Endres Matthias
Klinik und Poliklinik für Neurologie, Charité-Universitätsmedizin Berlin, Campus Mitte, Schumannstrasse 20/21, D-10117 Berlin, Germany.
Atheroscler Suppl. 2006 Apr;7(1):31-5. doi: 10.1016/j.atherosclerosissup.2006.01.005. Epub 2006 Feb 28.
Hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are potent cholesterol-lowering drugs. In addition to their cholesterol-lowering properties, statins exert a number of so-called 'pleiotropic', vasculoprotective actions that include improvement of endothelial function, increased nitric oxide (NO) bioavailability, antioxidant properties, stabilisation of atherosclerotic plaques, regulation of progenitor cells, inhibition of inflammatory responses and immunomodulatory actions. Pleiotropic actions of statins may have potential clinical impact in vascular disease beyond cholesterol lowering. The ongoing Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), for example, tests the effects of statins in the primary prevention of cardiovascular disease among patients with low levels of low-density lipoprotein cholesterol (LDL-C) and elevated high-sensitivity C-reactive protein (hs-CRP). Additionally, previous studies have shown that although cholesterol is not an established stroke risk factor, statin therapy is associated with a reduction in the incidence of strokes. It is known that sudden withdrawal of statin treatment may acutely impair vascular function and increase morbidity and mortality in patients with vascular disease. Furthermore, the anti-inflammatory effects of statins may have clinical impact in a number of non-vascular conditions including multiple sclerosis and rheumatoid arthritis.
羟甲基戊二酰辅酶A（HMG-CoA）还原酶抑制剂（他汀类药物）是强效的降胆固醇药物。除了具有降胆固醇特性外，他汀类药物还发挥许多所谓的“多效性”血管保护作用，包括改善内皮功能、增加一氧化氮（NO）生物利用度、抗氧化特性、稳定动脉粥样硬化斑块、调节祖细胞、抑制炎症反应和免疫调节作用。他汀类药物的多效性作用可能在降低胆固醇之外，对血管疾病产生潜在的临床影响。例如，正在进行的“他汀类药物在一级预防中的应用理由：评估瑞舒伐他汀的干预试验（JUPITER）”，测试了他汀类药物在低密度脂蛋白胆固醇（LDL-C）水平低且高敏C反应蛋白（hs-CRP）升高的患者中对心血管疾病一级预防的效果。此外，先前的研究表明，尽管胆固醇并非公认的中风危险因素，但他汀类药物治疗与中风发病率降低有关。已知突然停用他汀类药物治疗可能会急性损害血管功能，并增加血管疾病患者的发病率和死亡率。此外，他汀类药物的抗炎作用可能在包括多发性硬化症和类风湿关节炎在内的许多非血管疾病中产生临床影响。
