Clinic of Cardiovascular Diseases, Department of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
Eur J Clin Invest. 2014 May;44(5):501-15. doi: 10.1111/eci.12255.
The natural history of atherosclerosis might involve coronary plaque rupture/erosion, thrombus formation and vessel lumen occlusion, clinically recognized as acute coronary syndrome (ACS). International guidelines strongly recommend early statin administration in patients admitted for ACS. In addition to lowering circulating levels of low-density lipoprotein cholesterol (LDL-c), statin treatment was shown to promote plaque stabilization or regression in several ways, including reduction in necrotic lipid core, anti-inflammatory effects and improvement in endothelial function. The aim of this review is to summarize clinical evidence on the role of statins in secondary prevention of ACS.
This narrative review is based on the material found on medline and pubmed up to August 2013. We looked for the terms 'statin, acute coronary syndromes' in combination with 'atherosclerosis, acute myocardial infarction, pathophysiology'.
This review article emphasizes the relevance of the timing of statin administration to improve the outcomes after ACS. Early and continuous statin administration has emerged as key features to prevent adverse events, especially in patients admitted for ACS undergoing percutaneous coronary intervention. Clinical trials matching the improved clinical outcome with the imaging of atherosclerotic plaque stabilization/regression, further supporting the effectiveness of statin therapy. However, the achievement of these goals requires high dose of statins, thus increasing the risk of adverse events.
Although clinical trials and meta-analyses have provided conflicting results, it is likely that in clinical practice, the rate of adverse events is higher, so that many concerns still remain about a statin high-dose approach in ACS patients.
动脉粥样硬化的自然史可能涉及冠状动脉斑块破裂/侵蚀、血栓形成和血管腔闭塞，临床上称为急性冠状动脉综合征（ACS）。国际指南强烈建议在 ACS 住院患者中尽早使用他汀类药物。除了降低循环中的低密度脂蛋白胆固醇（LDL-c）水平外，他汀类药物治疗还通过多种方式促进斑块稳定或消退，包括减少坏死脂质核心、抗炎作用和改善内皮功能。本综述的目的是总结他汀类药物在 ACS 二级预防中的作用的临床证据。
本叙述性综述基于截至 2013 年 8 月在 Medline 和 PubMed 上找到的材料。我们搜索了“他汀类药物、急性冠状动脉综合征”与“动脉粥样硬化、急性心肌梗死、病理生理学”的组合术语。
本文强调了他汀类药物给药时间对改善 ACS 后结局的相关性。早期和持续的他汀类药物给药已成为预防不良事件的关键特征，尤其是在接受经皮冠状动脉介入治疗的 ACS 住院患者中。与动脉粥样硬化斑块稳定/消退的影像学相匹配的临床试验进一步支持了他汀类药物治疗的有效性，改善了临床结果。然而，实现这些目标需要高剂量的他汀类药物，从而增加不良事件的风险。
尽管临床试验和荟萃分析提供了相互矛盾的结果，但在临床实践中，不良事件的发生率可能更高，因此，对于 ACS 患者的他汀类药物高剂量方法仍存在许多担忧。
