Farnier M, Davignon J
Point Medical, Rond Point de la Nation, Dijon, France.
Am J Cardiol. 1998 Aug 27;82(4B):3J-10J. doi: 10.1016/s0002-9149(98)00423-8.
Hyperlipidemia is recognized as one of the major risk factors for the development of coronary artery disease and progression of atherosclerotic lesions. Dietary therapy together with hypolipidemic drugs are central to the management of hyperlipidemia, which aims to prevent atherosclerotic plaque progression, induce regression, and so decrease the risk of acute coronary events in patients with pre-existing coronary or peripheral vascular disease. In patients at high risk of coronary artery disease but without evidence of atherosclerosis, treatment is designed to prevent the premature development of coronary artery disease, whereas in those with hypertriglyceridemia, treatment aims to prevent the development of hepatomegaly, splenomegaly, and pancreatitis. The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins, are the most potent lipid-lowering agents currently available, and their use in the treatment of hyperlipidemia provides the focus for this review. Particular emphasis is given to cerivastatin, a new HMG-CoA reductase inhibitor that combines potent cholesterol-lowering properties with significant triglyceride-reducing effects. Recently completed primary and secondary intervention trials have shown that the significant reductions in low-density lipoprotein (LDL) cholesterol achieved with statins result in significant reductions in morbidity and mortality associated with coronary artery disease as well as reductions in the incidence of stroke and total mortality. Such benefits occur early in the course of statin therapy and have led to suggestions that these drugs may possess antiatherogenic effects over and above their capacity to lower atherogenic lipids and lipoproteins. Experimental studies have also shown statin-induced improvements in endothelial function, decreased platelet thrombus formation, improvements in fibrinolytic activity, and reductions in the frequency of transient myocardial ischemia.
高脂血症被认为是冠状动脉疾病发生和动脉粥样硬化病变进展的主要危险因素之一。饮食疗法与降血脂药物是高脂血症管理的核心，其目的是预防动脉粥样硬化斑块进展、促使斑块消退，从而降低已有冠状动脉或外周血管疾病患者发生急性冠状动脉事件的风险。对于有冠状动脉疾病高风险但无动脉粥样硬化证据的患者，治疗旨在预防冠状动脉疾病过早发生；而对于高甘油三酯血症患者，治疗目的是预防肝肿大、脾肿大和胰腺炎的发生。3-羟基-3-甲基戊二酰辅酶A（HMG-CoA）还原酶抑制剂，即他汀类药物，是目前可用的最有效的降脂药物，本文将重点综述其在高脂血症治疗中的应用。特别强调的是西立伐他汀，这是一种新型HMG-CoA还原酶抑制剂，兼具强效降低胆固醇和显著降低甘油三酯的作用。最近完成的一级和二级干预试验表明，他汀类药物使低密度脂蛋白（LDL）胆固醇显著降低，从而使与冠状动脉疾病相关的发病率和死亡率显著降低，同时中风发病率和总死亡率也降低。这些益处早在他汀类药物治疗过程中就已出现，这表明这些药物除了具有降低致动脉粥样硬化脂质和脂蛋白的能力外，可能还具有抗动脉粥样硬化作用。实验研究还表明，他汀类药物可改善内皮功能、减少血小板血栓形成、改善纤溶活性并减少短暂性心肌缺血的发生频率。
