LaRosa J C
Tulane University Medical Center, Office of the Chancellor, New Orleans, Louisiana 70112-2699, USA.
Am J Cardiol. 1995 Sep 28;76(9):5C-9C. doi: 10.1016/s0002-9149(99)80464-0.
A reexamination of early intervention trials in patients with coronary artery disease (CAD) shows that a pessimistic view of cholesterol reduction in such patients is inappropriate. In observational studies, individuals with documented coronary artery disease and elevated cholesterol levels fare worse than individuals with normal or low cholesterol levels. Early trials of cholesterol reduction in individuals with coronary artery disease succeeded in lowering total cholesterol levels by only 5-15%. Nevertheless, when reviewed in meta-analysis, these trials demonstrated borderline effects on total mortality, statistically significant benefits in terms of morbidity and mortality due to cardiovascular disease and CAD, and no increase in mortality from noncardiovascular causes. Substantially greater lowering of low density lipoprotein (LDL) levels was achieved in early regression studies. In these studies, examples of improvement were noted in individual coronary artery segments. What was not appreciated initially was the dramatic reduction in coronary events. Older secondary prevention trials did not definitively address the benefits of cholesterol reduction in individuals whose cholesterol levels were only modestly elevated (total cholesterol, 160-240 mg/dl [4.14-6.21 mmol/liter], and LDL cholesterol levels 100-160 mg/dl [2.59-4.14 mmol/liter]). Several other issues were not addressed in these early studies, including the effect of declines in triglyceride levels, increases in high density lipoprotein (HDL) levels, and the effects in women and individuals aged > 60 years. Even with these limitations, a comparison of meta-analyses of other medical interventions--i.e. beta blockade and aspirin therapy--indicates that declines in coronary mortality are in the same range as obtained in older studies with modest cholesterol reduction--i.e., 20-25%.(ABSTRACT TRUNCATED AT 250 WORDS)
对冠心病（CAD）患者早期干预试验的重新审视表明，对这类患者降低胆固醇持悲观态度是不合适的。在观察性研究中，有冠心病记录且胆固醇水平升高的个体比胆固醇水平正常或低的个体情况更差。早期针对冠心病患者降低胆固醇的试验仅成功将总胆固醇水平降低了5% - 15%。然而，在荟萃分析中，这些试验显示对总死亡率有临界影响，在心血管疾病和CAD导致的发病和死亡率方面有统计学显著益处，且非心血管原因导致的死亡率没有增加。早期回归研究中实现了低密度脂蛋白（LDL）水平的大幅降低。在这些研究中，个别冠状动脉节段出现了改善的例子。最初未认识到的是冠状动脉事件的显著减少。早期二级预防试验并未明确解决胆固醇水平仅适度升高（总胆固醇，160 - 240 mg/dl [4.14 - 6.21 mmol/升]，LDL胆固醇水平100 - 160 mg/dl [2.59 - 4.14 mmol/升]）的个体降低胆固醇的益处。这些早期研究还未解决其他几个问题，包括甘油三酯水平下降的影响、高密度脂蛋白（HDL）水平升高的影响以及对女性和60岁以上个体的影响。即便有这些局限性，对其他医学干预措施（即β受体阻滞剂和阿司匹林治疗）的荟萃分析比较表明，冠状动脉死亡率的下降幅度与早期适度降低胆固醇的研究结果相同，即20% - 25%。（摘要截短至250字）
