Institute for Clinical Pharmacology, Public Health Association Saxony, Technical University Dresden, Germany.
Curr Med Res Opin. 2010 Dec;26(12):2833-9. doi: 10.1185/03007995.2010.532088. Epub 2010 Nov 8.
The prevalence of atherogenic dyslipidaemia (AD) can be assessed using the lipid triad (low high-density lipoprotein cholesterol [HDL-C] < 35 mg/dl, high triglyceride (TG) levels (≥ 200 mg/dl) and a high total cholesterol HDL-C ratio (TC/HDL-C>5). The aim of the present analysis was (1) to describe the prevalence of the lipid triad, (2) to quantify the associated cardiovascular risk on the basis of the PROCAM score, and (3) to calculate the additional risk reduction that can be obtained by adding nicotinic acid (NA) to a pre-existing statin therapy (model based on the outcomes of a previous randomized controlled study).
Descriptive post-hoc analysis of the German 4E registry in 24,500 patients receiving statins for primary cardiovascular prevention in ambulatory care.
The sample comprised 24,500 patients in primary prevention, who had an overall 10-year risk of 16.2%. The prevalence of patients with lipid triad was 24.0%. The mean estimated risk reduction in the total sample (calculated on the basis of a mean LDL-C decrease by 24.3% and other lipid parameter changes) achieved after 6-week statin treatment was 46.6%, the estimated additional relative risk reduction by NA 45.1% (total effect compared to baseline about 70%). In the lipid triad group, the additional relative risk reduction by NA treatment was 42.9%. Relative treatment effects were consistent, irrespective of age and gender. Limitations of this analysis include the use of the TC/HDL-C ratio instead of the direct small dense LDL-C measurements, and the unknown variations of effect size of NA induced lipid reduction when used in combination with statins.
Our model calculations indicate that the residual risk which persists after statin treatment could be substantially lowered if besides LDL-C also HDL-C and TG would be addressed, e.g. by adding NA to statin therapy. Definitive prospective studies are needed to confirm this hypothesis.
通过脂质三联（低高密度脂蛋白胆固醇 [HDL-C] < 35mg/dl、高甘油三酯（TG）水平（≥ 200mg/dl）和总胆固醇/高密度脂蛋白胆固醇比值高（TC/HDL-C>5））可以评估动脉粥样硬化性血脂异常（AD）的流行率。本分析的目的是：（1）描述脂质三联的流行率；（2）根据 PROCAM 评分量化相关的心血管风险；（3）通过在现有的他汀类药物治疗中添加烟酸（NA）来计算可以获得的额外风险降低（基于之前随机对照研究的结果建立模型）。
对门诊接受他汀类药物进行一级心血管预防的 24500 例患者的德国 4E 登记处进行描述性事后分析。
样本包括 24500 例一级预防患者，总体 10 年风险为 16.2%。脂质三联的患者比例为 24.0%。在整个样本中，6 周他汀治疗后平均估计风险降低（根据 LDL-C 降低 24.3%和其他脂质参数变化计算）为 46.6%，NA 额外相对风险降低 45.1%（与基线相比总效应约为 70%）。在脂质三联组中，NA 治疗的额外相对风险降低为 42.9%。相对治疗效果一致，与年龄和性别无关。本分析的局限性包括使用 TC/HDL-C 比值而不是直接的小而密 LDL-C 测量，以及在与他汀类药物联合使用时，NA 诱导的脂质降低的效果大小未知变化。
我们的模型计算表明，如果除了 LDL-C 之外，还可以解决 HDL-C 和 TG 等问题，例如通过在他汀类药物治疗中添加 NA，可以大大降低他汀类药物治疗后仍然存在的残余风险。需要进行明确的前瞻性研究来证实这一假设。
