Xu Ming-Xing, Liu Chang, He Yong-Ming, Yang Xiang-Jun, Zhao Xin
Division of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China.
J Thorac Dis. 2017 May;9(5):1322-1332. doi: 10.21037/jtd.2017.04.32.
Lipoprotein (a) [Lp (a)] is a well-established risk factor for coronary artery disease (CAD). However, up till now, treatment of patients with higher Lp (a) levels is challenging. This current study aimed to investigate the therapeutic effects of short-, medium and long-term statin use on the Lp (a) reduction and its modifying factors.
The therapeutic duration was categorized into short-term (median, 39 days), medium term (median, 219 days) and long-term (median, 677 days). The lipid profiles before therapy served as baselines. Patients at short-, medium or long-term exactly matched with those at baseline. Every patient's lipid profiles during the follow-ups were compared to his own ones at baselines.
The current study demonstrated that long-term statin therapy significantly decreased the Lp (a) levels in CAD patients while short-term or medium term statin therapy didn't. When grouped by statin use, only long-term simvastatin use significantly decreased the Lp (a) levels while long-term atorvastatin use insignificantly decreased the Lp (a) levels. Primary hypertension (PH), DM, low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) could modify the therapeutic effects of statin use on the Lp (a) levels in CAD patients.
The long-term statin therapy could be efficacious in reducing the Lp (a) levels in CAD patients, which has been modified by some traditional risk factors. In the era of commercial unavailability of more reliable Lp (a) lowering drugs, our findings will bolster confidence in fighting higher Lp (a) abnormalities both for patients and for doctors.
脂蛋白(a)[Lp(a)]是冠状动脉疾病（CAD）公认的危险因素。然而，迄今为止，治疗Lp(a)水平较高的患者具有挑战性。本研究旨在探讨短期、中期和长期使用他汀类药物对降低Lp(a)及其调节因素的治疗效果。
治疗持续时间分为短期（中位数为39天）、中期（中位数为219天）和长期（中位数为677天）。治疗前的血脂谱作为基线。短期、中期或长期的患者与基线患者完全匹配。将每位患者随访期间的血脂谱与其基线时的血脂谱进行比较。
本研究表明，长期他汀类药物治疗可显著降低CAD患者的Lp(a)水平，而短期或中期他汀类药物治疗则不能。按使用的他汀类药物分组，只有长期使用辛伐他汀可显著降低Lp(a)水平，而长期使用阿托伐他汀对降低Lp(a)水平的作用不显著。原发性高血压（PH）、糖尿病、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）可改变他汀类药物对CAD患者Lp(a)水平的治疗效果。
长期他汀类药物治疗可有效降低CAD患者的Lp(a)水平，这已被一些传统危险因素所改变。在更可靠的降低Lp(a)药物尚未商业化的时代，我们的研究结果将增强患者和医生对抗较高Lp(a)异常的信心。
