药物治疗的高胆固醇血症患者膳食治疗状况与血脂控制达标率--高胆固醇血症临床控制状况多中心协作研究

目的了解接受调脂药物治疗的高胆固醇血症患者膳食状况及膳食对高胆固醇血症控制状况的影响.方法应用食物频数法,于2000年5至8月,对12个省市25家三级甲等医院收治的2136例接受药物治疗的高胆固醇血症患者的膳食状况进行信访调查,其中应答1746例,占81.7%.年龄最小22岁,最大75岁.结果应答者中,控制膳食者占68.3%(1192/1746).其中有75%(894/1192)达到<血脂异常防治建议>膳食合理标准.控制膳食者达标率为28.8%(343/1192),不控制膳食者达标率为13. 6%(12/88),差异有统计学意义 (P<0.01).多因素logistic回归分析控制应用调脂药物等混杂因素后,控制膳食组达标率是不控制膳食组的2.7倍,差异有统计学意义(P<0.01,OR=2.7,95%可信区间为1.4～5.2).结论目前我国高胆固醇血症患者的血脂控制状况不理想,与膳食治疗不足密切相关,合理膳食应作为临床治疗措施积极予以强化.     

我国高胆固醇血症患者临床控制状况变化趋势2000年与2004-2006年达标率比较

目的了解近年来我国高胆固醇血症患者临床控制达标率的变化趋势。方法于2000年和2006年进行两次全国临床血脂控制状况调查,分别调查2136例和539例接受调脂治疗的高胆固醇患者。患者均来自我国大城市的三级甲等医院,接受调脂治疗≥2个月（同一药物同一剂量）。依据我国《血脂异常防治建议》评价患者调脂治疗的达标情况。结果第1次和第2次所调查的患者基本特征相似,平均年龄分别为60．9岁和60．0岁,男性分别占47．2％和49．3％,两次调查患者均以混合型高胆固醇血症为主（62．5％对66．8％）,调脂治疗以使用他汀类药物为主。第2次调查达标率明显高于第1次,总达标率分别为39．9％和26．5％（P〈0．01）。其中,单纯型高胆固醇血症患者的达标率分别为40．2％和28．8％,混合型高胆固醇血症患者分别为39．7％和25．0％,有冠心病危险因素但无动脉硬化疾病患者分别为45．9％和31．7％,动脉硬化疾病患者分别为26．7％和16．6％,使用他汀类药物患者分别为42．2％和30．1％,控制饮食者分别为38．5％和28．3％。结论近5年来高胆固醇血症患者治疗的达标率显著提高,但仍不理想。进一步提高达标率尚需多方努力。     

118例高胆固醇血症患者调脂治疗达标情况分析

目的 调查高胆固醇血症患药物治疗达标率。方法 对现行调脂治疗持续时间≥2个月的118例高胆固醇血症患进行血脂检查,并根据1997年我国制定的《血脂异常防治建议》确定血脂是否达标。结果 总胆固醇（TC）和低密度脂蛋白胆固醇（LDL－C）总达标率分别为23．7％、38．1％,他汀类药物LDL－C总达标率高于海鱼油和绞股兰每日20mg辛伐他汀LDL－C达标率高于每日20mg氟伐他汀。结论 现行调脂治疗达标率较低,可能与选择药物的种类和药物剂量有关。     

第二次中国临床血脂控制达标率及影响因素多中心协作研究

目的了解我国临床血脂控制的最新现状,指导临床血脂异常防治实践。方法在全国21家省部级医院和6家地县级医院中,查阅2004年1月1日至2006年2月28日间开始服调脂药物,且同一药物同一剂量维持≥2个月的2237名患者病例资料,依据美国2004年国家胆固醇教育计划（NCEP）成人治疗组第三次报告（ATPⅢ）及《中国成人血脂异常防治指南》标准计算血脂控制达标率。结果（1）在符合任一血脂防治建议／指南的药物起始治疗标准的2094例患者中,80％来自省部级医院,60％为60岁以上,57％有胆固醇升高,15％无血脂异常,68％合并冠心病等动脉粥样硬化性疾病,75％合并高血压,80％为高危和极高危患者,84％使用他汀类药物,83％采取了不同程度的饮食治疗。（2）依据美国2004年NCEPATPⅢ最新报告,总达标率为34％,低危组、中危组、中高危组、高危组和极高危组达标率分别为85％、78％、61％、31％和22％,差异有统计学意义（趋势性检验P〈0．001）;依据我国新的《成人血脂异常防治指南》,总达标率为50％,低危组、中危组、高危组和极高危组达标率分别为91％、77％、49％和38％,组间差异及趋势性检验均有统计学意义（P〈0．001）。（3）联合用药者达标率为51％,单用他汀类35％,贝特类23％,烟酸类24％,其他类28％,组间差异有统计学意义（P〈0．001）。（4）对1808例服用他汀类药物患者的多元logistic回归分析表明,他汀类药物剂量（高剂量比低剂量,OR=1．72,95％CI：1．15—2．58）、危险分层（极高危比低危,OR=0．02,95％CI：0．01—0．03）、基线LDL-C[每升高0．259mmol／1410mg／d1）,OR=0．83,95％CI：0．80—0．86]和性别（女性比男性,OR=0．77,95％CI：0．60—0．99）等是影响达标率的主要因素。结论我国目前调脂药物的应用对象发生了很大变化,调脂治疗的目的已不单纯是为了降低胆固醇。临床血脂控制状况与各防治指南要求相距仍甚远,特别是高危和极高危患者。要进一步改善我国临床血脂控制状况,药物种类、药物剂量、联合治疗和治疗性生活方式改变等多方面均需要进一步提高。     

