Backes James M, Gibson Cheryl A, Howard Patricia A
Department of Pharmacy Practice, Lipid, Atherosclerosis, Metabolic and LDL Apheresis Center, University of Kansas Medical Center, Kansas City, KS 66160-7231, USA.
Vasc Health Risk Manag. 2005;1(4):317-31. doi: 10.2147/vhrm.2005.1.4.317.
An emphasis on more aggressive lipid-lowering, particularly of low-density lipoprotein cholesterol, to improve patient outcomes has led to an increased use of combination lipid-lowering drugs. This strategy, while potentially beneficial, has triggered concerns regarding fears of adverse effects, harmful drug interactions, and patient nonadherence.
To present key data regarding combination lipid-altering therapy including use, rationale, major trials, benefits, potential adverse effects, compliance issues, and limitations.
Literature was obtained from MEDLINE (1966 - June 2005) and references from selected articles.
A substantial body of evidence from epidemiological data and clinical trials indicates that aggressive lipid modification, especially low-density lipoprotein reduction, is associated with reduced cardiovascular events. Numerous studies utilizing various combinations of cholesterol-lowering agents including statin/fibrate, statin/niacin, statin/bile acid resin, and statin/ezetimibe have demonstrated significant changes in the lipid profile with acceptable safety. Long-term trials of combination therapy evaluating clinical outcomes or surrogate markers of cardiovascular disease, while limited, are promising.
Combining lipid-altering agents results in additional improvements in lipoproteins and has the potential to further reduce cardiovascular events beyond that of monotherapy.
强调更积极地降低血脂，尤其是低密度脂蛋白胆固醇，以改善患者预后，导致联合降脂药物的使用增加。这种策略虽然可能有益，但引发了对不良反应、有害药物相互作用和患者依从性的担忧。
介绍有关联合调脂治疗的关键数据，包括使用情况、基本原理、主要试验、益处、潜在不良反应、依从性问题和局限性。
从MEDLINE（1966年 - 2005年6月）获取文献，并从选定文章的参考文献中获取资料。
来自流行病学数据和临床试验的大量证据表明，积极的血脂修饰，尤其是降低低密度脂蛋白，与心血管事件减少相关。众多使用包括他汀类/贝特类、他汀类/烟酸、他汀类/胆汁酸树脂和他汀类/依泽替米贝等各种降脂药物组合的研究已证明血脂谱有显著变化且安全性可接受。评估心血管疾病临床结局或替代指标的联合治疗长期试验虽然有限，但前景乐观。
联合使用调脂药物可进一步改善脂蛋白水平，并有可能在单药治疗基础上进一步降低心血管事件。
