家族性高胆固醇血症患者经非他汀类药物治疗后的冠状动脉粥样硬化进展：脂肪改良饮食和树脂的影响。

Angiographic progression of coronary atherosclerosis in patients with familial hypercholesterolaemia treated with non-statin therapy: Impact of a fat-modified diet and a resin.

机构信息

School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia.

School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.

出版信息

Atherosclerosis. 2016 Sep;252:82-87. doi: 10.1016/j.atherosclerosis.2016.07.923. Epub 2016 Jul 31.

DOI:10.1016/j.atherosclerosis.2016.07.923

PMID:27508319

Abstract

BACKGROUND AND AIMS

Familial hypercholesterolaemia (FH) profoundly increases the risk of coronary artery disease (CAD). We investigated whether diet and a bile-acid sequestrant decrease coronary atherosclerosis in patients with FH.

METHODS

We identified 26 men with FH and CAD, participating in the St Thomas' Atherosclerosis Regression Study, who had been randomized to receive a fat-modified diet plus cholestyramine (8 g twice daily) (DC, n = 12) or usual care (UC, n = 14), and investigated the relative effects of these treatments on the angiographic progression of coronary atherosclerosis over 39 months. FH was defined as probable/definite according to Dutch Lipid Clinic Network criteria; mean FH score was 8.7 (range 6-15) and mean baseline low-density lipoprotein cholesterol (LDL-Ch) concentration was 5.4 (SD 1.4) mmol/L. Coronary atherosclerosis was assessed by serial quantitative angiography as the global changes in mean and minimum absolute width of segments (MAWS and MinAWS, respectively).

RESULTS

Mean plasma LDL-Ch concentration fell by 35% with DC and remained significantly (p < 0.001) lower during the trial at 3.78 (SD 0.98) mmol/L compared with UC at 4.89 (1.04). MAWS decreased by 0.252 (SEM 0.072) mm in the UC group and by 0.001 (0.065) mm in the DC group (p = 0.007), with corresponding reductions in MinAWS of 0.290 (0.087) mm and 0.013 (0.058) mm (p = 0.009); these changes were significant after adjusting for baseline variables, including coronary luminal dimensions and lipoprotein(a). Progression was observed in 7 patients (50%) on UC and 3 (25%) on DC (p = 0.19), with regression in no patients (0%) and 3 patients (25%) (p < 0.05), respectively.

CONCLUSIONS

This investigation, carried out in the pre-statin era, demonstrates that a prudent diet and cholestyramine could improve the course of coronary atherosclerosis in men with phenotypic FH through sustained reductions in LDL-Ch.

摘要

背景与目的

家族性高胆固醇血症（FH）可显著增加冠心病（CAD）的风险。我们研究了饮食和胆汁酸螯合剂是否能降低 FH 患者的冠状动脉粥样硬化。

方法

我们确定了 26 名患有 FH 和 CAD 的男性，他们参加了圣托马斯动脉粥样硬化消退研究，这些患者被随机分配接受改良饮食加考来烯胺（8g，每日 2 次）（DC，n=12）或常规治疗（UC，n=14），并研究了这些治疗方法对 39 个月期间冠状动脉粥样硬化进展的相对影响。FH 根据荷兰脂质诊所网络标准定义为可能/确定；平均 FH 评分 8.7（范围 6-15），基线时低密度脂蛋白胆固醇（LDL-Ch）浓度为 5.4（SD 1.4）mmol/L。通过连续定量血管造影评估冠状动脉粥样硬化，分别评估节段平均和最小绝对宽度的整体变化（MAWS 和 MinAWS）。

结果

DC 组患者的血浆 LDL-Ch 浓度降低了 35%，试验期间持续显著（p<0.001）低于 UC 组的 3.78（SD 0.98）mmol/L，而 UC 组为 4.89（1.04）mmol/L。UC 组的 MAWS 降低了 0.252（SEM 0.072）mm，DC 组降低了 0.001（0.065）mm（p=0.007），相应的 MinAWS 分别降低了 0.290（0.087）mm 和 0.013（0.058）mm（p=0.009）；在调整基线变量（包括冠状动脉管腔尺寸和脂蛋白（a））后，这些变化仍然显著。UC 组有 7 名患者（50%）进展，DC 组有 3 名患者（25%）进展（p=0.19），无患者（0%）和 3 名患者（25%）（p<0.05）发生消退。