[老年患者使用羟甲基戊二酰辅酶A还原酶抑制剂治疗：有必要吗？]

Alexa Ioana Dana, Panaghiu Larisa, Ungureanu G

Facultatea de Medicină, Clinica a IV-a Medicală-Nefrologie, Universitatea de Medicină si Farmacie "Gr. T. Popa", Iaşi.

Rev Med Chir Soc Med Nat Iasi. 2005 Oct-Dec;109(4):721-6.

OBJECTIVE

To study the benefit of the therapy with hydroxymethylglutaryl coenzyme A reductase inhibitors (simvastatin) associated with diet in treating dyslipidemia in elderly patients, considering that they are more exposed to sudden death, myocardial infarction and stroke. Efficient and long-term serum cholesterol concentration lowering has beneficial effects on the risk for coronary heart disease as well as on other major cardiovascular risk factors such as hypertension and diabetes.

METHODS

A retrospective study of 84 patients aged > or = 65 years, admitted in the last 6 months in Medical Clinic IV, was conducted. Admission criteria in the study were: age > or = 65 years old and high serum levels of cholesterol, triglycerides and LDL-C/HDL-C ratio. The patient population was divided into two groups: Group I of 40 patients treated for dyslipidemia only with diet and Group II with 44 patients in which was associated treatment with hydroxymethylglutaryl coenzyme A reductase inhibitors, 10 mg/day. The patients were controlled when admitted in the study and then at 3 and 6 weeks afterwards.

RESULTS

Serum cholesterol and triglycerides concentration lowering was modest in Group I at 3 and 6 weeks, maybe because we registered a progressively lowered compliance of patients to hypocholesterolemic diet. In Group II the results were much better as we obtained significant serum cholesterol and triglycerides levels lowering after 3 weeks of treatment, and in 32 cases (72%) we had a normal lipid profile after 6 weeks of treatment. The other 12 patients (28%) abandoned treatment after 4 weeks of therapy because of financial reasons. There were no side effects during the treatment with hydroxymethylglutaryl coenzyme A reductase inhibitors.

CONCLUSIONS

The therapy with hydroxymethylglutaryl coenzyme A reductase inhibitors associated to hypocholesterolemic diet controlled efficiently dyslipidemia in elderly patients. Diet alone could not control cholesterol and triglycerides levels, mainly because of lack of adherence of the patients to the diet. Based on the fact that dyslipidemia is a major, independent cardiovascular risk factor, we consider that therapy with hydroxymethylglutaryl coenzyme-A-reductase inhibitors is beneficial in elderly patients because of their efficacity, minimal side effects and protection against sudden death, myocardial infarction and stroke.

目的

鉴于老年患者更容易发生猝死、心肌梗死和中风，研究羟甲基戊二酰辅酶A还原酶抑制剂（辛伐他汀）联合饮食疗法治疗老年患者血脂异常的益处。有效且长期降低血清胆固醇浓度对冠心病风险以及其他主要心血管危险因素如高血压和糖尿病具有有益影响。

方法

对最近6个月在第四内科门诊收治的84例年龄≥65岁的患者进行回顾性研究。该研究的纳入标准为：年龄≥65岁且血清胆固醇、甘油三酯水平及低密度脂蛋白胆固醇/高密度脂蛋白胆固醇比值较高。患者人群分为两组：40例仅接受饮食治疗血脂异常的患者为第一组，44例接受羟甲基戊二酰辅酶A还原酶抑制剂10毫克/天联合治疗的患者为第二组。患者在纳入研究时以及之后3周和6周时接受检查。

结果

第一组在3周和6周时血清胆固醇和甘油三酯浓度降低幅度较小，可能是因为我们发现患者对降胆固醇饮食的依从性逐渐降低。第二组的结果要好得多，因为治疗3周后血清胆固醇和甘油三酯水平显著降低，6周治疗后32例（72%）患者血脂谱正常。另外12例患者（28%）在治疗4周后因经济原因放弃治疗。使用羟甲基戊二酰辅酶A还原酶抑制剂治疗期间未出现副作用。

结论

羟甲基戊二酰辅酶A还原酶抑制剂联合降胆固醇饮食疗法能有效控制老年患者的血脂异常。仅靠饮食无法控制胆固醇和甘油三酯水平，主要是因为患者对饮食的依从性差。鉴于血脂异常是主要的独立心血管危险因素，我们认为羟甲基戊二酰辅酶A还原酶抑制剂疗法对老年患者有益，因其疗效显著、副作用极小且可预防猝死、心肌梗死和中风。