Kakuda Hirokazu, Matoba Munetoshi, Nakatoh Hideaki, Nagao Shin, Takekoshi Noboru
Kakuda Clinic , Ishikawa , Japan.
Scand J Clin Lab Invest. 2014 Jun;74(4):285-95. doi: 10.3109/00365513.2014.882015. Epub 2014 Feb 24.
Low-density lipoprotein cholesterol (LDL-C) is a major cardiovascular risk. However, some patients show symptoms of coronary heart disease (CHD) even though their LDL-C is strictly controlled. Therefore, it is important to treat other risk factors.
Some 129 outpatients with dyslipidemia who were treated with either atorvastatin 10 mg/day (ATO), pitavastatin 2 mg/day (PIT), or rosuvastatin 2.5 mg/day (ROS) were enrolled. After informed consent was obtained, these patients were switched to another statin. Lipid profiles and lipoprotein fraction by polyacrylamide gel electrophoresis (PAGE) were compared between before and after 3 months of treatment with non-fasting blood sample.
LDL-C did not show any significant changes after switching and was maintained around 2.59 mmol/L in all groups. High-density lipoprotein cholesterol (HDL-C) was significantly increased in group ATO→PIT (1.43→1.54 mmol/L, p = 0.0010) and ROS→PIT (1.46→1.57 mmol/L, p = 0.0004), and was significantly decreased in group PIT→ATO (1.44→1.36 mmol/L, p = 0.0290). Apolipoprotein A-I (Apo A-I) and preheparin lipoprotein lipase (LPL) mass showed similar changes in HDL-C. Changes in HDL-C showed a significant positive correlation with those in Apo A-I and preheparin LPL mass, and a little but significant negative correlation with changes in Lp(a) and intermediate density lipoprotein (IDL) fraction.
ATO, PIT, and ROS have comparable effect on LDL-C lowering. Changes in HDL-C were similar to those in Apo A-I and preheparin LPL mass, and PIT was the most effective treatment in increasing HDL-C, Apo A-I, and preheparin LPL mass.
低密度脂蛋白胆固醇（LDL-C）是主要的心血管风险因素。然而，一些患者即使其LDL-C得到严格控制，仍表现出冠心病（CHD）症状。因此，治疗其他风险因素很重要。
招募了约129例血脂异常门诊患者，分别接受阿托伐他汀10毫克/天（ATO）、匹伐他汀2毫克/天（PIT）或瑞舒伐他汀2.5毫克/天（ROS）治疗。在获得知情同意后，这些患者换用另一种他汀类药物。使用非空腹血样比较治疗3个月前后的血脂谱和通过聚丙烯酰胺凝胶电泳（PAGE）检测的脂蛋白组分。
换药后LDL-C无显著变化，所有组均维持在约2.59毫摩尔/升左右。高密度脂蛋白胆固醇（HDL-C）在ATO→PIT组（1.43→1.54毫摩尔/升，p = 0.0010）和ROS→PIT组（1.46→1.57毫摩尔/升，p = 0.0004）显著升高，在PIT→ATO组（1.44→1.36毫摩尔/升，p = 0.0290）显著降低。载脂蛋白A-I（Apo A-I）和肝素前脂蛋白脂肪酶（LPL）质量在HDL-C方面表现出相似变化。HDL-C的变化与Apo A-I和肝素前LPL质量的变化呈显著正相关，与Lp(a)和中间密度脂蛋白（IDL）组分的变化呈轻微但显著的负相关。
ATO、PIT和ROS在降低LDL-C方面具有相当的效果。HDL-C的变化与Apo A-I和肝素前LPL质量的变化相似，PIT在升高HDL-C、Apo A-I和肝素前LPL质量方面是最有效的治疗方法。
