Watts G F
Department of Endocrinology and Chemical Pathology, United Medical and Dental Schools of Guy's and St. Thomas' Hospitals, London, England.
J Cardiovasc Pharmacol. 1995;25 Suppl 4:S11-9.
The St. Thomas' Atherosclerosis Regression Study (STARS) showed that treatment of mild hypercholesterolemia with diet or diet plus cholestyramine favorably influences the course of coronary heart disease (CHD) over 3 years in middle-aged men. The study employed quantitative angiography to measure change in coronary luminal dimensions. Angiographic benefit was paralleled by improvement in clinical outcomes. The study allowed a detailed analysis of the nutritional, metabolic, and genetic determinants of the progression of CHD. Significant associations were found between changes in both focal and diffuse estimates of coronary atherosclerosis and the plasma concentrations of low-density lipoprotein (LDL) cholesterol and apolipoprotein (apo) B, dietary intake at total and saturated fat, and polymorphisms of the apo-AI gene promoter region and angiotensin-converting enzyme (ACE) gene. Up to 38% of the variance in the progression of CHD could be explained by the independent effects of LDL cholesterol and dietary intake of saturated fat. The ACE genotype was only an independent predictor of the progression of CHD in patients whose LDL cholesterol had been substantially reduced with diet and cholestyramine. The clinical significance of the nutritional, metabolic and genetic findings is discussed.
圣托马斯动脉粥样硬化消退研究（STARS）表明，对于中年男性，采用饮食或饮食加考来烯胺治疗轻度高胆固醇血症，在3年时间里对冠心病（CHD）病程有积极影响。该研究采用定量血管造影术来测量冠状动脉管腔尺寸的变化。血管造影显示的益处与临床结果的改善相平行。该研究允许对冠心病进展的营养、代谢和遗传决定因素进行详细分析。研究发现，冠状动脉粥样硬化的局灶性和弥漫性评估变化与低密度脂蛋白（LDL）胆固醇和载脂蛋白（apo）B的血浆浓度、总脂肪和饱和脂肪的饮食摄入量以及apo-AI基因启动子区域和血管紧张素转换酶（ACE）基因的多态性之间存在显著关联。冠心病进展中高达38%的变异可由LDL胆固醇和饱和脂肪饮食摄入量的独立作用来解释。ACE基因型只是在那些通过饮食和考来烯胺使LDL胆固醇大幅降低的患者中，才是冠心病进展的独立预测因素。文中讨论了营养、代谢和遗传研究结果的临床意义。
