Cui Yadong, Watson Douglas J, Girman Cynthia J, Shapiro Deborah R, Gotto Antonio M, Hiserote Patricia, Clearfield Michael B
Merck & Compnay, Incorported, Whitehouse Station, New Jersey, USA.
Am J Cardiol. 2009 Sep 15;104(6):829-34. doi: 10.1016/j.amjcard.2009.05.020.
Reducing low-density lipoprotein (LDL) cholesterol with statins reduces cardiovascular risk, but the associations between increases in high-density lipoprotein (HDL) cholesterol and cardiovascular risk at different LDL levels have been less well characterized. To evaluate the associations between the 1-year changes in HDL cholesterol and LDL cholesterol with lovastatin and subsequent acute major coronary events (AMCEs), we studied 2,928 patients in the lovastatin arm who were followed for 5.2 years in a post-hoc analysis of the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). The percentage of HDL cholesterol increase and apolipoproteins at year 1 and the incidence of AMCEs thereafter were assessed stratified by the LDL cholesterol levels. With lovastatin, LDL cholesterol was reduced by 25% on average to 115 mg/dl at year 1, and HDL cholesterol increased 6.0%. Patients with both an increase in HDL cholesterol of > or =7.5% and LDL cholesterol of <115 mg/dl at year 1 had the lowest event rate (3.53/1,000 person-years; p = 0.028). Similar results were found for an increase in HDL cholesterol of > or =7.5% and a decrease in LDL cholesterol of >25%, as well as for apolipoproteins A-I and B. The 1-year percent increase in HDL cholesterol appeared to be associated with a reduction in AMCEs in subsequent follow-up (p = 0.07 with the percentage of HDL cholesterol increase analyzed continuously). Patients with an HDL cholesterol increase of > or =7.5% had an AMCE rate of 5.18 compared with 7.66/1,000 person-years in patients with a lower HDL cholesterol increase (p = 0.08). In conclusion, lovastatin therapy was associated with a greater risk reduction of AMCEs when LDL cholesterol was substantially reduced and the HDL cholesterol increased by > or =7.5%.
使用他汀类药物降低低密度脂蛋白（LDL）胆固醇可降低心血管疾病风险，但在不同LDL水平下，高密度脂蛋白（HDL）胆固醇升高与心血管疾病风险之间的关联尚未得到充分描述。为了评估洛伐他汀治疗后HDL胆固醇和LDL胆固醇1年变化与随后急性重大冠状动脉事件（AMCE）之间的关联，我们在空军/德克萨斯冠状动脉粥样硬化预防研究（AFCAPS/TexCAPS）的事后分析中，对洛伐他汀治疗组的2928例患者进行了为期5.2年的随访研究。根据LDL胆固醇水平对第1年HDL胆固醇升高百分比、载脂蛋白水平以及此后的AMCE发生率进行分层评估。使用洛伐他汀治疗后，第1年LDL胆固醇平均降低25%至115mg/dl，HDL胆固醇升高6.0%。第1年HDL胆固醇升高≥7.5%且LDL胆固醇<115mg/dl的患者事件发生率最低（3.53/1000人年；p=0.028）。HDL胆固醇升高≥7.5%且LDL胆固醇降低>25%，以及载脂蛋白A-I和B也有类似结果。HDL胆固醇第1年升高百分比似乎与后续随访中AMCE减少相关（连续分析HDL胆固醇升高百分比时p=0.07）。HDL胆固醇升高≥7.5%的患者AMCE发生率为5.18/1000人年，而HDL胆固醇升高较低的患者为7.66/1000人年（p=0.08）。总之，当LDL胆固醇大幅降低且HDL胆固醇升高≥7.5%时，洛伐他汀治疗与AMCE风险降低幅度更大相关。
