Goldenberg Naila, Glueck Charles
Cholesterol and Metabolism Center of Jewish Hospital, Cincinnati, Ohio, USA.
Vasc Health Risk Manag. 2009;5(1):369-76. doi: 10.2147/vhrm.s3241.
Statins became available for the treatment of hypercholesterolemia in 1987. Multiple, well-designed, placebo-controlled, double-blind studies revealed that each 1% reduction in serum cholesterol level was associated with about 1% reduction in risk of cardiovascular events. Low-density lipoprotein (LDL) cholesterol reduction to less than 78 mg/dL may be associated with reduction of atheroma burden. Patients with high levels of high specificity C-reactive protein and having LDL cholesterol less than 3.4 mmol/L (130 mg/dL) in primary prevention settings benefited from aggressive LDL cholesterol reduction with rosuvastatin over a 2-year period. However, in real life practice, about half of patients who are prescribed statins discontinue the medication by the end of the year. Medication adherence is lower in younger patients, women, and absence of known coronary heart disease. Personal features of the prescribing physician and dispensing pharmacies also affect patients' compliance. More studies are needed to evaluate if "compliance packets" would benefit patients in a real life situation.
他汀类药物于1987年开始用于治疗高胆固醇血症。多项精心设计的、安慰剂对照的双盲研究表明，血清胆固醇水平每降低1%，心血管事件风险约降低1%。将低密度脂蛋白（LDL）胆固醇降至低于78 mg/dL可能与动脉粥样硬化负担减轻有关。在一级预防中，高敏C反应蛋白水平高且LDL胆固醇低于3.4 mmol/L（130 mg/dL）的患者在2年期间通过瑞舒伐他汀积极降低LDL胆固醇而获益。然而，在实际临床实践中，约一半服用他汀类药物的患者在年底时停药。年轻患者、女性以及无已知冠心病的患者用药依从性较低。开处方医生和配药药房的个人特点也会影响患者的依从性。需要更多研究来评估“依从性包装”在实际临床情况中是否会使患者受益。
