Chrysant Steven G, Ibrahim Mohammed
Oklahoma Cardiovascular and Hypertension Center and University of Oklahoma School of Medicine, Oklahoma City, 73132-4904, USA.
J Clin Hypertens (Greenwich). 2006 Jul;8(7):493-9; quiz 500-1. doi: 10.1111/j.1524-6175.2006.05505.x.
Statins are effective drugs for lowering low-density lipoprotein cholesterol, and their use has been associated with a significant decrease in cardiovascular morbidity and mortality. However, statins are ineffective in lowering plasma triglycerides and lipoprotein(a), or increasing low high-density lipoprotein cholesterol (HDL-C) plasma levels, which are independent risk factors for coronary heart disease. Niacin, on the other hand, is the most potent drug available for lowering plasma levels of triglycerides and lipoprotein(a) and raising HDL-C levels. It follows, then, that a combination of niacin with a statin might be an effective combination in improving all components of the lipid profile. Previous studies have shown that the use of long-acting niacin with a statin, in dose combinations of niacin-ER/lovastatin 1,000/20 mg or 2,000/40 mg once daily, has been effective in favorably modifying low-density lipoprotein cholesterol, triglycerides, lipoprotein(a), and HDL-C plasma levels. Dyslipidemias often predate the onset of hypertension, and HDL-C has been found to be inversely related to the incidence of hypertension. Normalization of lipid components, including the total cholesterol/HDL-C ratio, is important in the management of hypertensive individuals and patients with the metabolic syndrome or diabetes. Thus, the long-term treatment of dyslipidemias with these two agents may help to modify risk and reduce cardiovascular morbidity and mortality in these patients over and above benefits achieved by lowering blood pressure.
他汀类药物是降低低密度脂蛋白胆固醇的有效药物，其使用与心血管疾病发病率和死亡率的显著降低相关。然而，他汀类药物在降低血浆甘油三酯和脂蛋白(a)或提高血浆高密度脂蛋白胆固醇(HDL-C)水平方面无效，而这些都是冠心病的独立危险因素。另一方面，烟酸是可用于降低血浆甘油三酯和脂蛋白(a)水平以及提高HDL-C水平的最有效药物。因此，烟酸与他汀类药物联合使用可能是改善血脂谱所有成分的有效组合。先前的研究表明，将长效烟酸与他汀类药物联合使用，采用烟酸缓释剂/洛伐他汀1000/20毫克或2000/40毫克的剂量组合，每日一次，已被证明能有效改善低密度脂蛋白胆固醇、甘油三酯、脂蛋白(a)和HDL-C的血浆水平。血脂异常往往早于高血压的发生，并且已发现HDL-C与高血压发病率呈负相关。包括总胆固醇/HDL-C比值在内的血脂成分正常化，对于高血压患者以及代谢综合征或糖尿病患者的管理非常重要。因此，用这两种药物长期治疗血脂异常可能有助于改变风险，并降低这些患者的心血管疾病发病率和死亡率，其益处超过了通过降低血压所获得的益处。
