Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Chuo, Japan.
Circ J. 2010 Aug;74(8):1644-50. doi: 10.1253/circj.cj-10-0079. Epub 2010 Jun 22.
Remnant lipoproteinemia is a strong risk factor for cardiovascular (CV) diseases. This study examined which of 2 common lipid-lowering drugs (fibrates and statins) is more effective in patients with remnant lipoproteinemia and if lowering remnant lipoprotein levels can reduce CV risk.
Remnant lipoprotein levels were measured by an immunoseparation method (remnant-like lipoprotein particles cholesterol: RLP-C) in 274 patients with coronary artery disease and high RLP-C levels (>or=5.0 mg/dl). They were randomly assigned to receive bezafibrate (200-400 mg/day) or pravastatin (10-20 mg/day), and were prospectively followed-up for 1 year or until the occurrence of CV events. Complete follow-up data were obtained in 180 patients. RLP-C levels at 1 year of treatment were reduced more by bezafibrate than pravastatin (37% and 25% from baseline, respectively). During follow-up, bezafibrate-treated patients had 3 CV events, compared with 12 events in pravastatin-treated patients (P<0.01). In multivariate logistic regression analysis, a decrease in RLP-C level was significantly associated with a reduction in CV events after adjustment for treatment group and changes in levels of other lipids.
Bezafibrate therapy decreased RLP-C levels to a greater extent than pravastatin and a decrease in RLP-C level may be associated with a reduction in CV events in patients with high RLP-C levels.
残粒脂蛋白血症是心血管疾病的一个强烈危险因素。本研究探讨了两种常见的降脂药物（贝特类和他汀类）中哪一种在残粒脂蛋白血症患者中更有效，以及降低残粒脂蛋白水平是否可以降低心血管风险。
在 274 名患有冠状动脉疾病和高残粒脂蛋白水平（>或=5.0mg/dl）的患者中，通过免疫分离法（残粒样脂蛋白颗粒胆固醇：RLP-C）测量残粒脂蛋白水平。他们被随机分配接受非诺贝特（200-400mg/天）或普伐他汀（10-20mg/天）治疗，并前瞻性随访 1 年或直至发生心血管事件。180 名患者获得了完整的随访数据。治疗 1 年后，非诺贝特组的 RLP-C 水平比普伐他汀组降低更多（分别为 37%和 25%）。在随访期间，非诺贝特治疗组有 3 例心血管事件，而普伐他汀治疗组有 12 例（P<0.01）。多变量逻辑回归分析显示，在校正治疗组和其他脂质水平变化后，RLP-C 水平的降低与心血管事件的减少显著相关。
非诺贝特治疗可更显著降低 RLP-C 水平，而 RLP-C 水平的降低可能与高 RLP-C 水平患者心血管事件的减少相关。
