Vo Anthony N, Kashyap Moti L
Atherosclerosis Research Center, Department of Veteran Affairs Healthcare System, 5901 E. Seventh Street, Long Beach, CA 90822, USA.
Expert Rev Cardiovasc Ther. 2008 Nov;6(10):1303-10. doi: 10.1586/14779072.6.10.1303.
Coronary heart disease (CHD) carries significant morbidity and mortality worldwide. Elevated LDL-cholesterol and reduced HDL-cholesterol levels are well-recognized CHD risk factors. Despite guideline recommendations for intensive therapy among patients at high risk for CHD to lower LDL-cholesterol, such lowering has failed to prevent approximately two-thirds of cardiovascular events. As a result of new data, guidelines have begun to focus on non-HDL-cholesterol, HDL-cholesterol and triglycerides as treatment targets, with the end result being a recommendation for combination therapy, such as niacin plus statin for the treatment of dyslipidemia. Compared with statin monotherapy, a combination of niacin and statin therapy provides beneficial effects on a broad range of lipid particles and some evidence suggests a further reduction in CHD risk. Recent studies have shown that the combination of a fixed dose of extended-release niacin plus simvastatin reduces non-HDL-cholesterol, LDL-cholesterol, triglycerides and total cholesterol:HDL-cholesterol ratio by approximately 50% while increasing HDL-cholesterol by 25%. The safety of this combination is consistent with the safety profiles of each individual component and is well tolerated. A long-term study is currently being conducted to evaluate whether this combination therapy confers an additive impact on clinical end points.
冠心病（CHD）在全球范围内都具有显著的发病率和死亡率。低密度脂蛋白胆固醇（LDL - C）升高和高密度脂蛋白胆固醇（HDL - C）水平降低是公认的冠心病危险因素。尽管有指南建议对冠心病高危患者进行强化治疗以降低LDL - C，但这种降低未能预防约三分之二的心血管事件。由于新的数据，指南已开始将非HDL - C、HDL - C和甘油三酯作为治疗靶点，最终结果是推荐联合治疗，如使用烟酸加他汀类药物治疗血脂异常。与他汀类药物单药治疗相比，烟酸与他汀类药物联合治疗对多种脂质颗粒具有有益作用，并且一些证据表明可进一步降低冠心病风险。最近的研究表明，固定剂量的缓释烟酸加辛伐他汀联合用药可使非HDL - C、LDL - C、甘油三酯和总胆固醇：HDL - C比值降低约50%，同时使HDL - C升高25%。这种联合用药的安全性与各单一成分的安全性相符，且耐受性良好。目前正在进行一项长期研究，以评估这种联合治疗是否对临床终点有附加影响。
