Endocrinology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
Int J Cardiol. 2013 Jun 5;166(1):8-14. doi: 10.1016/j.ijcard.2012.03.127. Epub 2012 Apr 12.
Lowering low-density lipoprotein-cholesterol (LDL-C) is the primary target in the management of dyslipidemia in patients at high risk of cardiovascular disease. However, patients who have achieved LDL-C levels below the currently recommended targets may still experience cardiovascular events. This may result, in part, from elevated triglyceride (TG) levels and low levels of high-density lipoprotein-cholesterol (HDL-C). Low HDL-C and high TG levels are common and are recognized as independent risk factors for cardiovascular morbidity and mortality. Furthermore, atherogenic dyslipidemia, characterized by low levels of HDL-C, high TG, and small, dense LDL particles, is a typical phenotype of dyslipidemia in subjects with insulin resistance and metabolic syndrome. Therefore, to reduce further the risk of coronary heart disease (CHD), raising HDL-C and lowering TG may be the secondary therapeutic target for patients who achieve LDL-C levels below the currently recommended targets but are still at risk of CHD. However, whether increasing HDL-C levels alone reduces CHD has not yet been confirmed in large randomized clinical trials, and whether functional HDL is more important than HDL-C in reducing CHD remains controversial. Large CHD endpoint trials that include many patients with diabetes are underway to compare combination treatments with statin and niacin, fibrates, or cholesteryl ester transfer protein inhibitors with statin alone treatments. In this review, we discuss the rationale and importance of increasing HDL-C levels with and without lowering TG levels in the treatment and prevention of cardiovascular events.
降低低密度脂蛋白胆固醇（LDL-C）是心血管疾病高危患者血脂异常管理的主要目标。然而，已经达到目前推荐目标以下 LDL-C 水平的患者仍可能经历心血管事件。这可能部分归因于甘油三酯（TG）水平升高和高密度脂蛋白胆固醇（HDL-C）水平降低。低 HDL-C 和高 TG 水平很常见，被认为是心血管发病率和死亡率的独立危险因素。此外，致动脉粥样硬化性血脂异常的特征是 HDL-C 水平降低、TG 水平升高和小而密的 LDL 颗粒，这是胰岛素抵抗和代谢综合征患者血脂异常的典型表型。因此，为了进一步降低冠心病（CHD）风险，提高 HDL-C 和降低 TG 可能是 LDL-C 水平低于目前推荐目标但仍有 CHD 风险的患者的次要治疗目标。然而，单独增加 HDL-C 水平是否能降低 CHD 尚未在大型随机临床试验中得到证实，功能性 HDL 是否比 HDL-C 更能降低 CHD 仍存在争议。正在进行大型 CHD 终点试验，比较他汀类药物和烟酸、贝特类药物或胆固醇酯转移蛋白抑制剂与他汀类药物单独治疗的联合治疗。在这篇综述中，我们讨论了在治疗和预防心血管事件中，无论是否降低 TG 水平，增加 HDL-C 水平的原理和重要性。
