Hochholzer Willibald, Berg David D, Giugliano Robert P
TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Ther Adv Cardiovasc Dis. 2011 Oct;5(5):227-40. doi: 10.1177/1753944711419197. Epub 2011 Sep 5.
Although low-density lipoprotein cholesterol (LDL-C) lowering represents the mainstay of current lipid treatment, high-density lipoprotein cholesterol (HDL-C) has generated increasing interest as a secondary therapeutic target because of strong evidence that serum HDL-C concentration is inversely associated with coronary heart disease risk. Niacin is a lipid-altering drug that has been used to lower cholesterol since the 1950s. In addition to its LDL-C-lowering effects, niacin is the most effective agent currently available for raising HDL-C. Despite its long history as a lipid-altering drug, only limited data are available regarding its clinical benefit alone and in combination with other agents, and the majority of studies investigating its impact on clinical outcomes are from the pre-statin area. Several studies have demonstrated a beneficial effect of treatment with niacin in combination with statin therapy on surrogate cardiovascular markers (e.g. carotid intima-media thickness). However, the clinical significance of these surrogate markers has been questioned. Two large randomized trials will address whether niacin-statin combination therapy is an appropriate therapeutic alternative to statin monotherapy.
尽管降低低密度脂蛋白胆固醇（LDL-C）是当前血脂治疗的主要手段，但高密度脂蛋白胆固醇（HDL-C）作为次要治疗靶点已引发越来越多的关注，因为有充分证据表明血清HDL-C浓度与冠心病风险呈负相关。烟酸是一种自20世纪50年代以来就被用于降低胆固醇的调脂药物。除了具有降低LDL-C的作用外，烟酸是目前可获得的升高HDL-C最有效的药物。尽管烟酸作为调脂药物已有很长历史，但关于其单独使用及与其他药物联合使用的临床益处的可用数据有限，且大多数研究其对临床结局影响的研究都来自他汀类药物出现之前的时期。几项研究已证明烟酸与他汀类药物联合治疗对替代心血管标志物（如颈动脉内膜中层厚度）有有益作用。然而，这些替代标志物的临床意义受到了质疑。两项大型随机试验将探讨烟酸-他汀联合治疗是否是他汀类药物单药治疗的合适替代疗法。
