Schachter Michael
Department of Clinical Pharmacology, Imperial College of Science, Technology and Medicine, St. Mary's Hospital, London, UK.
Cardiovasc Drugs Ther. 2005 Dec;19(6):415-22. doi: 10.1007/s10557-005-5685-0.
Statin-mediated lowering of low-density lipoprotein cholesterol (LDL-C) is regarded as the foundation of lipid-modifying therapy. However, the residual cardiovascular risk for statin-treated patients remains high, indicating the need for therapeutic intervention against other lipid targets as well as non-lipid risk factors. Low levels of high-density lipoprotein cholesterol (HDL-C) are established as a strong independent risk factor for cardiovascular disease. Intervention studies have also demonstrated clinical benefits associated with HDL-C raising. Although lifestyle modification does play an important role in raising HDL-C, most patients with a low HDL-C and at high risk of coronary events also require pharmacological treatment to achieve the target. Of the available treatment options, nicotinic acid is the most potent agent for raising HDL-C (by 26% at clinically recommended doses), while substantially lowering triglycerides and LDL-C. The addition of nicotinic acid to primary statin therapy is a logical approach to dyslipidaemia management, given their complementary mechanism of action, and is supported by recent clinical trials such as the Arterial Biology for the Investigation of the Treatment Effects of Reducing cholesterol (ARBITER) 2 study. Raising HDL-C will increasingly become an important secondary focus of dyslipidaemia management.
他汀类药物介导的低密度脂蛋白胆固醇（LDL-C）降低被视为调脂治疗的基础。然而，接受他汀类药物治疗的患者心血管残余风险仍然很高，这表明需要针对其他脂质靶点以及非脂质风险因素进行治疗干预。高密度脂蛋白胆固醇（HDL-C）水平低已被确认为心血管疾病的一个强大独立危险因素。干预研究也证明了升高HDL-C带来的临床益处。虽然生活方式改变在升高HDL-C方面确实发挥着重要作用，但大多数HDL-C水平低且有高冠状动脉事件风险的患者也需要药物治疗以达到目标。在现有的治疗选择中，烟酸是升高HDL-C最有效的药物（在临床推荐剂量下可升高26%），同时能显著降低甘油三酯和LDL-C。鉴于他汀类药物与烟酸作用机制互补，在初始他汀类药物治疗中添加烟酸是治疗血脂异常的合理方法，并且得到了近期临床试验（如降低胆固醇治疗效果的动脉生物学研究（ARBITER）2试验）的支持。升高HDL-C将日益成为血脂异常管理的一个重要次要关注点。
