Welty Francine K, Lewis Sandra J, Friday Karen E, Cain Valerie A, Anzalone Deborah A
1 Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, Massachusetts.
2 Northwest Cardiovascular Institute , Portland, Oregon.
J Womens Health (Larchmt). 2016 Jan;25(1):50-6. doi: 10.1089/jwh.2015.5271. Epub 2015 Nov 5.
Cardiovascular disease is the leading cause of mortality in women in the United States. Aggressive treatment of modifiable risk factors (e.g., hypercholesterolemia) is essential in reducing disease burden. Despite guidelines recommending the use of statin treatment in hypercholesterolemic women, this patient group is often undertreated. This subgroup analysis of the Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin (STELLAR) trial examines the effects of statin therapy in hypercholesterolemic women.
As part of the STELLAR trial, 1,146 women with elevated low-density lipoprotein cholesterol (LDL-C ≥160 and <250 mg/dL) and triglycerides <400 mg/dL were randomized to rosuvastatin 10-40 mg, atorvastatin 10-80 mg, simvastatin 10-80 mg, or pravastatin 10-40 mg for 6 weeks.
LDL-C reduction with rosuvastatin 10 mg, atorvastatin 10 mg, simvastatin 20 mg, and pravastatin 40 mg was 49%, 39%, 37%, and 30%, respectively, after 6 weeks. High-intensity statins (rosuvastatin 20-40 mg and atorvastatin 40-80 mg) reduced LDL-C to the greatest extent: 53% with rosuvastatin 20 mg, 57% with rosuvastatin 40 mg, 47% with atorvastatin 40 mg, and 51% with atorvastatin 80 mg. Similar results were observed for non-high-density lipoprotein cholesterol (non-HDL-C). Increases in HDL-C were greater with rosuvastatin across doses than with other statins. All treatments were well tolerated, with similar safety profiles across dose ranges.
Statin therapies in the STELLAR trial led to reductions in LDL-C, non-HDL-C, and triglycerides and increases in HDL-C among hypercholesterolemic women, with rosuvastatin providing the greatest reductions in LDL-C and non-HDL-C.
心血管疾病是美国女性死亡的主要原因。积极治疗可改变的风险因素（如高胆固醇血症）对于减轻疾病负担至关重要。尽管指南推荐对高胆固醇血症女性使用他汀类药物治疗，但该患者群体往往治疗不足。这项他汀类药物不同剂量与瑞舒伐他汀对比治疗血脂升高（STELLAR）试验的亚组分析，考察了他汀类药物治疗对高胆固醇血症女性的影响。
作为STELLAR试验的一部分，1146名低密度脂蛋白胆固醇升高（低密度脂蛋白胆固醇≥160且<250mg/dL）且甘油三酯<400mg/dL的女性被随机分为接受10 - 40mg瑞舒伐他汀、10 - 80mg阿托伐他汀、10 - 80mg辛伐他汀或10 - 40mg普伐他汀治疗6周。
6周后，10mg瑞舒伐他汀、10mg阿托伐他汀、20mg辛伐他汀和40mg普伐他汀使低密度脂蛋白胆固醇降低的幅度分别为49%、39%、37%和30%。高强度他汀类药物（20 - 40mg瑞舒伐他汀和40 - 80mg阿托伐他汀）使低密度脂蛋白胆固醇降低的幅度最大：20mg瑞舒伐他汀降低53%，40mg瑞舒伐他汀降低57%，40mg阿托伐他汀降低47%，80mg阿托伐他汀降低51%。对于非高密度脂蛋白胆固醇（非HDL-C）也观察到了类似结果。各剂量瑞舒伐他汀使高密度脂蛋白胆固醇升高的幅度均大于其他他汀类药物。所有治疗耐受性良好，各剂量范围的安全性概况相似。
STELLAR试验中的他汀类药物治疗使高胆固醇血症女性的低密度脂蛋白胆固醇、非HDL-C和甘油三酯降低，高密度脂蛋白胆固醇升高，其中瑞舒伐他汀使低密度脂蛋白胆固醇和非HDL-C降低的幅度最大。
