Moro J, Almenar L, Martínez-Dolz L, Izquierdo M, Agüero J, Sánchez-Lazaro I, Ortiz V, Salvador A
Heart Failure and Transplant Unit, Department of Cardiology, La Fe University Hospital, Valencia, Spain.
Transplant Proc. 2007 Sep;39(7):2389-92. doi: 10.1016/j.transproceed.2007.06.043.
Dyslipidemia is a common problem among heart transplant (HT) recipients; it is a frequent risk factor in these patients that is exacerbated by immunosuppressive drugs. Statins are effective drugs to treat dyslipidemia in HT recipients, but control is suboptimal in some patients. Ezetimibe acts through inhibition of the enterohepatic recirculation, a mechanism different from but complementary to statins. Our objective was to assess the effect of the addition of ezetimibe to statin therapy among a population of HT patients.
We included 19 stable patients on statin therapy with suboptimal control of cholesterol. Determinations were performed at baseline on statins and at 6 months (statins + ezetimibe). The analyzed variables were total cholesterol and fractions, triglycerides, cyclosporine levels, CPK, SGOT/SGPT, and bilirubin. The statistics were Student's t test for paired samples.
The overall mean age was 59 +/- 9 years with 95% males and mean BMI 27.5 +/- 3.5. The time since HT was 7 +/- 3 years. The reason for HT included ischemic heart disease in 68%. Pre-HT risk factors included in arterial hypertension in 32% and insulin-dependent diabetes mellitus in 10%, Dyslipidemia occurred in 68%; hypertriglyceridemia in 16% and hyperuricemia in 21%. Immunosuppression was cyclosporine in 100% and steroids in 94%. Type of lipid-lowering agent was simvastatin in 5%; pravastatin, 32%; atorvastatin, 58%; fibrates, 10%. The ezetimibe dose was 10 mg/day in 95% of cases. When ezetimibe was added we observed differences in total cholesterol values (total cholesterol at baseline: 279 +/- 74, total cholesterol with ezetimibe: 198 +/- 47 mg/dL; P = .0001) and LDL-cholesterol values (LDL-cholesterol at baseline: 171 +/- 69, LDL-cholesterol with ezetimibe: 109 +/- 41 mg/dL; P = .001). The remaining variables did not show significant differences.
The addition of ezetimibe to statin therapy among heart transplant patients was effective to control dyslipidemia and showed an excellent safety profile.
血脂异常是心脏移植（HT）受者中的常见问题；它是这些患者中常见的危险因素，且免疫抑制药物会使其加剧。他汀类药物是治疗HT受者血脂异常的有效药物，但部分患者的血脂控制并不理想。依折麦布通过抑制肠肝循环发挥作用，这一机制与他汀类药物不同但互补。我们的目的是评估在HT患者群体中，加用依折麦布至他汀类药物治疗方案的效果。
我们纳入了19例接受他汀类药物治疗但胆固醇控制欠佳的稳定患者。在基线时测定他汀类药物治疗的情况，并在6个月时（他汀类药物 + 依折麦布）进行测定。分析的变量包括总胆固醇及其组分、甘油三酯、环孢素水平、肌酸磷酸激酶（CPK）、谷草转氨酶/谷丙转氨酶（SGOT/SGPT）和胆红素。统计学方法采用配对样本的t检验。
总体平均年龄为59±9岁，男性占95%，平均体重指数（BMI）为27.5±3.5。心脏移植后的时间为7±3年。心脏移植的原因包括68%为缺血性心脏病。心脏移植前的危险因素包括32%患有动脉高血压和10%患有胰岛素依赖型糖尿病，68%存在血脂异常；16%患有高甘油三酯血症，21%患有高尿酸血症。免疫抑制治疗中100%使用环孢素，94%使用类固醇。降脂药物类型为5%使用辛伐他汀，32%使用普伐他汀，58%使用阿托伐他汀，10%使用贝特类药物。95%的病例中依折麦布剂量为10毫克/天。加用依折麦布后，我们观察到总胆固醇值存在差异（基线时总胆固醇：279±74，加用依折麦布后的总胆固醇：198±47毫克/分升；P = 0.0001）以及低密度脂蛋白胆固醇值存在差异（基线时低密度脂蛋白胆固醇：171±69，加用依折麦布后的低密度脂蛋白胆固醇：109±41毫克/分升；P = 0.001）。其余变量未显示出显著差异。
在心脏移植患者中，加用依折麦布至他汀类药物治疗方案对于控制血脂异常有效，且显示出良好的安全性。
