The Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland 21287, USA.
J Am Coll Cardiol. 2012 Jun 5;59(23):2058-64. doi: 10.1016/j.jacc.2012.01.045. Epub 2012 Apr 18.
Despite substantial risk reductions targeting low-density lipoprotein cholesterol with statins, there remains significant residual risk as evidenced by incident and recurrent cardiovascular disease (CVD) events among statin-treated patients. Observational studies have shown that low levels of high-density lipoprotein cholesterol (HDL-C) are associated with increased CVD risk. It remains unclear whether strategies aimed at increasing HDL-C in addition to background statin therapy will further reduce risk. The AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides: Impact on Global Health Outcomes) trial, which compared combined niacin/simvastatin with simvastatin alone, failed to demonstrate an incremental benefit of niacin among patients with atherosclerotic CVD and on-treatment low-density lipoprotein cholesterol values <70 mg/dl, but this study had some limitations. Previously, small randomized, clinical trials of niacin plus statins showed that modest regression of carotid atherosclerosis is possible in individuals with CVD, CVD risk equivalents, or atherosclerosis. This viewpoint summarizes these imaging trials studying niacin and places them in the context of the failure of AIM-HIGH to support the HDL-C-increasing hypothesis.
尽管通过他汀类药物显著降低了低密度脂蛋白胆固醇（LDL-C）的风险，但在他汀类药物治疗的患者中仍存在显著的剩余风险，这表现在心血管疾病（CVD）的发生和复发上。观察性研究表明，高密度脂蛋白胆固醇（HDL-C）水平低与 CVD 风险增加有关。目前尚不清楚在背景他汀类药物治疗的基础上增加 HDL-C 的策略是否会进一步降低风险。AIM-HIGH（载脂蛋白代谢综合征患者中低 HDL/高甘油三酯的动脉粥样硬化血栓形成干预：对全球健康结果的影响）试验比较了烟酸/辛伐他汀联合辛伐他汀与单独辛伐他汀的疗效，结果表明在动脉粥样硬化性 CVD 患者和治疗中 LDL-C 值<70mg/dl 的患者中，烟酸联合治疗并不能带来额外获益，但这项研究存在一些局限性。此前，烟酸联合他汀类药物的小型随机临床试验表明，在 CVD、CVD 风险等价物或动脉粥样硬化患者中，颈动脉粥样硬化的适度消退是可能的。本观点总结了这些研究烟酸的影像学试验，并将其置于 AIM-HIGH 未能支持 HDL-C 升高假说的背景下。
