Wendelhag I, Wiklund O, Wikstrand J
Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Hospital, Göteborg University, Sweden.
Atherosclerosis. 1995 Oct;117(2):225-36. doi: 10.1016/0021-9150(95)05575-h.
Patients with familial hypercholesterolemia (FH) (n = 53) were examined with B-mode ultrasound before and after 3 years of cholesterol-lowering therapy with pravastatin, cholestyramine, or a combination. The aim was to measure the progression rate of intima-media thickening during follow-up in the common carotid and common femoral arteries. Since for ethical reasons it was not possible to perform a randomized placebo controlled study in patients with FH, we chose to recruit an untreated control group with lower risk, matched for sex, age, height and weight, and with serum cholesterol below 6.5 mmol/l. At baseline, intima-media thickness was larger in the hypercholesterolemic group than in the control group in both the common carotid and common femoral arteries. The difference between the change over 3 years observed in the control group and the change observed in the hypercholesterolemic group was calculated and defined as 'net difference'. There was a -32% net difference in low density lipoprotein (LDL) in the hypercholesterolemic group during follow-up. The ultrasound investigation showed a concomitant net difference of -0.06 mm in mean carotid intima-media thickness (95% confidence interval, -0.11 to -0.01 mm) and of -0.09 mm in maximum carotid intima-media thickness (P < 0.05, 95% confidence interval, -0.16 to -0.01 mm), with no net change in lumen diameter. No decrease was recorded in common femoral intima-medial thickness. Seventeen of the patients with FH had a positive history of myocardial infarction (MI) and this subgroup had a significantly larger decrease in mean carotid intima-media thickness during follow-up than the subgroup of patients with a negative history of MI (P < 0.01). In conclusion, the results showed a reduction in common carotid intima-media thickness after long-term cholesterol-lowering therapy in patients with FH. This finding may indicate a beneficial effect on atherosclerosis development in these patients.
对53例家族性高胆固醇血症（FH）患者在使用普伐他汀、考来烯胺或两者联合进行3年降脂治疗前后进行B型超声检查。目的是测量颈总动脉和股总动脉随访期间内膜中层增厚的进展速率。由于伦理原因，无法对FH患者进行随机安慰剂对照研究，因此我们选择招募一个低风险的未治疗对照组，该组在性别、年龄、身高和体重方面进行匹配，血清胆固醇低于6.5 mmol/l。基线时，高胆固醇血症组颈总动脉和股总动脉的内膜中层厚度均大于对照组。计算并定义对照组3年观察到的变化与高胆固醇血症组观察到的变化之间的差异为“净差异”。随访期间，高胆固醇血症组低密度脂蛋白（LDL）的净差异为-32%。超声检查显示，颈总动脉平均内膜中层厚度的伴随净差异为-0.06 mm（95%置信区间，-0.11至-0.01 mm），颈总动脉最大内膜中层厚度的伴随净差异为-0.09 mm（P<0.05，95%置信区间，-0.16至-0.01 mm），管腔直径无净变化。股总动脉内膜中层厚度未记录到减少。17例FH患者有心肌梗死（MI）阳性病史，该亚组在随访期间颈总动脉平均内膜中层厚度的下降幅度明显大于MI阴性病史患者亚组（P<0.01）。总之，结果显示FH患者长期降脂治疗后颈总动脉内膜中层厚度减少。这一发现可能表明对这些患者的动脉粥样硬化发展有有益作用。
