辛伐他汀对高脂血症患者血脂和脂质比值的影响

目的:探讨辛伐他汀对高脂血症患者血脂和脂质比值的影响。方法:对34例动脉粥样硬化(AS)合并血脂异常的患者,给予辛伐他汀10mg/d晚一次服用,每月20d,停10d,持续服药疗程3²4个月,观察总胆固醇(TC)、低密度脂蛋白(LDL-C)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)等治疗前后及TC/HDL-C、LDL-C/HDL-C与ApoB/ApoA1三项比值治疗前后的变化。结果:治疗后TC、LDL-C、TG、ApoB等指标较治疗前下降(P<0.05);HDL-C、ApoA1也相应下降(P<0.05);TC/HDL-C、LDL-C/HDL-C比值治疗后下降(P<0.05);ApoB/ApoA1比值治疗前后比较无显著性差异(P>0.05)。结论:辛伐他汀用于社区长期防治AS、控制血脂剩留风险安全有效,比值TC/HDL-C>5可作为AS高危分层预警的指标。     

血脂和载脂蛋白的测定在诊治老年冠心病合并2型糖尿病中的意义

目的探讨血脂和载脂蛋白在诊治老年冠心病合并2型糖尿病患者中的变化。方法选择我院2008年1月至2010年6月住院的老年冠心病合并2型糖尿病组患者47例;正常对照组45例,观察两组血脂：总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白-胆固醇（LDL-C）、高密度脂蛋白-胆固醇（HDL-C）以及载脂蛋白A1（ApoA1）、载脂蛋白B（ApoB）。结果老年冠心病合并2型糖尿病患者的HDL-C[（0.79±0.11）mmol/L]和ApoA[（0.76±0.21）g/L]明显低于正常对照组患者的HDL-C[（1.42±0.13）mmol/L]和ApoA[（1.43±0.63）g/L],两组比较,差异有统计学意义。糖尿病组的TC、TG、LDL-C、ApoB明显增高,与对照组比较差异有统计学意义（P〈0.05）。结论老年冠心病合并2型糖尿病患者易出现脂质代谢紊乱,血脂和载脂蛋白可以作为老年冠心病合并2型糖尿病的诊断指标。     

冠心病患者超敏C反应蛋白与血脂联合检测的临床意义

目的通过检测冠状动脉粥样硬化性心脏病(CHD)患者血清超敏C反应蛋白(hs-CRP)与血脂的水平,探讨二者联合检测对冠心病患者的临床意义。方法采集124例CHD患者和100例正常对照组健康人血清,分别测定其hs-CRP、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)水平并计算TC/HDL-C比值。结果CHD患者组较正常对照组血清hs-CRP、TC、TG、LDL-C、ApoB、TC/HDL-C均显著增高,而HDL-C、ApoA1显著降低。结论hs-CRP与血脂均为冠心病诊断的重要标志物,二者联合检测对CHD的诊断、治疗具有重要意义。     

冠心病血浆ApoA1/ApoB值及其他相关危险因素的研究

目的探讨血浆载脂蛋白A1(ApoA1)/载脂蛋白B(ApoB)值及其他血脂指标在冠心病发生和发展的作用。方法选取2010-2011年于天津市胸科医院行冠脉造影(CAG)的患者550例,根据CAG结果分为冠心病组和正常组,其中冠心病组包括单支病变组、双支病变组、三支病变组。分别测定患者血浆载脂蛋白A1(ApoA1),载脂蛋白B(ApoB),总胆固醇(TC),甘油三酯(TG),高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C)及载脂蛋白A1/B(ApoA1/ApoB)值。结果 ApoA1/ApoB值与冠脉病变呈负相关(P<0.01);多因素Logistic回归分析证实ApoA1/ApoB为冠状动脉粥样硬化的保护因子(P<0.01)。结论 ApoA1/ApoB值与冠状动脉粥样硬化密切相关,相对于其他血脂因素更有意义。     

