Kondo Yoshinobu, Hamai Junko, Nezu Uru, Shigematsu Erina, Kamiko Kazunari, Yamazaki Shunsuke, Yoshii Taishi, Takahashi Mayumi, Takano Tatsuro, Kawasaki Satsuki, Yamada Masayo, Yamakawa Tadashi, Terauchi Yasuo
Department of Endocrinology and Metabolism, Chigasaki Municipal Hospital, Chigasaki, Japan.
Endocr J. 2014;61(4):343-51. doi: 10.1507/endocrj.ej13-0404. Epub 2014 Jan 22.
Previous studies have shown that approximately 50% patients at risk of cardiovascular disease do not achieve lipid management goals. Thus, improvements dyslipidemia management are needed. We investigated the clinical choice and efficacy of second-line treatments for dyslipidemia in the Japanese clinical setting. Using a retrospective cohort design, we collected lipid profile data from patients who had been treated with hypolipidemic agents at a stable dosage for at least 12 weeks. These patients had then been administered a second-line treatment for dyslipidemia because they had not achieved the low-density lipoprotein cholesterol (LDL-C) management goals. We included data from 641 patients in our analysis. The top three choices for second-line treatment were adding ezetimibe, switching to strong statins (statin switching), and doubling the original statin dosage (statin doubling). Adding ezetimibe, statin switching, and statin doubling decreased LDL-C levels by 28.2 ± 14.5%, 23.2 ± 24.4%, and 23.5 ± 17.2%, respectively. Among these three strategies, adding ezetimibe decreased LDL-C levels to the maximum extent. In patients with dysglycemia, baseline-adjusted change in hemoglobin A1c (HbA1c) levels decreased slightly in the adding-ezetimibe, statin-switching, and statin-doubling groups, but the differences were not statistically significant among the groups (-0.10 ± 0.62%, -0.22 ± 0.54%, and -0.12 ± 0.52%, p = 0.19). In conclusion, the most common second-line treatment options for dyslipidemia were adding ezetimibe, statin switching, or statin doubling. Adding ezetimibe resulted in the highest reduction in LDL-C levels. These strategies did not increase HbA1c levels when administered with conventional diabetes treatment.
先前的研究表明，约50%有心血管疾病风险的患者未达到血脂管理目标。因此，需要改善血脂异常管理。我们在日本临床环境中研究了血脂异常二线治疗的临床选择和疗效。采用回顾性队列设计，我们收集了接受稳定剂量降脂药物治疗至少12周的患者的血脂谱数据。这些患者因未达到低密度脂蛋白胆固醇（LDL-C）管理目标而接受了血脂异常的二线治疗。我们的分析纳入了641例患者的数据。二线治疗的前三大选择是加用依折麦布、换用强效他汀类药物（他汀类药物转换）和将原他汀类药物剂量加倍（他汀类药物加倍）。加用依折麦布、他汀类药物转换和他汀类药物加倍分别使LDL-C水平降低了28.2±14.5%、23.2±24.4%和23.5±17.2%。在这三种策略中，加用依折麦布使LDL-C水平降低的幅度最大。在血糖异常的患者中，可以看到加用依折麦布组、他汀类药物转换组和他汀类药物加倍组糖化血红蛋白（HbA1c）水平的基线校正变化略有下降，但各组之间差异无统计学意义（-0.10±0.62%、-0.22±0.54%和-0.12±0.52%，p=0.19）。总之，血脂异常最常见的二线治疗选择是加用依折麦布、他汀类药物转换或他汀类药物加倍。加用依折麦布使LDL-C水平降低幅度最大。这些策略与传统糖尿病治疗联合使用时不会增加HbA1c水平。
