Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 27599, USA.
Ann Pharmacother. 2009 Dec;43(12):2021-30. doi: 10.1345/aph.1M302. Epub 2009 Nov 17.
To review the published literature characterizing the impact of ezetimibe-containing lipid-lowering regimens on endothelial function and other markers of cardiovascular risk and discuss the potential relevance of these effects to the clinical benefit of ezetimibe.
A MEDLINE search (2000-August 2009) was completed using the key words ezetimibe, statins, endothelial function, flow-mediated dilation, pleiotropic, and inflammation to identify relevant literature. Bibliographies of identified literature were reviewed for additional references.
All clinical studies published in English that evaluated the effect of ezetimibe on ancillary endpoints of cardiovascular disease risk, including endothelial function, inflammation, thrombosis, and oxidative stress, were evaluated.
Recent studies in patients with coronary artery disease (CAD), heart failure, and hypercholesterolemia have demonstrated that treatment with ezetimibe for 4-12 weeks elicits no improvement of endothelial function or other measures of cardiovascular disease risk. In contrast, other studies have reported that ezetimibe improves endothelial function in certain patient populations, including those with rheumatoid arthritis, CAD with type 2 diabetes, and metabolic syndrome. However, the statin monotherapy comparator groups in these studies that yielded equivalent reductions in cholesterol were superior, or at least equivalent to, ezetimibe-containing regimens in the improvement of these ancillary endpoints.
Overall, the evidence to date suggests that administration of ezetimibe, either as monotherapy or in combination with a statin, exerts minimal beneficial effects on endothelial function and other ancillary measures of cardiovascular disease risk beyond those conferred by its cholesterol-lowering effects. Studies with larger sample sizes and follow-up beyond 12 weeks remain necessary to further define the impact of ezetimibe on the processes integral to the pathogenesis and progression of cardiovascular disease.
回顾已发表的文献，描述含依折麦布的降脂方案对血管内皮功能和其他心血管风险标志物的影响，并讨论这些作用对依折麦布临床益处的潜在意义。
通过关键词“ezetimibe、statins、endothelial function、flow-mediated dilation、pleiotropic、inflammation”在 MEDLINE 上进行 2000 年 8 月至 2009 年 8 月的搜索，以确定相关文献。对确定文献的参考文献进行了综述，以获取更多参考文献。
评估了所有以评估依折麦布对心血管疾病风险的辅助终点（包括内皮功能、炎症、血栓形成和氧化应激）的影响的已发表的英语临床研究。
最近在冠心病（CAD）、心力衰竭和高胆固醇血症患者中的研究表明，依折麦布治疗 4-12 周不会改善内皮功能或其他心血管疾病风险的衡量指标。相反，其他研究报告称，依折麦布可改善某些患者群体的内皮功能，包括类风湿关节炎、2 型糖尿病合并 CAD 和代谢综合征患者。然而，在这些研究中，与依折麦布治疗组相比，他汀类药物单药治疗组在改善这些辅助终点方面更为优越，或者至少与依折麦布治疗组相当。
总的来说，目前的证据表明，依折麦布无论是单药治疗还是与他汀类药物联合应用，除了降低胆固醇的作用外，对内皮功能和其他心血管疾病风险的辅助衡量指标的有益作用很小。需要进行更大样本量和随访时间超过 12 周的研究，以进一步确定依折麦布对心血管疾病发病机制和进展过程中固有过程的影响。
