Stein E A
Medical Research Laboratories, Christ Hospital Cardiovascular Research Center, Cincinnati, OH.
Atherosclerosis. 1994 Aug;108 Suppl:S105-16. doi: 10.1016/0021-9150(94)90156-2.
The recent guidelines for detection and treatment of hypercholesterolemia together with specific therapeutic goals have stimulated interest in, and use of, lipid lowering agents. The last decade has seen an explosive growth in the drug discovery area which is now translating into clinical trials with many new lipid lowering agents. In addition, clinical trials assessing clinical outcomes and cost effectiveness are resulting in a changing approach to how current lipid lowering drugs are used, especially in terms of dosing and combination therapies. At present only four classes of lipid altering agents remain in wide use; bile acid binding resins, niacin, fibrates and HMG CoA reductase inhibitors. Although only a decade has passed since the first HMG CoA reductase inhibitor, lovastatin, entered clinical trials this group of compounds are not only the most widely used lipid lowering agents, but more than six such agents have been or are currently being developed. In addition to pharmacological therapies, there have been significant advances in the non-pharmacological treatment of hypercholesterolemia, the most important being LDL-receptor gene replacement and selective LDL-apheresis.
近期关于高胆固醇血症检测与治疗的指南以及特定的治疗目标激发了人们对降脂药物的兴趣并促使其得到应用。在过去十年中，药物研发领域迅猛发展，如今众多新型降脂药物已进入临床试验阶段。此外，评估临床疗效和成本效益的临床试验正在改变当前降脂药物的使用方式，尤其是在给药剂量和联合治疗方面。目前仍广泛使用的降脂药物仅有四类：胆汁酸结合树脂、烟酸、贝特类药物和HMG CoA还原酶抑制剂。尽管自首个HMG CoA还原酶抑制剂洛伐他汀进入临床试验至今仅过去了十年，但这类化合物不仅是使用最广泛的降脂药物，而且已有六种以上此类药物已研发成功或正在研发中。除了药物治疗，高胆固醇血症的非药物治疗也取得了重大进展，其中最重要的是低密度脂蛋白受体基因替代疗法和选择性低密度脂蛋白分离法。
