Bays Harold
L-MARC Research Center, Louisville, Kentucky 40213, USA.
Am J Cardiol. 2008 Apr 17;101(8A):3B-8B. doi: 10.1016/j.amjcard.2008.02.026.
Niacin is the most potent lipid-altering agent for raising high-density lipoprotein (HDL) cholesterol levels. Niacin also lowers triglyceride (TG) levels, lowers low-density lipoprotein (LDL) cholesterol levels, and improves lipoprotein particle size and subclass distribution. Niacin's major adverse experience (AE) is flushing. Niacin may also increase glucose levels, liver enzymes, and uric acid levels and cause other AEs that may have clinical relevance in selected patients. Simvastatin is representative of the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) class of lipid-altering drugs, which are the most effective agents for lowering LDL cholesterol levels and also have modest benefits in raising HDL cholesterol and lowering TG levels. The most common AEs with statins are muscle AEs and modest liver enzyme elevations. Because niacin and statins have complementary lipid effects and because individually, niacin and statins have been shown in outcomes studies to reduce atherosclerotic coronary artery disease events, the combined use of these 2 agents has significant potential to not only improve the lipid values of patients but improve their lives as well. Equally important is ensuring that the combination of niacin and simvastatin has an acceptable safety profile, with no greater AEs than would otherwise be expected by adding 1 agent to the other.
烟酸是提升高密度脂蛋白（HDL）胆固醇水平最有效的血脂调节药物。烟酸还能降低甘油三酯（TG）水平、降低低密度脂蛋白（LDL）胆固醇水平，并改善脂蛋白颗粒大小和亚类分布。烟酸的主要不良反应（AE）是潮红。烟酸还可能升高血糖水平、肝酶和尿酸水平，并引发其他可能对特定患者具有临床意义的不良反应。辛伐他汀是3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（他汀类）血脂调节药物的代表，这类药物是降低LDL胆固醇水平最有效的药物，在提升HDL胆固醇水平和降低TG水平方面也有一定益处。他汀类药物最常见的不良反应是肌肉不良反应和肝酶轻度升高。由于烟酸和他汀类药物具有互补的血脂调节作用，而且在结局研究中已分别证明烟酸和他汀类药物可减少动脉粥样硬化性冠状动脉疾病事件，因此联合使用这两种药物不仅有显著潜力改善患者的血脂指标，还能改善他们的生活。同样重要的是要确保烟酸和辛伐他汀联合使用具有可接受的安全性，其不良反应不比单独使用一种药物后预期的不良反应更严重。
