Horwich Tamara
Division of Cardiology, University of California, Los Angeles, CA 90095, USA.
Curr Atheroscler Rep. 2009 Sep;11(5):343-9. doi: 10.1007/s11883-009-0052-4.
Hypercholesterolemia is a risk factor for coronary artery disease (CAD), CAD mortality, and incident heart failure (HF). Lipid-lowering therapy with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) has been shown to reduce the risk of developing HF in patients with CAD. However, in patients with chronic established HF, hypercholesterolemia has not been associated with an increased risk of mortality. Several studies have demonstrated that higher lipid and lipoprotein levels, including total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides, are associated with significantly improved outcomes in HF of both ischemic and nonischemic etiologies. In light of the association between high cholesterol levels and improved survival in HF, statin or other lipid-lowering therapy in HF remains controversial. To date, large outcome trials of statin therapy in HF of multiple etiologies have not demonstrated mortality benefit.
高胆固醇血症是冠状动脉疾病（CAD）、CAD死亡率及新发心力衰竭（HF）的一个危险因素。使用3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）进行降脂治疗已被证明可降低CAD患者发生HF的风险。然而，在慢性稳定性HF患者中，高胆固醇血症与死亡率增加并无关联。多项研究表明，较高的血脂和脂蛋白水平，包括总胆固醇、低密度脂蛋白、高密度脂蛋白和甘油三酯，与缺血性和非缺血性病因的HF患者预后显著改善相关。鉴于高胆固醇水平与HF患者生存率提高之间的关联，HF患者使用他汀类药物或其他降脂治疗仍存在争议。迄今为止，针对多种病因的HF患者进行他汀类药物治疗的大型结局试验尚未证明对死亡率有获益。
