Shepherd J
Department of Pathological Biochemistry, Institute of Biochemistry, Royal Infirmary, University of Glasgow, Scotland, United Kingdom.
Am J Med. 1998 Feb 23;104(2A):19S-22S. doi: 10.1016/s0002-9343(98)00042-4.
The benefits of cholesterol lowering for primary and secondary prevention of coronary artery disease (CAD) have been well established. However, to accurately assess a patient's risk for CAD, clinicians must be aware of their patients' specific levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides, and not just total serum cholesterol. Clinicians must also evaluate other factors in assessing a patient's risk profile. These include smoking, weight, family history of CAD, age, hypertension, and others. Absolute risk, rather than relative risk, can then be determined. Although LDL cholesterol may be the most potent predictor of risk, triglycerides are also an important indicator of CAD risk. Currently, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors ("statins") are first-line therapy for the reduction of elevated levels of LDL cholesterol. All statins are effective in achieving some level of LDL cholesterol lowering. However, atorvastatin, which was recently introduced in the United States, has greater efficacy at maximal dosage in lowering LDL cholesterol, and also has a more beneficial effect on elevated levels of triglycerides, than other statins.
降低胆固醇对冠状动脉疾病（CAD）一级和二级预防的益处已得到充分证实。然而，为准确评估患者患CAD的风险，临床医生必须了解患者低密度脂蛋白（LDL）胆固醇、高密度脂蛋白（HDL）胆固醇和甘油三酯的具体水平，而不仅仅是总血清胆固醇水平。临床医生在评估患者风险状况时还必须考虑其他因素。这些因素包括吸烟、体重、CAD家族史、年龄、高血压等。然后才能确定绝对风险而非相对风险。尽管LDL胆固醇可能是最有力的风险预测指标，但甘油三酯也是CAD风险的重要指标。目前，3-羟基-3-甲基戊二酰辅酶A（HMG-CoA）还原酶抑制剂（“他汀类药物”）是降低LDL胆固醇水平升高的一线治疗药物。所有他汀类药物在降低LDL胆固醇水平方面都有一定效果。然而，最近在美国上市的阿托伐他汀在最大剂量时降低LDL胆固醇的效果比其他他汀类药物更好，对甘油三酯水平升高也有更有益的作用。