辛伐他汀对老年冠心病患者强化降脂治疗的临床观察

目的了解辛伐他汀(舒降之)对老年冠心病患者强化降脂治疗的有效剂量和安全性.方法选择老年冠心病并原发性高脂血症患者50例,予辛伐他汀20mg/d治疗,随访中按预定的总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)达标水平调整药物用量.随访6～18个月.结果治疗后TC、LDL-C和甘油三酯分别下降27%、36%和26%(P均<0.001),HDL-C无显著变化.载脂蛋白A1升高14%,载脂蛋白B下降25%.LDL-C/HDL-C比值下降为1.96(P<0.001).随访结束时,31%的患者服用辛伐他汀10mg/d,保持TC<4.7mmol/L和LDL-C<2.6mmol/L;69%的患者服用辛伐他汀5mg/d,保持TC<4.2mmol/L和LDL-C<2.1mmol/L.无明显不良反应发生.多因素分析表明,年龄增加是影响辛伐他汀剂量调整的重要因素.结论辛伐他汀对老年冠心病患者强化降脂治疗效果确切,所用剂量较小,安全性良好.     

老年冠心病患者超敏C反应蛋白与血脂联合检测结果分析

目的 探讨老年冠心病患者超敏C反应蛋白和血脂检测分析的临床意义.方法 测定180例老年冠心病患者和150例老年正常对照组血清超敏C反应蛋白(HS-CRP)、总胆固醇(TC),甘油三脂(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、脂蛋白(a)[Lp(a)]水平并进行统计学分析.结果 180例老年冠心病患者和150例正常对照组HS-CRP、TC、TG、LDL-C、ApoB、Lp(a)均显著高于正常组(P＜0.01),HDL-C、ApoA1低于正常组(P＜0.01).结论 HS-CRP是心血管疾病的独立危险因素,冠心病患者HS-CRP与血脂代谢异常有相关性;其与血脂联合检测对老年冠心病的诊断和治疗有重要意义.     

冠心病患者血脂多指标联合检测结果分析

目的 探讨脂类代谢与冠心病(CHD)之间的密切关系,为冠心病的预测及临床诊断提供参考依据.方法 分别采用免疫比浊法、酶法、选择性抑制法对180例冠心病患者及40例健康成人的血清低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-c)、载脂蛋白A1(ApoA1)、载脂蛋白B100(ApoB100)、总胆固醇(TC)和甘油三酯(TG)水平进行分析测定.结果 与正常对照组相比,冠心病患者血清TC、TG、ApoB100和LDL-C水平及LDL-C/HDL-C、LDL-C/ApoA1和TC/HDL-C比值显著增高,而血清HDL-C和ApoA1水平及ApoA1/ApoB100比值显著降低(P均<0.01);采用LDL-C、HDL-C、ApoA1、ApoB100、TC和TG等多指标的联合分析时,冠心病患者的脂类代谢异常率高达88.3%,远远高于单纯检测TC和TG时的26.7%(P<0.01);TC和TG均正常的非高脂血症患者中有84.1%的患者普遍存在一项和/或多项的脂类代谢异常,显著高于正常人(P<0.01);TC为临界水平时脂类代谢异常的阳性率要明显高于TC为理想水平时(P<0.05).结论 冠心病患者普遍存在脂类代谢异常,脂类代谢异常与冠心病的发生发展密切相关,多指标的联合分析可以更全面准确地对患者的冠心病危险性进行评估.     

不同剂量辛伐他汀对不稳定型心绞痛患者的血脂和炎症因子的影响

目的探讨不同剂量辛伐他汀对不稳定型心绞痛患者的降脂和抑制炎症作用。方法将104例不稳定型心绞痛型冠状动脉粥样硬化性心脏病患者随机分为辛伐他汀20mg组和40mg组,检测比较治疗前后及两组间的血胆固醇(TC)、低密度脂蛋白(LDL-C)、载脂蛋白B(ApoB)、高密度脂蛋白(HDL-C)、载脂蛋白A1、(ApoA1)、CRP、TNF-α、CTnI的浓度及不良反应。结果治疗4周后40mg组明显较20mg组降低TC(P<0.01)、LDL-C(P<0.01)、ApoB(P<0.01)、CRP(P<0.01)、TNF-α(P<0.05)、CTnI(P<0.01),升高HDL-C(P<0.01)、ApoA1(P<0.05)、ApoA1/ApoB(P<0.01)。40mg剂量对肝功能影响不大(P>0.05)。结论辛伐他汀能降低血胆固醇,抑制冠心病动脉粥样硬化的炎症反应。40mg/d,晚上一次服较20mg效果更好,能更好减轻不稳定型心绞痛的危险性,改善预后。     

