Bach L A, Cooper M E, O'Brien R C, Jerums G
Endocrine Unit, Austin Hospital, Heidelberg, Victoria, Australia.
J Am Geriatr Soc. 1990 Jan;38(1):10-4. doi: 10.1111/j.1532-5415.1990.tb01589.x.
Epidemiological evidence suggests that elevated serum cholesterol, especially the low density lipoprotein (LDL) fraction, the total/high density lipoprotein (HDL)-cholesterol ratio, and the LDL/HDL-cholesterol ratio, remains a risk factor for atheromatous disease up to the age of 79 years. We studied the efficacy and tolerability of simvastatin, an HMG CoA reductase inhibitor, in 20 patients aged 65 to 75 years with clinical evidence of atheromatous disease. After four weeks of treatment, there was a 29% fall in LDL-cholesterol levels (P less than .01 vs placebo) with low dose simvastatin and a 38% fall with high dose simvastatin (P less than .001 vs placebo). Similar falls were seen in total cholesterol levels and the LDL/HDL-cholesterol and total/HDL-cholesterol ratios. Apoprotein B levels decreased by approximately 20% with both doses (P less than .05 vs placebo). In an open extension of the study, the decreases in lipid parameters were sustained for a further 48 weeks of treatment with doses of simvastatin ranging from 10 to 40 mg. Two patients required the addition of cholestyramine. Although a small study like this cannot establish safety and tolerance, side effects were minor and did not require stopping therapy in any patient. Simvastatin is an effective cholesterol lowering agent in older patients.
流行病学证据表明，血清胆固醇升高，尤其是低密度脂蛋白（LDL）部分、总胆固醇/高密度脂蛋白（HDL）胆固醇比值以及LDL/HDL胆固醇比值升高，在79岁之前一直是动脉粥样硬化疾病的危险因素。我们研究了HMG CoA还原酶抑制剂辛伐他汀对20例年龄在65至75岁、有动脉粥样硬化疾病临床证据患者的疗效和耐受性。治疗四周后，低剂量辛伐他汀使LDL胆固醇水平下降29%（与安慰剂相比P<0.01），高剂量辛伐他汀使LDL胆固醇水平下降38%（与安慰剂相比P<0.001）。总胆固醇水平以及LDL/HDL胆固醇和总胆固醇/HDL胆固醇比值也出现类似下降。两种剂量均使载脂蛋白B水平下降约20%（与安慰剂相比P<0.05）。在该研究的开放扩展阶段，使用10至40毫克剂量的辛伐他汀进一步治疗48周，脂质参数的下降得以持续。两名患者需要加用消胆胺。虽然这样的小型研究无法确定安全性和耐受性，但副作用较小，没有任何患者需要停止治疗。辛伐他汀是老年患者有效的降胆固醇药物。
