Brown B Greg, Stukovsky Karen Hinckley, Zhao Xue-Qiao
Cardiology Division, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Curr Opin Lipidol. 2006 Dec;17(6):631-6. doi: 10.1097/MOL.0b013e32800ff750.
Our analysis presents an alternative hypothesis to the prevailing view that low-density lipoprotein-C is the only important target of lipid therapy.
Two recently published studies showed surprising results. In the Armed Forces Regression Study, low-density lipoprotein-C was lowered only 22% with cholystyramine, niacin and gemfibrozil. Coronary stenosis regressed, however, and the primary clinical event rate was reduced by 54%. Conversely, in the FIELD trial, the primary event rate reduction was only 11% (P = NS). These differences appeared to be explained largely by the difference in high-density lipoprotein response to these regimens (38 vs. 3%). This meta-analysis of 23 trials strongly supports the notion that the sum of percent reduction in low-density lipoprotein-C plus percent increase in high-density lipoprotein-C predicts benefits much more effectively than either lipoprotein component.
Epidemiology suggests that the cardiovascular event rate is reduced by nearly 1% for each 1% reduction in low-density lipoprotein-C and by at least 1% for each 1% increase in high-density lipoprotein. These effects are statistically independent; thus, for moderate lipid changes, they are additive. If this simple algorithm is proven accurate, a 30% high-density lipoprotein-C increase and a 40% low-density lipoprotein-C reduction would result in a nearly 70% CHD risk reduction - and a revolution in cardiovascular prevention.
我们的分析提出了一种替代假说，以挑战低密度脂蛋白胆固醇是脂质治疗唯一重要靶点的主流观点。
最近发表的两项研究显示了惊人的结果。在武装部队回归研究中，使用消胆胺、烟酸和吉非贝齐治疗后，低密度脂蛋白胆固醇仅降低了22%。然而，冠状动脉狭窄有所减轻，主要临床事件发生率降低了54%。相反，在FIELD试验中，主要事件发生率仅降低了11%（P=无显著性差异）。这些差异似乎很大程度上是由这些治疗方案对高密度脂蛋白的反应差异所解释的（38%对3%）。这项对23项试验的荟萃分析有力地支持了这样一种观点，即低密度脂蛋白胆固醇降低百分比与高密度脂蛋白胆固醇升高百分比之和比任何一种脂蛋白成分更有效地预测获益情况。
流行病学表明，低密度脂蛋白胆固醇每降低1%，心血管事件发生率降低近1%，高密度脂蛋白每升高1%，心血管事件发生率至少降低1%。这些效应在统计学上是独立的；因此，对于中等程度的脂质变化，它们是相加的。如果这个简单的算法被证明是准确的，高密度脂蛋白胆固醇升高30%和低密度脂蛋白胆固醇降低40%将导致冠心病风险降低近70%——并引发心血管预防领域的一场革命。