92例单纯性肥胖儿童血脂检测结果分析

目的:通过对单纯性肥胖儿童血脂、脂蛋白及载脂蛋白的研究,了解其脂质代谢紊乱的状况,并探讨其发生动脉粥样硬化(AS)的危险性。方法:对92例单纯性肥胖儿童及80例正常体重儿童采禁食12h以上的静脉血,分别测定其血浆甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和极低密度脂蛋白胆固醇(VLDL-C)、载脂蛋白(ApoAI、ApoB)及动脉粥样硬化指数(atherosclerosisindex,AI)。结果:肥胖组儿童TG、LDL-C、VLDL-C、LDL-C/HDL-C、ApoB、AI水平显著高于正常儿童(P<0.05),HDL-C、HDL-C/TC、ApoA、ApoA/ApoB水平显著低于正常儿童(P<0.05),肥胖组与正常组儿童TC浓度差异没有显著性(P>0.05)。结论:单纯性肥胖儿童脂质代谢紊乱,其发生AS的危险性增加。     

急性脑出血与血脂水平相关性的分层研究

目的:探讨急性脑出血患者血脂水平与发病的关系。方法:收集2009年12月-2012年6月我院急性脑出血患者703例,同期体检者1 066例,采用性别、年龄分层的方法,比较不同性别、年龄组甘油三酯(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、ApoB/ApoA1水平。结果:男性脑出血组和老年脑出血组ApoA1水平下降(P<0.05),ApoB/ApoA1水平上升(P<0.05);女性脑出血组和非老年脑出血组ApoA1水平下降(P<0.05),TG、TC、LDL、ApoB、ApoB/ApoA1水平上升(P<0.05)。结论:女性和非老年脑出血与血脂水平紊乱密切相关;ApoA1水平的下降和ApoB/ApoA1比值上升是脑出血的危险因素。     

Impact of HIV infection and HAART on serum lipids in men

Context  Alterations in serum lipid values have been widely reported among persons infected with human immunodeficiency virus (HIV) type 1 treated with highly active antiretroviral therapy (HAART), but no data have yet been reported on changes from preseroconversion lipid values. Objective  To describe changes in serum cholesterol levels associated with HIV infection and antiretroviral medication exposure, and 1-time assessment of triglyceride levels post-HAART initiation. Design, Setting, and Participants  The Multicenter AIDS Cohort Study, a prospective study in which homosexual and bisexual men were enrolled and from which 50 of 517 HIV seroconverters were drawn for the analysis herein, who later initiated HAART, involving measurements of stored serum samples obtained between 1984 and 2002. Main Outcome Measures  Changes in levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) at 6 time points during an average of 12 years; 1-time assessment of triglyceride levels from the third post-HAART clinic visit. Results  Among the 50 men, notable declines in mean serum TC (–30 mg/dL [-0.78 mmol/L]), HDL-C (–12 mg/dL [-0.31 mmol/L]), and LDL-C values (–22 mg/dL [-0.57 mmol/L]) were observed after HIV infection. Following HAART initiation, there were large increases in mean TC and LDL-C values (50 and 21 mg/dL [1.30 and 0.54 mmol/L], respectively); however, the mean changes from the preseroconversion values were 20 mg/dL (0.52 mmol/L) (95% confidence interval [CI], –1 to 41) and –1 mg/dL (-0.03 mmol/L) (95% CI, –25 to 22), respectively. Mean HDL-C remained below baseline levels throughout follow-up. The median value (interquartile range) of triglycerides was 225 mg/dL (2.54 mmol/L) (147-331 mg/dL). Conclusions  Before treatment, HIV infection results in substantial decreases in serum TC, HDL-C, and LDL-C levels. Subsequent HAART initiation is associated with increases in TC and LDL-C but little change in HDL-C. Increases in TC and LDL-C observed after about 3 years of HAART possibly represent a return to preinfection serum lipid levels after accounting for expected age-related changes.      

