Nakagomi Akihiro, Shibui Toshiyuki, Kohashi Keiichi, Kosugi Munenori, Kusama Yoshiki, Atarashi Hirotsugu, Shimizu Wataru
Department of Internal Medicine and Cardiology, Tama-Nagayama Hospital, Nippon Medical School.
J Atheroscler Thromb. 2015;22(11):1158-71. doi: 10.5551/jat.29520. Epub 2015 Jun 17.
3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have multiple pleiotropic effects, such as anti-inflammatory and vascular endothelium protection, that are independent of their low-density-lipoprotein (LDL) cholesterol lowering effects. However, whether different statins exert diverse effects on inflammation, insulin resistance, and the progression of carotid atherosclerosis [as indicated by the intima-media thickness (CIMT)] in patients with dyslipidemia remains unclear.
A total of 146 patients with hypercholesterolemia without known cardiovascular disease were randomly assigned to receive 5 mg/day of atorvastatin (n=73) or 1 mg/day of pitavastatin (n=73).
At baseline, age, gender, blood pressure, lipid profiles, and the serum monocyte chemoattractant protein (MCP)-1, homeostasis model assessment of insulin resistance (HOMA-IR) and CIMT values were comparable between the groups. After 12 months of treatment, atorvastatin and pitavastatin equally reduced the LDL cholesterol levels; however, atorvastatin increased the HOMA-IR by ＋26% and pitavastatin decreased this parameter by －13% (p＜0.001). The MCP-1 values were reduced by －28% in the patients treated with pitavastatin and only －11% in those treated with atorvastatin (p=0.016). A greater percent decrease in the mean CIMT from baseline was observed in the patients treated with pitavastatin than in those treated with atorvastatin (－4.9% vs. －0.5%, p=0.020).
These data indicate that, while these agents significantly and equally reduce the LDL cholesterol levels, atorvastatin and pitavastatin have different effects on inflammation, insulin resistance, and the progression of carotid atherosclerosis in patients with dyslipidemia.
3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）具有多种多效性作用，如抗炎和血管内皮保护作用，这些作用独立于其降低低密度脂蛋白（LDL）胆固醇的作用。然而，不同他汀类药物对血脂异常患者的炎症、胰岛素抵抗以及颈动脉粥样硬化进展[以内膜中层厚度（CIMT）表示]是否有不同影响仍不清楚。
总共146例无已知心血管疾病的高胆固醇血症患者被随机分配接受每日5毫克阿托伐他汀（n = 73）或每日1毫克匹伐他汀（n = 73）治疗。
在基线时，两组之间的年龄、性别、血压、血脂谱以及血清单核细胞趋化蛋白（MCP）-1、胰岛素抵抗稳态模型评估（HOMA-IR）和CIMT值具有可比性。治疗12个月后，阿托伐他汀和匹伐他汀同样降低了LDL胆固醇水平；然而，阿托伐他汀使HOMA-IR升高了＋26%，而匹伐他汀使该参数降低了－13%（p＜0.001）。接受匹伐他汀治疗的患者MCP-1值降低了－28%，而接受阿托伐他汀治疗的患者仅降低了－11%（p = 0.016）。与接受阿托伐他汀治疗的患者相比，接受匹伐他汀治疗的患者平均CIMT较基线的下降百分比更大（－4.9%对－0.5%，p = 0.020）。
这些数据表明，虽然这些药物显著且同等程度地降低了LDL胆固醇水平，但阿托伐他汀和匹伐他汀对血脂异常患者的炎症、胰岛素抵抗以及颈动脉粥样硬化进展具有不同影响。
