Gupta Milan, Braga Manoela F B, Teoh Hwee, Tsigoulis Michelle, Verma Subodh
Division of Cardiology, William Osler Health Centre, Department of Medicine, McMaster University, 3 Conestoga Drive, Brampton, Ontario, Canada L6Z 4N5.
J Clin Pharmacol. 2009 Jul;49(7):831-7. doi: 10.1177/0091270009334376. Epub 2009 Apr 27.
Inasmuch as statins appear to exhibit altered efficacy in some Asian populations (predominantly East Asian), current lipid guidelines recommend the use of lower statin doses in all Asians. Whether this should also apply to South Asians, a population at high risk for coronary heart disease, remains unclear. The authors evaluated the lipid-modifying effects of statins in South Asian and white patients with established coronary heart disease. Atorvastatin (median dose=20 mg/d in both groups) produced similar decreases in low-density lipoprotein cholesterol (LDL-c) in South Asian (43%) and white (41%) patients and raised high-density lipoprotein cholesterol (HDL-c) by 19% in South Asians and by 12% in whites. Simvastatin (median dose=20 mg/d in both groups) reduced LDL-c by 35% in South Asians and by 37% in whites while raising HDL-c by 12% in both groups. Using a multiple linear regression model (atorvastatin equivalent), the expected decrease in LDL-c for 10 mg atorvastatin and 20 mg atorvastatin was similar between the groups. Results indicate that atorvastatin and simvastatin, at commonly prescribed doses, modulate LDL-c and HDL-c levels to a similar degree in both South Asians and whites with documented coronary heart disease. These findings suggest that South Asian patients may be treated with atorvastatin and simvastatin at doses typically applied to white patients.
鉴于他汀类药物在一些亚洲人群(主要是东亚人群)中似乎表现出疗效改变,当前的血脂指南建议在所有亚洲人中使用较低剂量的他汀类药物。对于南亚人这一冠心病高危人群是否也应如此,目前尚不清楚。作者评估了他汀类药物对已确诊冠心病的南亚患者和白人患者的血脂调节作用。阿托伐他汀(两组的中位剂量均为20毫克/天)使南亚患者(43%)和白人患者(41%)的低密度脂蛋白胆固醇(LDL-c)有相似程度的降低,南亚患者的高密度脂蛋白胆固醇(HDL-c)升高了19%,白人患者升高了12%。辛伐他汀(两组的中位剂量均为20毫克/天)使南亚患者的LDL-c降低了35%,白人患者降低了37%,同时两组的HDL-c均升高了12%。使用多元线性回归模型(阿托伐他汀等效剂量),两组中10毫克阿托伐他汀和20毫克阿托伐他汀预期的LDL-c降低相似。结果表明,对于已确诊冠心病的南亚患者和白人患者,阿托伐他汀和辛伐他汀在常用剂量下对LDL-c和HDL-c水平的调节程度相似。这些发现表明,南亚患者可以使用通常用于白人患者的剂量的阿托伐他汀和辛伐他汀进行治疗。