依折麦布/辛伐他汀与阿托伐他汀降低 2 型糖尿病患者 LDL-C、非 HDL-C、ApoB 和 hs-CRP 水平的效果比较。
Effect of ezetimibe/simvastatin vs atorvastatin on lowering levels of LDL-C and non-HDL-C, ApoB, and hs-CRP in patients with type 2 diabetes.
机构信息
Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University and VA Medical Center, 750 E. Adams Street, CWB 353, Syracuse, NY 13210, USA.
出版信息
J Clin Lipidol. 2008 Feb;2(1):25-35. doi: 10.1016/j.jacl.2008.01.001. Epub 2008 Jan 11.
BACKGROUND
In addition to low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein B (ApoB), and high-sensitivity C-reactive protein (hs-CRP) are considered predictive for cardiovascular disease in type 2 diabetes mellitus (T2DM) patients.
OBJECTIVE
To assess the proportion of T2DM patients with hypercholesterolemia who attained the optional target level of LDL-C (<70 mg/dL) and additionally non-HDL-C (<100 mg/dL), ApoB (<90 mg/dL), and hs-CRP (<2 mg/L), following treatment with ezetimibe/simvastatin (E/S) vs atorvastatin (A).
METHODS
This post-hoc analysis of a multicenter, randomized, double-blind, 6-week parallel study assessed the proportion of T2DM patients who attained specified LDL-C levels and non-HDL-C, ApoB, and hs-CRP with usual, recommended starting doses of E/S (10/20 mg) vs A (10 or 20 mg) and next highest doses of E/S (10/40 mg) vs A (40 mg) by logistic regression. Baseline triglyceride and hs-CRP effects were also evaluated.
RESULTS
Significantly higher percentages of patients treated with E/S compared to A achieved individual and concurrent target levels of LDL-C (<70 mg/dL), non-HDL-C (<100 mg/dL), and ApoB (<90 mg/dL) at all dose comparisons (P < 0.05 to P < 0.001). Baseline triglyceride levels had no effect on reaching LDL-C levels. Attainment of non-HDL-C (<100 mg/dL), and ApoB (<90 mg/dL) was lower at triglycerides ≥200 mg/dL than <200 mg/dL. Achievement of hs-CRP level (<2 mg/L) was comparable for both treatments. Significantly more patients attained both LDL-C (<70 mg/dL) and hs-CRP (<2 mg/L) at all E/S doses compared to A (P < 0.05 to P < 0.001), regardless of baseline CRP levels.
CONCLUSION
E/S provides a therapeutic option to T2DM patients for lowering not only LDL-C, but also non-HDL-C, ApoB, and hs-CRP. These factors may help guide assessment and treatment of cardiovascular disease risk in these patients.
背景
除了低密度脂蛋白胆固醇（LDL-C），非高密度脂蛋白胆固醇（non-HDL-C）、载脂蛋白 B（ApoB）和高敏 C 反应蛋白（hs-CRP）也被认为可预测 2 型糖尿病（T2DM）患者的心血管疾病。
目的
评估在接受依折麦布/辛伐他汀（E/S）与阿托伐他汀（A）治疗后，T2DM 患者中达到 LDL-C（<70mg/dL）和非 HDL-C（<100mg/dL）、ApoB（<90mg/dL）和 hs-CRP（<2mg/L）可选目标水平的高胆固醇血症患者的比例。
方法
这是一项多中心、随机、双盲、6 周平行研究的事后分析，通过逻辑回归评估了 T2DM 患者接受 E/S（10/20mg）与 A（10 或 20mg）的常规起始剂量和 E/S（10/40mg）与 A（40mg）的最高剂量治疗时，达到特定 LDL-C 水平以及非 HDL-C、ApoB 和 hs-CRP 的比例。还评估了基线甘油三酯和 hs-CRP 的影响。
结果
与 A 相比，接受 E/S 治疗的患者达到 LDL-C（<70mg/dL）、非 HDL-C（<100mg/dL）和 ApoB（<90mg/dL）的个体和同时目标水平的比例显著更高，所有剂量比较均具有统计学意义（P<0.05 至 P<0.001）。基线甘油三酯水平对 LDL-C 水平的达标无影响。与甘油三酯<200mg/dL 相比，甘油三酯≥200mg/dL 时，非 HDL-C（<100mg/dL）和 ApoB（<90mg/dL）的达标率较低。两种治疗方法的 hs-CRP 水平达标率相当。与 A 相比，无论基线 CRP 水平如何，所有 E/S 剂量组均有更多患者同时达到 LDL-C（<70mg/dL）和 hs-CRP（<2mg/L）（P<0.05 至 P<0.001）。
结论
E/S 为 T2DM 患者提供了一种治疗选择，不仅可降低 LDL-C，还可降低非 HDL-C、ApoB 和 hs-CRP。这些因素可能有助于指导这些患者心血管疾病风险的评估和治疗。
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