Department of Clinical Biochemistry and The Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Department of Clinical Biochemistry and The Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Lancet. 2014 Aug 16;384(9943):626-635. doi: 10.1016/S0140-6736(14)61177-6.
After the introduction of statins, clinical emphasis first focussed on LDL cholesterol-lowering, then on the potential for raising HDL cholesterol, with less focus on lowering triglycerides. However, the understanding from genetic studies and negative results from randomised trials that low HDL cholesterol might not cause cardiovascular disease as originally thought has now generated renewed interest in raised concentrations of triglycerides. This renewed interest has also been driven by epidemiological and genetic evidence supporting raised triglycerides, remnant cholesterol, or triglyceride-rich lipoproteins as an additional cause of cardiovascular disease and all-cause mortality. Triglycerides can be measured in the non-fasting or fasting states, with concentrations of 2-10 mmol/L conferring increased risk of cardiovascular disease, and concentrations greater than 10 mmol/L conferring increased risk of acute pancreatitis and possibly cardiovascular disease. Although randomised trials showing cardiovascular benefit of triglyceride reduction are scarce, new triglyceride-lowering drugs are being developed, and large-scale trials have been initiated that will hopefully provide conclusive evidence as to whether lowering triglycerides reduces the risk of cardiovascular disease.
他汀类药物问世后，临床重点首先集中在降低 LDL 胆固醇上，然后是提高 HDL 胆固醇的潜力，而对降低甘油三酯的关注较少。然而，从遗传研究和随机试验的阴性结果中可以看出，最初认为低 HDL 胆固醇不会导致心血管疾病，这重新引起了人们对升高的甘油三酯浓度的兴趣。这种新的兴趣也受到了支持升高的甘油三酯、残余胆固醇或富含甘油三酯的脂蛋白作为心血管疾病和全因死亡率的另一个原因的流行病学和遗传证据的推动。甘油三酯可以在非禁食或禁食状态下测量，浓度为 2-10mmol/L 会增加心血管疾病的风险，浓度大于 10mmol/L 会增加急性胰腺炎和可能的心血管疾病的风险。虽然显示甘油三酯降低对心血管有益的随机试验很少，但新的降甘油三酯药物正在开发中，并且已经启动了大规模试验，希望能提供确凿的证据，证明降低甘油三酯是否能降低心血管疾病的风险。
