Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, USA.
Am J Cardiol. 2012 May 1;109(9):1239-46. doi: 10.1016/j.amjcard.2011.12.015. Epub 2012 Feb 21.
Patients with acute coronary syndrome are recommended for early aggressive low-density lipoprotein (LDL) cholesterol-lowering therapy. The LUNAR study compared the efficacy of rosuvastatin with that of atorvastatin in decreasing LDL cholesterol in patients with acute coronary syndrome. Adult patients with coronary artery disease who were hospitalized for an acute coronary syndrome within 48 hours of first symptoms were randomized (n = 825) to an open-label, once-daily treatment with rosuvastatin 20 mg (RSV20), rosuvastatin 40 mg (RSV40), or atorvastatin 80 mg (ATV80) for 12 weeks. Patients were evaluated at weeks 2, 6, and 12. The primary end point was treatment efficacy in lowering LDL cholesterol averaged over 6 to 12 weeks. Changes in other lipoproteins, including high-density lipoprotein (HDL) cholesterol, and safety were evaluated. Analysis of covariance was used to compare least squares mean differences between each rosuvastatin treatment arm and the atorvastatin arm. The efficacy of RSV40 in lowering LDL cholesterol was significantly greater than that of ATV80 (46.8% vs 42.7% decrease, p = 0.02). LDL cholesterol lowering by RSV20 was similar to that by ATV80. Increases in HDL cholesterol were significantly greater with RSV40 (11.9%, p <0.001) and RSV20 (9.7%, p <0.01) than with ATV80 (5.6%). RSV40 was also significantly more effective than ATV80 in improving most other secondary efficacy variables, whereas the effects of RSV20 on these parameters were generally similar to those of ATV80. All 3 treatments were generally well tolerated over 12 weeks. In conclusion, results from the LUNAR study show that RSV40 more effectively decreased LDL cholesterol, increased HDL cholesterol, and improved other blood lipid parameters than ATV80 in patients with acute coronary syndrome.
急性冠状动脉综合征患者建议早期进行积极的低密度脂蛋白（LDL）胆固醇降低治疗。LUNAR 研究比较了瑞舒伐他汀与阿托伐他汀降低急性冠状动脉综合征患者 LDL 胆固醇的疗效。冠心病患者在首发症状后 48 小时内因急性冠状动脉综合征住院，随机（n = 825）接受每日一次、开放性标签治疗，分别接受瑞舒伐他汀 20 mg（RSV20）、瑞舒伐他汀 40 mg（RSV40）或阿托伐他汀 80 mg（ATV80）治疗 12 周。患者在第 2、6 和 12 周进行评估。主要终点是 6 至 12 周期间平均 LDL 胆固醇降低的治疗效果。评估了其他脂蛋白（包括高密度脂蛋白（HDL）胆固醇）的变化和安全性。采用协方差分析比较了各瑞舒伐他汀治疗组与阿托伐他汀组之间最小二乘均数差异。RSV40 降低 LDL 胆固醇的疗效明显优于 ATV80（降幅分别为 46.8%和 42.7%，p = 0.02）。RSV20 降低 LDL 胆固醇的疗效与 ATV80 相似。RSV40 使 HDL 胆固醇升高明显大于 ATV80（增加 11.9%，p<0.001）和 RSV20（增加 9.7%，p<0.01）。RSV40 在改善大多数其他次要疗效指标方面也明显优于 ATV80，而 RSV20 对这些参数的影响通常与 ATV80 相似。三种治疗方法在 12 周内总体耐受良好。总之，LUNAR 研究结果表明，与 ATV80 相比，RSV40 能更有效地降低急性冠状动脉综合征患者的 LDL 胆固醇，升高 HDL 胆固醇，并改善其他血脂参数。
