Rosenberg M, Haass M
Medizinische Universitätsklinik Heidelberg.
Internist (Berl). 2005 May;46 Suppl 1:S11-7. doi: 10.1007/s00108-005-1409-6.
Alterations in lipid metabolism play a major role in the pathogenesis of atherosclerosis and are an important risk factor for cardiovascular events. Lowering of LDL cholesterol by statins reduces morbidity and mortality in patients with coronary artery disease (CAD), both in primary and secondary prevention. The results of large controlled trials that included more than 50,000 patients are the basis for target values promoted by current guidelines. According to the NCEP-ATP III guidelines LDL cholesterol should be lowered to less than 100 mg/dl in high risk patients (CAD or CAD equivalent) and in very high risk patients optional to less than 70 mg/dl. Up to now even in high risk patients the recommended goals are not sufficiently achieved: Up to 80% of high risk patients do not receive a statin and only a minority of those being treated with a statin have a LDL cholesterol below 100 mg/dl. Furthermore, after a major event (e.g. myocardial infarction) the quality of lipid reduction decreases over time. Further efforts are required to improve this situation as a guide-line oriented approach may help to prevent up to 100,000 myocardial infarctions and deaths alone in high risk patients in Germany.
脂质代谢改变在动脉粥样硬化发病机制中起主要作用，并且是心血管事件的重要危险因素。他汀类药物降低低密度脂蛋白胆固醇（LDL-C）可降低冠心病（CAD）患者的发病率和死亡率，无论是在一级预防还是二级预防中。纳入超过50,000例患者的大型对照试验结果是当前指南所推荐目标值的依据。根据美国国家胆固醇教育计划成人治疗组第三次报告（NCEP-ATP III）指南，高危患者（CAD或CAD等危症）的LDL-C应降至100mg/dl以下，极高危患者可选择降至70mg/dl以下。到目前为止，即使在高危患者中，推荐目标也未充分实现：高达80%的高危患者未接受他汀类药物治疗，并且接受他汀类药物治疗的患者中只有少数LDL-C低于100mg/dl。此外，在发生重大事件（如心肌梗死）后，脂质降低的质量会随时间下降。需要进一步努力改善这种情况，因为仅在德国，以指南为导向的方法可能有助于预防高危患者中多达100,000例心肌梗死和死亡。
