧化和抗血栓形成特性。增加HDL-C的治疗干预措施包括他汀类药物、贝特类药物和烟酸。其中，烟酸比他汀类药物或贝特类药物治疗更有效地提高HDL-C，并且在单药治疗研究中已被证明可减少心血管事件。初步临床研究表明，在他汀类药物初始治疗中添加烟酸是安全的，已证明对动脉粥样硬化有益，还可能降低主要冠状动脉事件的发生率。现有临床证据表明，在初始降脂治疗中添加烟酸对患有冠心病或有患冠心病风险的患者具有重要的抗动脉粥样硬化作用。
