The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
Am J Med. 2012 May;125(5):440-6. doi: 10.1016/j.amjmed.2011.11.013. Epub 2012 Mar 2.
Three-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, commonly known as statins, are widely available, inexpensive, and represent a potent therapy for treating elevated cholesterol. Current national guidelines put forth by the Adult Treatment Panel III recommend statins as part of a comprehensive primary prevention strategy for patients with elevated low-density lipoprotein cholesterol at increased risk for developing coronary heart disease within 10 years. Lack of a clear-cut mortality benefit in primary prevention has caused some to question the use of statins for patients without known coronary heart disease. On review of the literature, we conclude that current data support only a modest mortality benefit for statin primary prevention when assessed in the short term (<5 years). Of note, statin primary prevention results in a significant decrease in cardiovascular morbidity over the short and long term and a trend toward increased reduction in mortality over the long term. When appraised together, these data provide compelling evidence to support the use of statins for primary prevention in patients with risk factors for developing coronary heart disease over the next 10 years.
三羟基-3-甲基戊二酰辅酶 A 还原酶抑制剂，通常被称为他汀类药物，广泛可用，价格低廉，是治疗高胆固醇的有效方法。目前成人治疗专家组 III 提出的国家指南建议将他汀类药物作为患有高胆固醇血症且在 10 年内有发展为冠心病风险的患者综合一级预防策略的一部分。一级预防中缺乏明确的死亡率获益使得一些人质疑他汀类药物在没有已知冠心病的患者中的使用。对文献的回顾表明，我们的结论是，当在短期内（<5 年）评估时，他汀类药物一级预防仅支持适度的死亡率获益。值得注意的是，他汀类药物一级预防在短期和长期内显著降低心血管发病率，并在长期内有降低死亡率的趋势。综合这些数据，有力地证明了在未来 10 年内有发展为冠心病风险的患者中使用他汀类药物进行一级预防的合理性。
