Jones Peter H
Section of Atherosclerosis and Lipid Research, Baylor College of Medicine, Houston, Texas 77030, USA.
Am J Cardiol. 2008 Dec 22;102(12A):41L-47L. doi: 10.1016/j.amjcard.2008.09.074.
Even with optimal statin therapy, many patients with type 2 diabetes mellitus or metabolic syndrome fail to achieve all lipid targets and remain at high risk of cardiovascular events. Add-on lipid-modifying therapy that is effective in improving the triglyceride and high-density lipoprotein (HDL) cholesterol abnormalities characteristic of these conditions is a recommended approach to reduce this risk. Fibrates or niacin is a logical option, supported by clinical studies showing improved lipid control in combination with a statin. Of the fibrates, fenofibrate may offer microvascular benefits in type 2 diabetes--as demonstrated by the Diabetes Atherosclerosis Intervention Study (DAIS) and the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study--as well as a low risk of myopathy when combined with statins compared with gemfibrozil. Although there is good evidence that both agents favorably affect clinical outcome, we need to evaluate their impact against a baseline of statin therapy. We await data from ongoing large-scale studies to evaluate the efficacy and safety of these combinations and to determine the most appropriate option for reducing residual cardiovascular risk in this important patient population.
即使采用最佳的他汀类药物治疗，许多2型糖尿病或代谢综合征患者仍无法实现所有血脂目标，心血管事件风险依然很高。加用能有效改善这些病症所特有的甘油三酯和高密度脂蛋白（HDL）胆固醇异常的调脂治疗是降低这种风险的推荐方法。贝特类药物或烟酸是一种合理的选择，临床研究表明与他汀类药物联合使用可改善血脂控制。在贝特类药物中，非诺贝特可能对2型糖尿病具有微血管益处——如糖尿病动脉粥样硬化干预研究（DAIS）和非诺贝特干预与糖尿病事件降低研究（FIELD）所示——并且与吉非贝齐相比，与他汀类药物联合使用时发生肌病的风险较低。尽管有充分证据表明这两种药物均对临床结局有有利影响，但我们需要在他汀类药物治疗的基础上评估它们的影响。我们正在等待正在进行的大规模研究的数据，以评估这些联合用药的疗效和安全性，并确定在这一重要患者群体中降低残余心血管风险的最合适选择。
