Weill Cornell Medical College, New York, New York 10021, USA.
Am J Cardiol. 2012 Jul 1;110(1 Suppl):15A-26A. doi: 10.1016/j.amjcard.2012.04.003.
Results from multiple clinical trials, primarily with the class of lipid-lowering agents known as statins, have shown that reductions in low-density lipoprotein (LDL) cholesterol are associated with reduced risk of coronary artery disease. Although LDL cholesterol is the primary target of cholesterol management strategies, increasing attention has focused on the role of inflammation, high-density lipoprotein cholesterol, and triglycerides in atherosclerosis and cardiovascular disease. We review major trials with lipid-modifying therapies published since the 2004 update of the Adult Treatment Panel (ATP) III guidelines. A pivotal trial was the Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), which demonstrated significant reductions in cardiovascular morbidity and mortality in healthy individuals without elevated LDL cholesterol but with high levels of the inflammatory marker high-sensitivity C-reactive protein. Additional trials demonstrated the efficacy of intensive statin therapy in secondary prevention, whereas other agents, including fibrates, omega-3 fatty acids, niacin, ezetimibe, and experimental cholesteryl ester transfer protein inhibitors, have been evaluated for their ability to reduce residual cardiovascular risk.
多项临床试验的结果表明，降低低密度脂蛋白（LDL）胆固醇与降低冠心病风险有关，这些临床试验主要针对降脂药物类别，即他汀类药物。虽然 LDL 胆固醇是胆固醇管理策略的主要目标，但越来越多的关注集中在炎症、高密度脂蛋白胆固醇和甘油三酯在动脉粥样硬化和心血管疾病中的作用。我们回顾了自 2004 年成人治疗专家组（ATP）III 指南更新以来发表的主要脂质调节治疗试验。一项关键试验是他汀类药物在一级预防中的应用的合理性：评价瑞舒伐他汀的干预试验（JUPITER），该试验表明，在 LDL 胆固醇不高但炎症标志物高敏 C 反应蛋白水平高的健康人群中，心血管发病率和死亡率显著降低。其他试验表明强化他汀类药物治疗在二级预防中的有效性，而其他药物，包括贝特类药物、ω-3 脂肪酸、烟酸、依折麦布和实验性胆固醇酯转移蛋白抑制剂，也已被评估其降低残余心血管风险的能力。