Primary Prevention of Acute Coronary Events With Lovastatin in Men and Women With Average Cholesterol Levels: Results of AFCAPS/TexCAPS

Context.— Although cholesterol-reducing treatment has been shown to reduce fatal and nonfatal coronary disease in patients with coronary heart disease (CHD), it is unknown whether benefit from the reduction of low-density lipoprotein cholesterol (LDL-C) in patients without CHD extends to individuals with average serum cholesterol levels, women, and older persons. Objective.— To compare lovastatin with placebo for prevention of the first acute major coronary event in men and women without clinically evident atherosclerotic cardiovascular disease with average total cholesterol (TC) and LDL-C levels and below-average high-density lipoprotein cholesterol (HDL-C) levels. Design.— A randomized, double-blind, placebo-controlled trial. Setting.— Outpatient clinics in Texas. Participants.— A total of 5608 men and 997 women with average TC and LDL-C and below-average HDL-C (as characterized by lipid percentiles for an age- and sex-matched cohort without cardiovascular disease from the National Health and Nutrition Examination Survey [NHANES] III). Mean (SD) TC level was 5.71 (0.54) mmol/L (221 [21] mg/dL) (51st percentile), mean (SD) LDL-C level was 3.89 (0.43) mmol/L (150 [17] mg/dL) (60th percentile), mean (SD) HDL-C level was 0.94 (0.14) mmol/L (36 [5] mg/dL) for men and 1.03 (0.14) mmol/L (40 [5] mg/dL) for women (25th and 16th percentiles, respectively), and median (SD) triglyceride levels were 1.78 (0.86) mmol/L (158 [76] mg/dL) (63rd percentile). Intervention.— Lovastatin (20-40 mg daily) or placebo in addition to a low–saturated fat, low-cholesterol diet. Main Outcome Measures.— First acute major coronary event defined as fatal or nonfatal myocardial infarction, unstable angina, or sudden cardiac death. Results.— After an average follow-up of 5.2 years, lovastatin reduced the incidence of first acute major coronary events (183 vs 116 first events; relative risk [RR], 0.63; 95% confidence interval [CI], 0.50-0.79; P<.001), myocardial infarction (95 vs 57 myocardial infarctions; RR, 0.60; 95% CI, 0.43-0.83; P=.002), unstable angina (87 vs 60 first unstable angina events; RR, 0.68; 95% CI, 0.49-0.95; P=.02), coronary revascularization procedures (157 vs 106 procedures; RR, 0.67; 95% CI, 0.52-0.85; P=.001), coronary events (215 vs 163 coronary events; RR, 0.75; 95% CI, 0.61-0.92; P=.006), and cardiovascular events (255 vs 194 cardiovascular events; RR, 0.75; 95% CI, 0.62-0.91; P=.003). Lovastatin (20-40 mg daily) reduced LDL-C by 25% to 2.96 mmol/L (115 mg/dL) and increased HDL-C by 6% to 1.02 mmol/L (39 mg/dL). There were no clinically relevant differences in safety parameters between treatment groups. Conclusions.— Lovastatin reduces the risk for the first acute major coronary event in men and women with average TC and LDL-C levels and below-average HDL-C levels. These findings support the inclusion of HDL-C in risk-factor assessment, confirm the benefit of LDL-C reduction to a target goal, and suggest the need for reassessment of the National Cholesterol Education Program guidelines regarding pharmacological intervention.      

Effect of a Garlic Oil Preparation on Serum Lipoproteins and Cholesterol Metabolism: A Randomized Controlled Trial

