Tani Shigemasa, Nagao Ken, Anazawa Takeo, Kawamata Hirofumi, Furuya Shingo, Takahashi Hiroshi, Iida Kiyoshi, Matsumoto Michiaki, Washio Takahiko, Kumabe Narimichi, Hirayama Atsushi
Department of Cardiology, Nihon University Surugadai Hospital, Tokyo 101-8309, Japan.
J Atheroscler Thromb. 2009 Jun;16(3):275-82. doi: 10.5551/jat.e653. Epub 2009 Jun 26.
Obesity is a well known strong risk factor for coronary artery disease (CAD). We prospectively investigated the influence of body mass index (BMI) on the inhibitory effects of pravastatin against the development of coronary atherosclerosis.
In 56 patients with stable CAD, 3-dimensional intravascular ultrasound was performed in matched coronary segments at the baseline and after 6-month treatment with pravastatin.
The plaque volume was significantly reduced by 11% after treatment (p<0.001 vs. baseline). The percent plaque volume was positively correlated with the baseline BMI (r=0.37, p<0.001), and negatively correlated with the serum total cholesterol / high-density lipoprotein cholesterol ratio (r=0.27, p<0.05) and total leukocyte count (r=0.27, p<0.05). Multivariate regression analysis showed that BMI was an independent predictor of the change in plaque volume (beta coefficient: 0.326; 95% CI: 0.003 to 0.037; p<0.05). No correlations were found between BMI and changes in the serum levels of any other lipids, apolipoproteins, or hs-CRP.
The present study demonstrated that an increase in BMI attenuated pravastatin-induced coronary atherosclerosis regression. The results may provide new insight into the framework for the treatment of obese patients with CAD.
肥胖是冠状动脉疾病（CAD）众所周知的重要危险因素。我们前瞻性地研究了体重指数（BMI）对普伐他汀抑制冠状动脉粥样硬化发展作用的影响。
对56例稳定型CAD患者，在基线时及接受普伐他汀治疗6个月后，对匹配的冠状动脉节段进行三维血管内超声检查。
治疗后斑块体积显著减少11%（与基线相比，p<0.001）。斑块体积百分比与基线BMI呈正相关（r=0.37，p<0.001），与血清总胆固醇/高密度脂蛋白胆固醇比值（r=0.27，p<0.05）和白细胞总数（r=0.27，p<0.05）呈负相关。多因素回归分析显示，BMI是斑块体积变化的独立预测因子（β系数：0.326；95%置信区间：0.003至0.037；p<0.05）。未发现BMI与任何其他血脂、载脂蛋白或hs-CRP血清水平变化之间存在相关性。
本研究表明，BMI升高减弱了普伐他汀诱导的冠状动脉粥样硬化消退。该结果可能为CAD肥胖患者的治疗框架提供新的见解。
