Kuo P T, Kostis J B, Moreyra A E
Am Heart J. 1982 Jul;104(1):36-43. doi: 10.1016/0002-8703(82)90638-x.
We report 11 in a group of 21 asymptomatic patients with heterozygous familial hypercholesterolemia (FH) and progressive coronary artery disease to evaluate the role of compensatory mechanism(s), especially coronary collaterals, in providing adequate blood supply to the myocardium, following complete occlusion of one or more major coronary arteries. Diet-colestipol-nicotinic acid treatment decreased their plasma total cholesterol and low density lipoprotein cholesterol (mg/dl, mean +/- SEM) from 442.9 +/- 25.8 and 363.0 +/-24.1, respectively, to 231.2 +/- 11.8 and 185.3 +/- 14.2, respectively, for 6 to 9 years. The initially stenotic lesions of these 11 patients slowly progressed to complete occlusion, while the patients remained free of myocardial ischemia or infarction and exhibited no abnormality on 24-hour ambulatory ECG monitoring, exercise stress, and thallium 201 stress tests. We conclude that coronary occlusion can be retarded in FH patients by strenuous hypocholesterolemic therapy to allow the development of compensatory mechanism including coronary collaterals. Apparently, the angiographically visualizable collaterals combined with subendocardial anastomosis can give adequate myocardial blood supply to this series of FH patients following occlusion of one or more of their major coronary arteries.
我们报告了21例无症状的杂合子家族性高胆固醇血症（FH）和进展性冠状动脉疾病患者中的11例，以评估在一条或多条主要冠状动脉完全闭塞后，代偿机制（尤其是冠状动脉侧支循环）在为心肌提供充足血液供应方面的作用。饮食-考来替泊-烟酸治疗使他们的血浆总胆固醇和低密度脂蛋白胆固醇（mg/dl，平均值±标准误）分别从442.9±25.8和363.0±24.1降至6至9年时的231.2±11.8和185.3±14.2。这11例患者最初的狭窄病变缓慢进展至完全闭塞，而患者仍无心肌缺血或梗死，24小时动态心电图监测、运动负荷试验和铊201负荷试验均无异常。我们得出结论，通过严格的降胆固醇治疗可以延缓FH患者的冠状动脉闭塞，以允许包括冠状动脉侧支循环在内的代偿机制的发展。显然，血管造影可见的侧支循环与心内膜下吻合相结合，可以在这一系列FH患者的一条或多条主要冠状动脉闭塞后为心肌提供充足的血液供应。
