Fernández-Avilés F, García-Morán E
Servicio de Cardiología, Hospital Universitario de Valladolid.
Rev Esp Cardiol. 1995;48 Suppl 5:43-51.
Elevated serum cholesterol level has a causal role in the genesis of coronary atherosclerosis and causes plaque activation because it leads to plaque rupture, increases thrombus formation and adversely influences the function of endothelial cells. In patients with evidence of coronary heart disease (angina pectoris, previous myocardial infarction or previous coronary revascularization) the overall effect of cholesterol reduction therapy on the progression of lesions is modest. Nevertheless, the results of secondary prevention trials provide evidence that a reduction in the level of cholesterol leads to a significant decrease in the rate of cardiovascular events, in the rate of new procedures of revascularization by means of coronary surgery or angioplasty, in the coronary-heart-disease-mortality and in the non-coronary-heart-disease mortality. These effects probably mean some benefit on function, vulnerability and thrombogenicity of the plaque. In patients with previous revascularization procedures interest of secondary prevention by means of cholesterol lowering must be special, because in them the probability of long-term success should be optimized for the maximum patient benefit and the best use of health-care resources.
血清胆固醇水平升高在冠状动脉粥样硬化的发生中起因果作用，并导致斑块激活，因为它会导致斑块破裂、增加血栓形成并对内皮细胞功能产生不利影响。在有冠心病证据（心绞痛、既往心肌梗死或既往冠状动脉血运重建）的患者中，胆固醇降低治疗对病变进展的总体影响较小。然而，二级预防试验的结果表明，胆固醇水平的降低会导致心血管事件发生率、通过冠状动脉手术或血管成形术进行新的血运重建手术的发生率、冠心病死亡率和非冠心病死亡率显著降低。这些作用可能意味着对斑块的功能、易损性和血栓形成性有一定益处。对于既往接受过血运重建手术的患者，通过降低胆固醇进行二级预防的意义尤为特殊，因为对于他们而言，应优化长期成功的可能性，以实现最大的患者获益和最佳的医疗资源利用。
