Department of Clinical Biochemistry (Vascular Disease Prevention clinics), Royal Free campus, University College London Medical School, University College London (UCL), London, UK.
Curr Vasc Pharmacol. 2010 Nov;8(6):820-30. doi: 10.2174/157016110793563825.
Small, dense low density lipoprotein (sdLDL) particles are considered an emerging cardiovascular risk factor. Obese patients with mixed dyslipidaemia frequently have elevated sdLDL cholesterol (sdLDL-C) levels. Therefore, agents that favourably modulate the LDL phenotype may be of clinical value in these patients. We review the efficacy of anti-obesity and lipid lowering drugs other than statins on LDL subfractions in patients with mixed dyslipidaemia primarily focusing on those who are overweight/obese. The literature search was based on PubMed listings up to 26 November 2009. In most studies ezetimibe decreases the large and medium LDL subclasses and, to a lesser extent, the sdLDL particles, while it does not substantially influence LDL size. Fibrates and niacin reduce sdLDL particles and shift LDL size towards large, buoyant LDL particles. More studies are needed to elucidate the effects of fish oils and resins on LDL phenotype. Orlistat and rimonabant have been associated with reductions in sdLDL-C levels along with an increase in LDL particle size. We did not find any literature describing the effect of sibutramine on sdLDL profile. Treatment with fibrates and niacin seems to be beneficial in patients with mixed dyslipidaemia. The addition of orlistat may further improve LDL phenotype in overweight/obese patients.
小而密的低密度脂蛋白（sdLDL）颗粒被认为是一种新出现的心血管风险因素。患有混合性血脂异常的肥胖患者常伴有 sdLDL 胆固醇（sdLDL-C）水平升高。因此，能够有利调节 LDL 表型的药物可能对这些患者具有临床价值。我们主要针对超重/肥胖的混合性血脂异常患者，综述了除他汀类药物以外的抗肥胖和调脂药物对 LDL 亚组份的疗效。文献检索基于截止到 2009 年 11 月 26 日的 PubMed 目录。在大多数研究中，依折麦布降低大、中 LDL 亚组份，在较小程度上降低 sdLDL 颗粒，而对 LDL 大小无显著影响。贝特类药物和烟酸降低 sdLDL 颗粒，并使 LDL 大小向大而轻的 LDL 颗粒转移。需要更多的研究来阐明鱼油和树脂对 LDL 表型的影响。奥利司他和利莫那班与 sdLDL-C 水平降低及 LDL 颗粒大小增加相关。我们没有发现任何描述西布曲明对 sdLDL 谱影响的文献。贝特类药物和烟酸治疗似乎对混合性血脂异常患者有益。奥利司他的加入可能会进一步改善超重/肥胖患者的 LDL 表型。
