Division of Endocrinology and Metabolism, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Can J Cardiol. 2012 Nov-Dec;28(6):667-77. doi: 10.1016/j.cjca.2012.03.017. Epub 2012 Aug 15.
Many patients remain at high risk for future cardiovascular events despite levels of low-density lipoprotein cholesterol (LDL-C) at, or below, target while taking statin therapy. Much effort is therefore being focused on strategies to reduce this residual risk. High-density lipoprotein cholesterol (HDL-C) is a strong, independent, inverse predictor of coronary heart disease risk and is therefore an attractive therapeutic target. Currently available agents that raise HDL-C have only modest effects and there is limited evidence of additional cardiovascular risk reduction on top of background statin therapy associated with their use. It was hoped that the use of cholesteryl ester transfer protein (CETP) inhibitors would provide additional benefit, but the results of clinical outcome studies to date have been disappointing. The results of ongoing trials with other CETP inhibitors that raise HDL-C to a greater degree and also lower LDL-C, as well as with other emerging therapies are awaited.
许多患者在服用他汀类药物治疗时，低密度脂蛋白胆固醇（LDL-C）水平达到或低于目标值，但仍存在发生心血管事件的高风险。因此，人们正在努力寻找降低这种残余风险的策略。高密度脂蛋白胆固醇（HDL-C）是冠心病风险的一个强有力的、独立的、反向预测因素，因此是一个有吸引力的治疗靶点。目前可用的升高 HDL-C 的药物只有适度的效果，而且在使用这些药物的基础上，与他汀类药物联合应用，其对心血管风险的额外降低作用的证据有限。人们曾希望胆固醇酯转移蛋白（CETP）抑制剂的使用能带来额外的益处，但迄今为止，临床结局研究的结果令人失望。目前正在进行的其他 CETP 抑制剂的临床试验结果正在等待中，这些药物能更有效地升高 HDL-C，并降低 LDL-C，同时还有其他新的治疗方法。
