St. John Providence Health System, Providence Park Heart Institute, Novi, MI, USA.
Rev Cardiovasc Med. 2011;12(4):173-85. doi: 10.3909/ricm0619.
This review investigates how the treatment of hypertriglyceridemia with fibric acid derivatives impacts lipid concentrations, lipid particle size, and the rate of cardiovascular events: expressly, to decide whether the use of fibric acid derivatives is an effective treatment option in the reduction of cardiovascular endpoints for patients with specific lipid parameters at baseline. Fibric acid derivatives reduce fasting triglyceride (TG) values by 15% to 50% (depending on baseline level) and low-density lipoprotein cholesterol (LDL-C) by 8%, and raise high-density lipoprotein cholesterol (HDL-C) by 9%. In conjunction with a statin, the amount of TG lowering is approximately doubled with the addition of the fibrate. When measured, fibrates decrease the TG concentration of very low-density lipoprotein cholesterol particles while increasing the TG content of LDL particles. The mean size of LDL particles increases and there is a substantial reduction in the number and proportion of small, dense LDL. In randomized trials in primary and secondary prevention populations, fibrates were associated with a significant reduction in nonfatal myocardial infarction in most studies. In the subgroup with elevated TG and/or depressed HDL-C at baseline, all trials have found statistically significant relative risk reductions of 27% to 65% in the primary cardiovascular endpoint of myocardial infarction and cardiovascular death.
这篇综述探讨了用纤维酸衍生物治疗高甘油三酯血症如何影响脂质浓度、脂质颗粒大小以及心血管事件的发生率：具体来说，就是要确定对于基线时特定血脂参数的患者，使用纤维酸衍生物是否是降低心血管终点的有效治疗选择。纤维酸衍生物可使空腹甘油三酯（TG）降低 15%至 50%（取决于基线水平），使低密度脂蛋白胆固醇（LDL-C）降低 8%，并使高密度脂蛋白胆固醇（HDL-C）升高 9%。与他汀类药物联合使用时，添加纤维酸酯可使 TG 降低量增加约一倍。当进行测量时，纤维酸酯会降低极低密度脂蛋白胆固醇颗粒中的 TG 浓度，同时增加 LDL 颗粒中的 TG 含量。LDL 颗粒的平均大小增加，小而密的 LDL 颗粒的数量和比例也大幅减少。在原发性和二级预防人群的随机试验中，纤维酸酯与大多数研究中的非致死性心肌梗死发生率显著降低相关。在基线时 TG 升高和/或 HDL-C 降低的亚组中，所有试验均发现心肌梗死和心血管死亡这一主要心血管终点的相对风险降低了 27%至 65%。
