Crisostomo Luciola M L, Souza Carlos A M, Mendes Carlos M C, Coimbra Silmara R, Favarato Desiderio, Luz Protasio L da
Escola Bahiana de Medicina e Saúde Pública, Universidade Federal da Bahia, Salvador, BA, Brazil.
Clinics (Sao Paulo). 2008 Oct;63(5):589-94. doi: 10.1590/s1807-59322008000500004.
Much evidence indicates the importance of the endothelium and hypercholesterolemia in atherosclerosis, as well as the decline in endothelial function with aging. However, it is unclear if treating dyslipidemia in elderly patients improves endothelial function and reduces C-reactive protein levels.
To evaluate vasomotor function, lipids and C-reactive protein in mildly hypertensive and hypercholesterolemic elderly patients treated with atorvastatin.
Forty-seven elderly Brazilian subjects (> or = 65 years old) with LDL cholesterol (LDL-c) > or = 130 mg/dL were randomly assigned, in a double-blinded manner, to receive either placebo (n = 23) or 20 mg/day of atorvastatin (n = 24) for 4 weeks. Exclusion criteria included diabetes, serious hypertension, obesity, steroid use, hormone replacement, and statin use within the previous six months. All patients underwent clinical examinations, laboratory tests (glucose, lipids, liver enzymes, creatine phosphokinase and high sensitivity C-reactive protein) and assessment of vasomotor function by high-resolution ultrasound examination of the brachial artery (flow-mediated dilation and sublingual nitrate), both before and after treatment.
The patients were 65 to 91 years old; there was no significant difference between basal flow-mediated dilation of placebo (7.3 +/- 6.1%) and atorvastatin (4.5 +/- 5.1%; p = 0.20). The same was observed after treatment (6.6 +/- 6.2 vs. 5.0 +/- 5.6; p = 0.55). The initial nitrate dilatation (8.1 +/- 5.4% vs. 10.8 +/- 7.5%; p = 0.24) and that after 4 week treatment (7.1 +/- 4.7% vs. 8.6 +/- 5.0%; p = 0.37) were similar. Atorvastatin produced a reduction of 20% of the C-reactive protein and 42% in the LDL-c; however, there were no changes in the flow-mediated dilation.
Atorvastatin produced a significant change of lipids and C-reactive protein; however, there were no changes in vasomotor function, suggesting the existence of intrinsic age-related vessel alterations.
大量证据表明内皮功能和高胆固醇血症在动脉粥样硬化中的重要性，以及内皮功能随年龄增长而下降。然而，目前尚不清楚治疗老年患者的血脂异常是否能改善内皮功能并降低C反应蛋白水平。
评估接受阿托伐他汀治疗的轻度高血压和高胆固醇血症老年患者的血管舒缩功能、血脂和C反应蛋白。
47名年龄≥65岁、低密度脂蛋白胆固醇（LDL-c）≥130mg/dL的巴西老年受试者，以双盲方式随机分为两组，分别接受安慰剂（n = 23）或20mg/天的阿托伐他汀（n = 24）治疗4周。排除标准包括糖尿病、严重高血压、肥胖、使用类固醇、激素替代治疗以及在过去6个月内使用他汀类药物。所有患者在治疗前后均接受临床检查、实验室检查（血糖、血脂、肝酶、肌酸磷酸激酶和高敏C反应蛋白），并通过高分辨率超声检查肱动脉评估血管舒缩功能（血流介导的舒张和舌下含服硝酸酯）。
患者年龄在65至91岁之间；安慰剂组的基础血流介导的舒张（7.3±6.1%）与阿托伐他汀组（4.5±5.1%；p = 0.20）之间无显著差异。治疗后情况相同（6.6±6.2对5.0±5.6；p = 0.55）。初始硝酸酯舒张（8.1±5.4%对10.8±7.5%；p = 0.24）和4周治疗后的舒张（7.1±4.7%对8.6±5.0%；p = 0.37）相似。阿托伐他汀使C反应蛋白降低了20%，LDL-c降低了42%；然而，血流介导的舒张无变化。
阿托伐他汀使血脂和C反应蛋白发生了显著变化；然而，血管舒缩功能无变化，提示存在与年龄相关的内在血管改变。
