Cheung Raphael C, Morrell Jonathan M, Kallend David, Watkins Claire, Schuster Herbert
Southwestern Ontario Medical Education Network Windsor, Schulich School of Medicine, University of Western Ontario, Canada.
Int J Cardiol. 2005 Apr 20;100(2):309-16. doi: 10.1016/j.ijcard.2004.12.011.
Lipid ratios are clinically useful markers of coronary artery disease (CAD) risk. The effects of rosuvastatin, atorvastatin, simvastatin, and pravastatin on lipid ratios were investigated in the Measuring Effective Reductions in Cholesterol Using Rosuvastatin TherapY (MERCURY) I trial.
This trial was conducted in 3140 hypercholesterolemic patients with CAD, atherosclerosis, type 2 diabetes mellitus, or a 20% 10-year risk for CAD. Patients were randomized to rosuvastatin 10 mg, atorvastatin 10 or 20 mg, simvastatin 20 mg, or pravastatin 40 mg for 8 weeks; all patients except those receiving rosuvastatin 10 mg either were switched to rosuvastatin 10 or 20 mg or remained on initial treatment for 8 more weeks.
At 8 weeks, reductions in total cholesterol (TC):high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol:HDL-C, non-HDL-C:HDL-C, and apolipoprotein (apo) B:apo A-I ratios with rosuvastatin 10 mg were significantly greater than those with atorvastatin 10 mg, atorvastatin 20 mg, simvastatin 20 mg, and pravastatin 40 mg (P<0.0001 for all). At week 16, switching to rosuvastatin 10 mg from atorvastatin 10 mg, simvastatin 20 mg, and pravastatin 40 mg and to rosuvastatin 20 mg from atorvastatin 20 mg produced significantly greater reductions in all lipid ratios (P< or =0.0001 for all). Switching to rosuvastatin 10 mg from atorvastatin 20 mg produced significantly greater reductions in TC:HDL-C (P<0.025) and apo B:apo A-I (P<0.01).
Rosuvastatin 10 mg reduces lipid ratios more than equivalent and higher doses of other statins; switching to equal or lower doses of rosuvastatin produces significantly improved reductions in lipid ratios.
脂质比率是冠状动脉疾病（CAD）风险的临床有用标志物。在使用瑞舒伐他汀治疗评估胆固醇有效降低（MERCURY）I试验中，研究了瑞舒伐他汀、阿托伐他汀、辛伐他汀和普伐他汀对脂质比率的影响。
该试验在3140例患有CAD、动脉粥样硬化、2型糖尿病或有20%的10年CAD风险的高胆固醇血症患者中进行。患者被随机分为接受10mg瑞舒伐他汀、10或20mg阿托伐他汀、20mg辛伐他汀或40mg普伐他汀治疗8周；除接受10mg瑞舒伐他汀的患者外，所有患者要么换用10或20mg瑞舒伐他汀，要么继续初始治疗8周。
8周时，10mg瑞舒伐他汀降低总胆固醇（TC）：高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇：HDL-C、非HDL-C：HDL-C和载脂蛋白（apo）B：apo A-I比率的幅度显著大于10mg阿托伐他汀、20mg阿托伐他汀、20mg辛伐他汀和40mg普伐他汀（所有P<0.0001）。在第16周时，从10mg阿托伐他汀、20mg辛伐他汀和40mg普伐他汀换用10mg瑞舒伐他汀以及从20mg阿托伐他汀换用20mg瑞舒伐他汀，所有脂质比率的降低幅度均显著更大（所有P≤0.0001）。从20mg阿托伐他汀换用10mg瑞舒伐他汀使TC：HDL-C（P<0.025）和apo B：apo A-I（P<0.01）的降低幅度显著更大。
10mg瑞舒伐他汀降低脂质比率的效果优于同等剂量及更高剂量的其他他汀类药物；换用同等或更低剂量的瑞舒伐他汀可显著改善脂质比率的降低效果。
