Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Curr Opin Cardiol. 2011 Sep;26(5):420-3. doi: 10.1097/HCO.0b013e3283499ef1.
Residual cardiovascular risk remains in individuals treated with statins and combination therapies may reduce this risk further.
Most previous trials of combination therapies have shown a favorable effect on lipid profiles without clinical superiority over statin monotherapy. Trial design has been hampered by short duration and comparison with a low dose statin. The Study of Heart and Renal Protection trial has recently reported findings and shows a benefit of ezetimibe/simvastatin over simvastatin alone. AIM-HIGH (Atherothrombosis Intervention in Metabolic syndrome with Low HDL/High Triglycerides and Impact on Global Health Outcomes), a trial of statin/niacin, has been prematurely halted for futility. Finally, combining a statin with both niacin and ezetimibe shows significant enhancement of the therapeutic effect on lipid profiles.
Current evidence continues to support initiation of a potent statin with titration to achieve targets. Combinations may be useful in individuals unable to reach desired lipid levels on maximal tolerated doses of statins.
接受他汀类药物和联合治疗的个体仍存在残余心血管风险，进一步降低这种风险可能会有所帮助。
大多数以前的联合治疗试验显示对血脂谱有有利影响，但与他汀类药物单药治疗相比没有临床优势。试验设计受到持续时间短和与低剂量他汀类药物比较的限制。心脏和肾脏保护研究最近报告了研究结果，表明依折麦布/辛伐他汀比辛伐他汀单药治疗更有益。AIM-HIGH（代谢综合征中低 HDL/高甘油三酯的动脉粥样硬化血栓形成干预及其对全球健康结果的影响），一项他汀类药物/烟酸的试验，因无效而提前终止。最后，将他汀类药物与烟酸和依折麦布联合使用可显著增强对血脂谱的治疗效果。
目前的证据继续支持起始使用强效他汀类药物并滴定以达到目标。对于最大耐受剂量的他汀类药物仍无法达到理想血脂水平的个体，联合治疗可能有用。