Context.— Garlic-containing drugs have been used in the treatment of hypercholesterolemia even though their efficacy is not generally established. Little is known about the mechanisms of action of the possible effects on cholesterol in humans. Objective.— To estimate the hypocholesterolemic effect of garlic oil and to investigate the possible mechanism of action. Design.— Double-blind, randomized, placebo-controlled trial. Setting.— Outpatient lipid clinic. Patients.— We investigated 25 patients (mean age, 58 years) with moderate hypercholesterolemia. Intervention.— Steam-distilled garlic oil preparation (5 mg twice a day) vs placebo each for 12 weeks with wash-out periods of 4 weeks. Main Outcome Measures.— Serum lipoprotein concentrations, cholesterol absorption, and cholesterol synthesis. Results.— Baseline lipoprotein profiles were (mean [SD]): total cholesterol, 7.53 (0.75) mmol/L (291 [29] mg/dL); low-density lipoprotein cholesterol (LDL-C), 5.35 (0.78) mmol/L (207 [30] mg/dL); high-density lipoprotein cholesterol (HDL-C), 1.50 (0.41) mmol/L (58 [16] mg/dL); and triglycerides, 1.45 (0.73) mmol/L (127 [64] mg/dL). Lipoprotein levels were virtually unchanged at the end of both treatment periods (mean difference [95% confidence interval]): total cholesterol, 0.085 (-0.201 to 0.372) mmol/L (3.3 [-7.8 to 14.4] mg/dL), P=.54; LDL-C, 0.001 (-0.242 to 0.245) mmol/L (0.04 [-9.4 to 9.5] mg/dL), P=.99; HDL-C, 0.050 (-0.028 to 0.128) mmol/L (1.9 [-1.1 to 4.9] mg/dL), P=.20; triclycerides, 0.047 (-0.229 to 0.135) mmol/L (4.2 [-20.3 to 12.0]) mg/dL, P=.60. Cholesterol absorption (37.5% [10.5%] vs 38.3% [10.7%], P=.58), cholesterol synthesis (12.7 [6.5] vs 13.4 [6.6] mg/kg of body weight per day, P=.64), mevalonic acid excretion (192 [66] vs 187 [66] µg/d, P=.78), and changes in the ratio of lathosterol to cholesterol in serum (4.4% [24.3%] vs 10.6% [21.1%], P=.62) were not different in garlic and placebo treatment. Conclusions.— The commercial garlic oil preparation investigated had no influence on serum lipoproteins, cholesterol absorption, or cholesterol synthesis. Garlic therapy for treatment of hypercholesterolemia cannot be recommended on the basis of this study.      

Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial

Context  Limited data are available evaluating how the timing and intensity of statin therapy following an acute coronary syndrome (ACS) event affect clinical outcome. Objective  To compare early initiation of an intensive statin regimen with delayed initiation of a less intensive regimen in patients with ACS. Design, Setting, and Participants  International, randomized, double-blind trial of patients with ACS receiving 40 mg/d of simvastatin for 1 month followed by 80 mg/d thereafter (n = 2265) compared with ACS patients receiving placebo for 4 months followed by 20 mg/d of simvastatin (n = 2232), who were enrolled in phase Z of the A to Z trial between December 29, 1999, and January 6, 2003. Main Outcome Measure  The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, readmission for ACS, and stroke. Follow-up was for at least 6 months and up to 24 months. Results  Among the patients in the placebo plus simvastatin group, the median low-density lipoprotein (LDL) cholesterol level achieved while taking placebo was 122 mg/dL (3.16 mmol/L) at 1 month and was 77 mg/dL (1.99 mmol/L) at 8 months while taking 20 mg/d of simvastatin. Among the patients in the simvastatin only group, the median LDL cholesterol level achieved at 1 month while taking 40 mg/d of simvastatin was 68 mg/dL (1.76 mmol/L) and was 63 mg/dL (1.63 mmol/L) at 8 months while taking 80 mg/d of simvastatin. A total of 343 patients (16.7%) in the placebo plus simvastatin group experienced the primary end point compared with 309 (14.4%) in the simvastatin only group (40 mg/80 mg) (hazard ratio [HR], 0.89; 95% confidence interval [CI] 0.76-1.04; P = .14). Cardiovascular death occurred in 109 (5.4%) and 83 (4.1%) patients in the 2 groups (HR, 0.75; 95% CI, 0.57-1.00; P = .05) but no differences were observed in other individual components of the primary end point. No difference was evident during the first 4 months between the groups for the primary end point (HR, 1.01; 95% CI, 0.83-1.25; P = .89), but from 4 months through the end of the study the primary end point was significantly reduced in the simvastatin only group (HR, 0.75; 95% CI, 0.60-0.95; P = .02). Myopathy (creatine kinase >10 times the upper limit of normal associated with muscle symptoms) occurred in 9 patients (0.4%) receiving simvastatin 80 mg/d, in no patients receiving lower doses of simvastatin, and in 1 patient receiving placebo (P = .02). Conclusions  The trial did not achieve the prespecified end point. However, among patients with ACS, the early initiation of an aggressive simvastatin regimen resulted in a favorable trend toward reduction of major cardiovascular events.      