军队老干部血脂水平及冠心病构成比分析

目的了解北京军区师以上千部冠心病（CHD）危险因素积聚程度，血脂异常状况，CHD患者在各血脂水平问所占比率。方法采用国际标准化心血管病流行病学调查方法，对北京军区驻京1926名离退休、部分在职师以上干部的基线危险因素水平进行调查。结果军队老干部几乎每人至少存在一项危险因素，并存3种危险因素者占78．23％，CHD患病率高达52．13％；血脂异常55．24％；高胆圊醇（TC）血症39．62％，其中混合型高TC血症患者占45．35％；高甘油三酯（TG）血症者31．57％，其中混合型占58．88％；TC控制未达标者占65．16％；应用调脂药物的人数仅16．72％。其中76．40％服用他汀类；各组血脂间CHD患者所占比率无统计学显著意义（P〉0．05）。结论北京军区师以上老干部CHD危险因素积聚度很高，发病率高，是一群CHD高危人群；血脂控制情况与我国《血脂异常防治建议》相比还有很大的差距，调脂药物服用率低。     

不同起始剂量阿托伐他汀治疗高胆固醇血症的疗效与安全性

目的　观察不同起始剂量阿托伐他汀治疗高胆固醇血症的达标率与安全性。方法　入选2012年2月至7月在我院门诊就诊的高胆固醇血症患者122例作为实验组，患者按心血管病危险因素分为4组：低危组（29例）、中危组（33例）、高危组（32例）及极高危组（28例），根据心血管病危险分层及低密度脂蛋白胆固醇水平确定个体化阿托伐他汀起始剂量；另选同期39例高胆固醇血症患者作为对照组，常规给予阿托伐他汀治疗；6周后所有入选患者低密度脂蛋白胆固醇不达标者每天加阿托伐他汀10　mg；均观察12周，同时记录不良事件。结果　实验组的低危组、中危组、高危组、极高危组患者在6周时低密度脂蛋白胆固醇达标率分别为75.9%、72.7%、71.9%、57.1%，12周时各组的达标率增至89.7%、81.8%、78.1%、71.4%；实验组患者低密度脂蛋白胆固醇总的达标率在6周及12周分别为69.7%及81.1%。对照组患者6周及12周达标率分别为48.7%及66.7%。实验组6周及12周达标率均显著高于对照组（分别为P<0.01，P<0.05）。所有患者均耐受治疗剂量。结论　根据心血管病危险分层及低密度脂蛋白胆固醇水平个体化确定阿托伐他汀治疗起始剂量，患者的达标率显著高于常规治疗的对照组，安全有效，值得推广。     

新版《中国成人血脂异常防治指南》6大精髓抢先看

正2016年10月24日,《中国成人血脂异常防治指南(2016年)》发布,其主要更新要点如下:1血脂异常患病率升高我国成年人血脂异常患病率为40.40%,较2002年大幅度升高。其中,高胆固醇血症患病率为4.9%,高三酰甘油血症患病率为13.1%,高低密度胆固醇血症患病率为33.9%。2他汀类药物有效减少心脑血管事件的作用得到首肯近20年来多项大规模临床试验结果显示,他汀类药物在一、二级预防中均能有效降低心血管事件发生风险,已成为防治心脑血管事件的重要药物。为了调脂达标,临床上应首选他汀类药物(Ⅰ类推荐,A级证据)。他汀类药物     

糖尿病合并血脂异常的营养治疗策略

血脂异常通常是指血浆中胆固醇和（或）甘油三酯升高,通常称为高脂血症,可表现为高胆固醇血症、高甘油三酯血症及混合型高脂血症。高脂血症是因为代谢紊乱等多种因素造成的,糖尿病合并高脂血症很常见,而糖尿病患者的血脂异常往往又会加重其血糖的控制难度。因此,糖尿病患者要注意监测自己的血脂,血脂异常者要及时调整饮食,才利于血糖控制,并延缓糖尿病并发症的发生。     

