Department of Cardiology, The Second Xiang Ya Hospital, Central South University, No, 139, Renmin Zhonglu, Changsha, Hunan 410011, China.
Lipids Health Dis. 2013 Sep 9;12:133. doi: 10.1186/1476-511X-12-133.
Statin-fibrate combination therapy has been used to treat patients with acute coronary syndrome (ACS) complicated by elevated triglycerides (TG) and decreased high density lipoprotein cholesterol (HDL-C). The purpose of this study was to evaluate the influence of the combination therapy on lipids profile and apolipoprotein A5 (apoA5) level in patients with ACS.
One hundred and four patients with ACS were recruited and randomly assigned into two groups: one was statin group (n = 52), given atorvastatin (20 mg QN) or other statins with equivalent dosages; the other was combination group (n = 52), given the same dose of statin plus bezafibrate (200 mg BID). Follow-up visits were scheduled at the end of 6 and 12 weeks post treatment. Serum apoA5 levels were determined using a commercial available ELISA kit.
(1) Compared with that of statin monotherapy, statin-bezafibrate combination treatment not only resulted in a significant reduction of TG, TC and LDL-C levels, (all p < 0.05), but also led to increases in HDL-C and apoA5 levels (p < 0.05).(2) The percentage changes of TC, TG, LDL-C and apoA5 levels in both groups were even bigger at 12 weeks after treatment than that at 6 weeks (all p < 0.05). Similarly, the rates of achieving lipid-control target were higher in statin-bezafibrate combination treatment group than those in statin monotherapy group (all p < 0.05).(3) Spearman rank correlation analysis showed that the pre-treatment apoA5 level was positively correlated with TG (r = 0.359, p = 0.009). However, a negative correlation was observed between apoA5 and TG (r = -0.329, p = 0.017) after 12 weeks treatment.
Statin and fibrate combination therapy is more effective than statin alone in achieving a comprehensive lipid control for ACS patients. Serum apoA5 elevation after statin and fibrate combination treatment could be due to the synergistic effect of both drugs on hypertriglyceridemia control.
他汀类药物与贝特类药物联合治疗已被用于治疗伴有甘油三酯（TG）升高和高密度脂蛋白胆固醇（HDL-C）降低的急性冠脉综合征（ACS）患者。本研究旨在评估联合治疗对 ACS 患者血脂谱和载脂蛋白 A5（apoA5）水平的影响。
纳入 104 例 ACS 患者，随机分为两组：他汀组（n=52）给予阿托伐他汀（20 mg QN）或等效剂量的其他他汀类药物；联合组（n=52）给予相同剂量的他汀类药物加苯扎贝特（200 mg BID）。治疗结束后 6 周和 12 周进行随访。采用商业 ELISA 试剂盒测定血清 apoA5 水平。
（1）与他汀类药物单药治疗相比，他汀类药物与贝特类药物联合治疗不仅显著降低了 TG、TC 和 LDL-C 水平（均 P<0.05），还导致 HDL-C 和 apoA5 水平升高（均 P<0.05）。（2）治疗 12 周后，两组 TC、TG、LDL-C 和 apoA5 水平的变化百分比均大于治疗 6 周后的变化百分比（均 P<0.05）。同样，他汀类药物与贝特类药物联合治疗组达到降脂目标的比例高于他汀类药物单药治疗组（均 P<0.05）。（3）Spearman 秩相关分析显示，治疗前 apoA5 水平与 TG 呈正相关（r=0.359，P=0.009）。然而，治疗 12 周后，apoA5 与 TG 呈负相关（r=-0.329，P=0.017）。
与他汀类药物单药治疗相比，他汀类药物与贝特类药物联合治疗更能有效实现 ACS 患者的全面血脂控制。他汀类药物与贝特类药物联合治疗后血清 apoA5 升高可能是由于两种药物协同作用于高甘油三酯血症的控制。