Major outcomes in moderately hypercholesterolemic,hypertensive patients randomized to pravastatin vs usual care: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT)

Context  Studies have demonstrated that statins administered to individuals with risk factors for coronary heart disease (CHD) reduce CHD events. However, many of these studies were too small to assess all-cause mortality or outcomes in important subgroups. Objective  To determine whether pravastatin compared with usual care reduces all-cause mortality in older, moderately hypercholesterolemic, hypertensive participants with at least 1 additional CHD risk factor. Design and Setting  Multicenter (513 primarily community-based North American clinical centers), randomized, nonblinded trial conducted from 1994 through March 2002 in a subset of participants from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Participants  Ambulatory persons (n = 10 355), aged 55 years or older, with low-density lipoprotein cholesterol (LDL-C) of 120 to 189 mg/dL (100 to 129 mg/dL if known CHD) and triglycerides lower than 350 mg/dL, were randomized to pravastatin (n = 5170) or to usual care (n = 5185). Baseline mean total cholesterol was 224 mg/dL; LDL-C, 146 mg/dL; high-density lipoprotein cholesterol, 48 mg/dL; and triglycerides, 152 mg/dL. Mean age was 66 years, 49% were women, 38% black and 23% Hispanic, 14% had a history of CHD, and 35% had type 2 diabetes. Intervention  Pravastatin, 40 mg/d, vs usual care. Main Outcome Measures  The primary outcome was all-cause mortality, with follow-up for up to 8 years. Secondary outcomes included nonfatal myocardial infarction or fatal CHD (CHD events) combined, cause-specific mortality, and cancer. Results  Mean follow-up was 4.8 years. During the trial, 32% of usual care participants with and 29% without CHD started taking lipid-lowering drugs. At year 4, total cholesterol levels were reduced by 17% with pravastatin vs 8% with usual care; among the random sample who had LDL-C levels assessed, levels were reduced by 28% with pravastatin vs 11% with usual care. All-cause mortality was similar for the 2 groups (relative risk [RR], 0.99; 95% confidence interval [CI], 0.89-1.11; P = .88), with 6-year mortality rates of 14.9% for pravastatin vs 15.3% with usual care. CHD event rates were not significantly different between the groups (RR, 0.91; 95% CI, 0.79-1.04; P = .16), with 6-year CHD event rates of 9.3% for pravastatin and 10.4% for usual care. Conclusions  Pravastatin did not reduce either all-cause mortality or CHD significantly when compared with usual care in older participants with well-controlled hypertension and moderately elevated LDL-C. The results may be due to the modest differential in total cholesterol (9.6%) and LDL-C (16.7%) between pravastatin and usual care compared with prior statin trials supporting cardiovascular disease prevention.      

不同剂量阿托伐他汀与辛伐他汀用于老年冠心病合并高脂血症治疗的临床效果比较

目的：对比不同剂量阿托伐他汀与辛伐他汀治疗老年冠心病合并高脂血症的临床疗效。方法选取肇庆市高要区人民医院心血管内科2013年5月至2015年4月期间收治的123例老年冠心病合并高脂血症患者,以数字表法随机分为观察A组、观察B组和对照组各41例,观察A组给予阿托伐他汀10 mg/d治疗,观察B组给予阿托伐他汀20 mg/d治疗,对照组给予辛伐他汀20 mg/d治疗,8周为一个疗程,三组均治疗3个疗程,比较三组患者治疗前后的总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平,以及治疗过程中的不良反应情况。结果治疗后观察A组、观察B组和对照组患者的TC分别为(3.94±0.49) mmol/L、(3.16±0.47) mmol/L、(4.04±0.48) mmol/L,TG分别为(1.54±0.39) mmol/L、(1.31±0.37) mmol/L、(1.55±0.40) mmol/L、LDL-C分别为(3.24±0.38) mmol/L、(2.93±0.39) mmol/L、(3.17±0.39) mmol/L,均显著低于治疗前的TC (5.93±0.54) mmol/L、(5.92±0.53) mmol/L、(5.95±0.52) mmol/L,TG (1.99±0.43)mmol/L、(1.97±0.41) mmol/L、(1.96±0.40) mmol/L,LDL-C (3.98±0.41) mmol/L、(3.95±0.42) mmol/L、(3.97±0.40) mmol/L,差异均有显著统计学意义(P<0.01);治疗后观察A组、观察B组和对照组患者的HDL-C分别为(1.78±0.32) mmol/L、(1.75±0.34) mmol/L、(1.68±0.33) mmol/L,均显著高于治疗前的(1.06±0.34) mmol/L、(1.03±0.31) mmol/L、(1.04±0.33) mmol/L,差异均有显著统计学意义(P<0.01);治疗后对照组HDL-C显著低于观察A、B两组,观察B组TC、TG、LDL-C均显著低于观察A组与对照组,HDL-C显著高于对照组,差异均有显著统计学意义(P<0.01);观察B组患者的治疗有效率为95.1%(39/41),明显高于观察A组的78.0%(32/41)和对照组的65.8%(27/41),差异均有统计学意义(P<0.05或0.01);三组不良反应发生率分别为4.9%,7.3%,2.4%,差异无统计学意义(P>0.05)。结论阿托伐他汀与辛伐他汀均能够有效降低冠心病合并高脂血症患者的血脂水平,但阿托伐他汀20 mg/d的临床疗效明显优于10 mg/d与辛伐他汀,安全有效,值得推广。     

