Ertaş Fatih Sinan
Department of Cardiology, Medicine Faculty of Ankara University, Ankara, Turkey.
Turk Kardiyol Dern Ars. 2009 Mar;37 Suppl 2:29-36.
LDL cholesterol is the primary target of treatment for lowering the risk of cardiovascular events in both primary and secondary prevention. The usual drug to achieve this goal is HMG-CoA reductase inhibitors (statins), which constitute the most potent and effective class to reduce LDL cholesterol. Statins have been shown to be associated with good patient compliance, lower adverse events, and few drug interactions. Clinical trials have demonstrated that statin therapy reduces all clinical manifestations of atherosclerotic disease. These trials have also shown that the amount of risk reduction achieved is closely related to the degree of adherence to treatment. Despite evidence for the benefits of LDL-lowering with statins, initiation of treatment, achievement of the goals, and long-term adherence to therapy remain far from optimal. However, in order to achieve maximum benefit from statin therapy as seen in clinical trials, it is important that patients receive optimal-dose therapy for the rest of their lives. This review is concerned with a combination of patient-, physician-, and health delivery system-focused interventions, as outlined by the ATP III guidelines to improve adherence in clinical practice.
低密度脂蛋白胆固醇是一级和二级预防中降低心血管事件风险的主要治疗靶点。实现这一目标的常用药物是HMG-CoA还原酶抑制剂（他汀类药物），这是降低低密度脂蛋白胆固醇最有效且最具效力的一类药物。他汀类药物已被证明与良好的患者依从性、较低的不良事件发生率以及较少的药物相互作用相关。临床试验表明，他汀类药物治疗可减少动脉粥样硬化疾病的所有临床表现。这些试验还表明，降低风险的程度与治疗依从性密切相关。尽管有证据表明他汀类药物降低低密度脂蛋白有益，但治疗的启动、目标的达成以及长期治疗依从性仍远未达到最佳状态。然而，为了像在临床试验中那样从他汀类药物治疗中获得最大益处，患者在余生接受最佳剂量治疗非常重要。本综述关注的是ATP III指南概述的以患者、医生和医疗服务系统为重点的干预措施组合，以提高临床实践中的依从性。
