Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Am J Cardiol. 2010 Jan 1;105(1):69-76. doi: 10.1016/j.amjcard.2009.08.651.
Statins are the most commonly prescribed agents for lowering levels of low-density lipoprotein (LDL) cholesterol. Although dose-dependent reductions in levels of atherogenic lipids are observed with all statins, the impact of increasing dose has not been fully elucidated. An individual patient data pooled analysis was performed of 32,258 patients in studies comparing the efficacy of rosuvastatin with that of atorvastatin or simvastatin. The impact of increasing dose on lowering LDL cholesterol, triglycerides, non-high-density lipoprotein (HDL) cholesterol, and apolipoprotein B was investigated. Doubling the dose of each statin was accompanied by a 4% to 7% greater degree of lowering of all atherogenic lipids. A stronger correlation was observed between changes in LDL cholesterol and non-HDL cholesterol (r = 0.92, p <0.001) or apolipoprotein B (r = 0.76, p <0.001) than triglycerides (r = 0.14, p <0.001). On multivariate analysis, baseline lipid level (p <0.0001) and increasing statin dose (p <0.0001) were strong predictors of achieving treatment goals in high-risk patients. Increasing age was a strong independent predictor of achieving goal for all atherogenic lipids (p <0.0001). Achieving LDL cholesterol goals was also more likely in women (p <0.0001), patients with diabetes (p <0.0001), and patients without atherosclerotic disease (p = 0.0002). In contrast, normal triglyceride levels were more often observed in men (p <0.0001) and patients without diabetes mellitus (p = 0.03). In conclusion, doubling statin dose was associated with greater lowering of LDL cholesterol by 4% to 6% and non-HDL cholesterol by 3% to 6%. Greater lipid goal achievement with increasing dose supports the use of high-dose statin therapy for more effective cardiovascular prevention.
他汀类药物是降低低密度脂蛋白(LDL)胆固醇水平最常用的药物。虽然所有他汀类药物都能观察到剂量依赖性的致动脉粥样脂质水平降低,但增加剂量的影响尚未完全阐明。对比较瑞舒伐他汀与阿托伐他汀或辛伐他汀疗效的 32258 例患者的个体患者数据进行了汇总分析。研究了增加剂量对降低 LDL 胆固醇、甘油三酯、非高密度脂蛋白(HDL)胆固醇和载脂蛋白 B 的影响。将每种他汀类药物的剂量加倍,所有致动脉粥样脂质的降低程度增加 4%至 7%。观察到 LDL 胆固醇和非 HDL 胆固醇(r = 0.92,p <0.001)或载脂蛋白 B(r = 0.76,p <0.001)之间的变化与甘油三酯(r = 0.14,p <0.001)之间的相关性更强。多变量分析显示,基线血脂水平(p <0.0001)和增加他汀类药物剂量(p <0.0001)是高危患者达到治疗目标的强有力预测因素。年龄增长是所有致动脉粥样脂质达到目标的独立强预测因素(p <0.0001)。在女性(p <0.0001)、糖尿病患者(p <0.0001)和无动脉粥样硬化疾病患者(p = 0.0002)中,更有可能达到 LDL 胆固醇目标。相反,在男性(p <0.0001)和无糖尿病患者(p = 0.03)中,更常观察到正常的甘油三酯水平。总之,他汀类药物剂量加倍与 LDL 胆固醇降低 4%至 6%和非 HDL 胆固醇降低 3%至 6%相关。随着剂量的增加,血脂目标的实现率更高,支持使用高剂量他汀类药物治疗以实现更有效的心血管预防。
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