辛伐他汀对稳定性冠心病患者的血清高敏C-反应蛋白水平的影响

目的探讨辛伐他汀20mg/d对稳定性冠心病患者降脂达标率及血清高敏C-反应蛋白(hs-CRP)水平的影响。方法34例稳定性冠心病患者(其中男26例,女8例),年龄41～79岁,平均(64.4±11.3)岁,服用辛伐他汀20mg/d,疗程12周。治疗前、治疗4周及12周时分别检测血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、肌酐(Cr)、尿素氮(BUN)、尿酸(UA)、血糖(GLU)、肌酸激酶(CPK)及血清高敏C-反应蛋白(hs-CRP)。结果辛伐他汀20mg/d治疗12周降低TC、LDL-C、TG的幅度分别为34.8%、46.1%、24.7%;升高HDL-C2.0%,使76.5%冠心病患者LDL-C降至目标值,并可显著降低hs-CRP水平(P=0.018)。结论辛伐他汀20mg/d治疗冠心病患者有较高的降脂达标率,并可能有利于抑制炎症反应。     

血脂比值及单项血脂对冠心病的应用价值研究

目的探讨血脂比值及单项血脂在冠心病（CHD）中的应用价值。方法测定冠心病组和正常对照组的总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL—C）、载脂蛋白A1（ApoA1）、载脂蛋白B（ApoB）水平,计算TG／HDL—C、TC／HDL—C、LDL—C／HDL-C、ApoA1／ApoB比值,并作统计分析。结果冠心病组的Tc、TG、LDL—C、ApoB、TG／HDL—C、TC／HDL—C、LDL—C／HDL—C显著高于正常对照组,HDL-C、ApoA1、ApoA1／ApoB显著低于正常对照组;冠心病组中,各项血脂比值的异常率从高至低依次为：ApoA1／ApoB、LDL—C／HDL—C、TC／HDL—C、TG／HDL—C,均高于单项血脂的异常率。结论血脂比值对冠心病的早期预防和诊断有较大的临床应用价值,优于各单项血脂指标。     

Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis

Context  Statins reduce low-density lipoprotein cholesterol (LDL-C) levels and slow progression of coronary atherosclerosis. However, no data exist describing the relationship between statin-induced changes in high-density lipoprotein cholesterol (HDL-C) and disease progression. Objective  To investigate the relationship between changes in LDL-C and HDL-C levels and atheroma burden. Design, Setting, and Patients  Post-hoc analysis combining raw data from 4 prospective randomized trials (performed in the United States, North America, Europe, and Australia between 1999 and 2005), in which 1455 patients with angiographic coronary disease underwent serial intravascular ultrasonography while receiving statin treatment for 18 months or for 24 months. Ultrasound analysis was performed in the same core laboratory for all of the studies. Main Outcome Measure  Relationship between changes in lipoprotein levels and coronary artery atheroma volume. Results  During statin therapy, mean (SD) LDL-C levels were reduced from 124.0 (38.3) mg/dL (3.2 [0.99] mmol/L) to 87.5 (28.8) mg/dL (2.3 [0.75] mmol/L) (a 23.5% decrease; P<.001), and HDL-C levels increased from 42.5 (11.0) mg/dL (1.1 [0.28] mmol/L) to 45.1 (11.4) mg/dL (1.2 [0.29] mmol/L) (a 7.5% increase; P<.001). The ratio of LDL-C to HDL-C was reduced from a mean (SD) of 3.0 (1.1) to 2.1 (0.9) (a 26.7% decrease; P<.001). These changes were accompanied by a mean (SD) increase in percent atheroma volume from 39.7% (9.8%) to 40.1% (9.7%) (a 0.5% [3.9%] increase; P = .001) and a mean (SD) decrease in total atheroma volume of 2.4 (23.6) mm³ (P<.001). In univariate analysis, mean levels and treatment-mediated changes in LDL-C, total cholesterol, non-HDL cholesterol, apolipoprotein B, and ratio of apolipoprotein B to apolipoprotein A-I were significantly correlated with the rate of atherosclerotic progression, whereas treatment-mediated changes in HDL-C were inversely correlated with atheroma progression. In multivariate analysis, mean levels of LDL-C ( coefficient, 0.11 [95% confidence interval, 0.07-0.15]) and increases in HDL-C ( coefficient, –0.26 [95% confidence interval, –0.41 to –0.10]) remained independent predictors of atheroma regression. Substantial atheroma regression (5% reduction in atheroma volume) was observed in patients with levels of LDL-C less than the mean (87.5 mg/dL) during treatment and percentage increases of HDL-C greater than the mean (7.5%; P<.001). No significant differences were found with regard to clinical events. Conclusions  Statin therapy is associated with regression of coronary atherosclerosis when LDL-C is substantially reduced and HDL-C is increased by more than 7.5%. These findings suggest that statin benefits are derived from both reductions in atherogenic lipoprotein levels and increases in HDL-C, although it remains to be determined whether the atherosclerotic regression associated with these changes in lipid levels will translate to meaningful reductions in clinical events and improved clinical outcomes.      

Trends in serum lipids and lipoproteins of adults, 1960-2002

Context  Serum total and low-density lipoprotein (LDL) cholesterol contribute significantly to atherosclerosis and its clinical sequelae. Previous analyses of data from the National Health and Nutrition Examination Surveys (NHANES) showed that mean levels of total cholesterol of US adults had declined from 1960-1962 to 1988-1994, and mean levels of LDL cholesterol (available beginning in 1976) had declined between 1976-1980 and 1988-1994. Objective  To examine trends in serum lipid levels among US adults between 1960 and 2002, with a particular focus on changes since the 1988-1994 NHANES survey. Design, Setting, and Participants  Blood lipid measurements taken from 6098 to 15 719 adults who were examined in 5 distinct cross-sectional surveys of the US population during 1960-1962, 1971-1974, 1976-1980, 1988-1994, and 1999-2002. Main Outcome Measures  Mean serum total cholesterol, LDL cholesterol, high-density lipoprotein (HDL) cholesterol, and geometric mean serum triglyceride levels, and the percentage of adults with a serum total cholesterol level of at least 240 mg/dL (6.22 mmol/L). Results  Between 1988-1994 and 1999-2002, total serum cholesterol level of adults aged 20 years or older decreased from 206 mg/dL (5.34 mmol/L) to 203 mg/dL (5.26 mmol/L) (P=.009) and LDL cholesterol levels decreased from 129 mg/dL (3.34 mmol/L) to 123 mg/dL (3.19 mmol/L) (P<.001). Greater and significant decreases were observed in men 60 years or older and in women 50 years or older. The percentage of adults with a total cholesterol level of at least 240 mg/dL (6.22 mmol/L) decreased from 20% during 1988-1994 to 17% during 1999-2002 (P<.001). There was no change in mean HDL cholesterol levels and a nonsignificant increase in geometric mean serum triglyceride levels (P = .06). Conclusions  The decrease in total cholesterol level observed during 1960-1994 and LDL cholesterol level observed during 1976-1994 has continued during 1999-2002 in men 60 to 74 years and women 50 to 74 years. The target value of no more than 17% of US adults with a total cholesterol level of at least 240 mg/dL (6.22 mmol/L), an objective of Healthy People 2010, has been attained. The increase in the proportion of adults using lipid-lowering medication, particularly in older age groups, likely contributed to the decreases in total and LDL cholesterol levels observed. The increased prevalence of obesity in the US population may have contributed to the increase in mean serum triglyceride levels.