Institute of Cardiovascular and Medical Sciences, University of Glasgow, Ground Floor, Room G31, McGregor Building, University Avenue, Glasgow, G12 8QQ, UK.
Curr Cardiol Rep. 2018 Jun 14;20(8):60. doi: 10.1007/s11886-018-1003-x.
The advent of combination therapy to provide LDL lowering beyond that achieved with statins necessitates the development of greater understanding of how drugs work together, what changes occur in key lipoprotein fractions, and what residual risk remains.
Clinical trials of agents that, when added to statins, generate profound LDL lowering have been successful in reducing further the risk of cardiovascular disease. LDL cholesterol can be now decreased to unprecedented levels, so the focus of attention then shifts to other apolipoprotein B-containing, atherogenic lipoprotein classes such as lipoprotein(a) and remnants of the metabolism of triglyceride-rich particles. "Non-HDL cholesterol" is used increasingly (especially if measured in the non-fasting state) as a more comprehensive index of risk. Metabolic studies reveal how current drugs act in combination to achieve profound lipid lowering. However, care is needed in interpreting achieved LDLc and non-HDLc levels in the emerging treatment paradigm.
联合治疗的出现使 LDL 降低幅度超过了他汀类药物所能达到的水平，这就需要我们更深入地了解药物如何协同作用，关键脂蛋白亚群发生了哪些变化，以及仍存在哪些残余风险。
当添加到他汀类药物中时，能显著降低 LDL 的药物的临床试验已成功降低了心血管疾病的风险。现在 LDL 胆固醇可以降低到前所未有的水平，因此关注的焦点转移到其他载脂蛋白 B 含量高、动脉粥样硬化脂蛋白类，如脂蛋白(a)和富含甘油三酯颗粒代谢的残粒。“非高密度脂蛋白胆固醇”（特别是在非禁食状态下测量时）作为一种更全面的风险指标被越来越多地使用。代谢研究揭示了当前的药物如何协同作用以实现深度降脂。然而，在解释新兴治疗模式下达到的 LDLc 和非-HDLc 水平时需要谨慎。
