Brown W V
Medlantic Research Foundation, Washington, DC 20010.
Am J Cardiol. 1990 Sep 4;66(6):11A-15A. doi: 10.1016/0002-9149(90)90563-g.
The incidence of myocardial infarction (MI), sudden death and other clinical manifestations of coronary heart disease can be reduced by lowering the blood cholesterol level. This is now well established by multiple clinical trials using a variety of interventions including diet and lipid-lowering drugs. Dietary studies in Los Angeles and in Oslo, Norway, have induced a reduction in blood cholesterol of between 10 and 15% with correlated reductions in coronary disease of 20 to 50%. Both niacin and clofibrate in separate cohorts demonstrated a significant reduction in new MI during 5 years of treatment in the Coronary Drug Project. Similar reductions in new MI occurred in the World Health Organization Study with clofibrate. However, in this trial and different from all other trials, mortality in the drug-treatment group actually increased. This finding remains unexplained. In the more recent Lipid Research Clinics Coronary Primary Prevention Trial using the bile acid-binding resin cholestyramine, only a 9% reduction in total cholesterol resulted in a highly significant reduction in the major end points--MI and sudden death--as well as in other secondary end points, including the need for coronary artery bypass graft surgery, ischemic changes on exercise electrocardiography and new-onset angina. Recently, another primary prevention trial using gemfibrozil produced a similar reduction in total cholesterol but a much more significant increase in high-density lipoprotein cholesterol. The reduction in coronary heart disease was in excess of 34% and was strongly related to both low-density lipoprotein cholesterol reduction and high-density lipoprotein elevation. Combination drug studies have produced larger reductions in total cholesterol.(ABSTRACT TRUNCATED AT 250 WORDS)
降低血液胆固醇水平可减少心肌梗死（MI）、猝死及冠心病的其他临床表现的发生率。这一点现已通过多项临床试验得到充分证实，这些试验采用了包括饮食和降脂药物在内的多种干预措施。在洛杉矶和挪威奥斯陆进行的饮食研究使血液胆固醇降低了10%至15%，同时冠心病的发生率相应降低了20%至50%。在冠心病药物项目中，烟酸和氯贝丁酯在不同队列中均显示在5年治疗期间新发MI显著减少。在世界卫生组织使用氯贝丁酯的研究中也出现了类似的新发MI减少情况。然而，在该试验中，与所有其他试验不同的是，药物治疗组的死亡率实际上增加了。这一发现仍无法解释。在最近使用胆汁酸结合树脂消胆胺的脂质研究临床冠心病一级预防试验中，总胆固醇仅降低9%就导致主要终点——MI和猝死——以及其他次要终点，包括冠状动脉搭桥手术需求、运动心电图缺血改变和新发心绞痛显著减少。最近，另一项使用吉非贝齐的一级预防试验使总胆固醇有类似程度的降低，但高密度脂蛋白胆固醇有更显著的升高。冠心病的减少超过34%，且与低密度脂蛋白胆固醇降低和高密度脂蛋白升高均密切相关。联合药物研究使总胆固醇有更大程度的降低。（摘要截取自250词）