关注联合用药强调合理安全——选择性胆固醇吸收抑制剂临床应用中国专家共识（2013版）正式公布

中华医学会心血管病学分会与中国老年学学会心脑血管病专业委员会,于2013年4月14日正式发布《选择性胆固醇吸收抑制剂临床应用中国专家共识（2013版）》（以下简称《共识》）。《共识》的主要发起人和核心撰稿专家胡大一、史旭波、郭艺芳教授出席了会议,向媒体同仁介绍了《共识》的撰写背景和主要内容,并回答了媒体提问。基于现有研究结论,此次《共识》也就依折麦布的适用症达成以下共识：①主要用于原发性高胆固醇血症的治疗。作为饮食控制以外辅助治疗,可单独或与他汀联合应用于治疗原发性（杂合子家族性或非家族性）高胆固醇血症。治疗纯合子家族性高胆固醇血症时可联合应用依折麦布与他汀。治疗纯合子谷甾醇血症（或植物甾酵血症）时可作为饮食控制以外的辅助治疗;②高胆固醇血症患者经常规剂量他汀治疗后胆固醇水平仍不能达标者,可联合应用依折麦布;③不适于或不能耐受他汀治疗的高胆固醇血症患者,可应用依折麦布治疗;④中重度高胆固醇血症患者可起始联合应用依折麦布与常规剂量他汀治疗;⑤与贝特类或烟酸类药物联合用于混合型血脂异常患者：⑥与常规剂量他汀联合用于慢性肾脏疾病患者预防心血管事件;⑦应用由他汀与依折麦布组成的单片复方制剂可简化治疗方案,提高患者长期治疗的依从性,对于有适应证的患者推荐首先选用。     

氟伐他汀对高胆固醇血症患者载脂蛋白的影响

近年来的研究表明,高胆固醇血症是发生动脉粥样硬化的重要因素,其中载脂蛋白 A Ⅰ(ApoA Ⅰ)和载脂蛋白B(ApoB)与动脉粥样硬化密切相关。而他汀类调脂药物被广泛应用于临床治疗高胆固醇血症。本研究旨在观察氟伐他汀对原发性高胆固醇血症患者载脂蛋白的作用。1 资料与方法1.1 对象1998-2002年在我院就诊的原发性高胆固醇血症患者,经高脂血症膳食控制方案[1]饮食控制2周后血清总胆固醇(TC)≥5.98mmol/L的未     

Failure to achieve recommended LDL cholesterol levels by suboptimal statin therapy relates to elevated cardiac event rates

OBJECTIVES: The majority of patients with myocardial infarction (MI) and hypercholesterolaemia does not achieve guideline recommended low-density lipoprotein cholesterol (LDL) levels. Suboptimal dosages of statins explain this dilemma in most patients. DESIGN AND SETTING: We evaluated the relationship between statin treatment quality (optimal: LDL<115 mg/dl, suboptimal: LDL>/=115 mg/dl, no statin therapy despite hypercholesterolaemia) and the subsequent incidence of coronary events (coronary death, nonfatal MI, bypass surgery) over a 30 months follow-up in a large cohort of post MI patients with hypercholesterolaemia (n=2045). Analysis was performed in a nested case-control manner comparing 173 cases with a coronary event and 346 matched controls. RESULTS: Patients who developed a coronary event were treated optimally in 11.0%, suboptimally in 43.4% (p<0.05 vs. optimal treatment) and were untreated in 45.7% (p<0.001 vs. optimal treatment). Respective numbers in event-free patients were 21.4%, 47.7%, and 30.9%. After adjustment for most potential confounders, including all cardiovascular risk factors and medication, the relative risk of future non-fatal MI and coronary death associated with a suboptimal statin treatment was 2.02 (95% CI 1.04 to 4.18) compared to optimal statin treatment. Moreover, the statin equivalent dose in optimally treated individuals was significantly higher than in suboptimally treated individuals (0.85+/-0.03 vs. 0.78+/-0.02, p<0.05). CONCLUSION: In this community-based study, a lipid lowering therapy with statins into the recommended target range of LDL levels may be associated with decreased cardiovascular risk compared to a statin therapy without titrating the LDL level below 115 mg/dl. Thus, the quality of statin treatment was identified as an independent predictor of coronary events in post MI patients.     

Effects of atorvastatin and atorvastatin withdrawal on soluble CD40L and adipocytokines in patients with hypercholesterolaemia

OBJECTIVE: Beyond lipid lowering, statins have pleiotropic effects with favourable benefits against atherogenesis.Withdrawal of statin therapy has been demonstrated to abrogate vascular protective activity and even increase the incidence of thrombotic vascular events.The purpose of this study is to investigate the serial changes of soluble CD40 ligand (sCD40L) and two adipocytokines, adiponectin and resistin, after short-term atorvastatin therapy and withdrawal in patients with hypercholesterolaemia. METHODS AND RESULTS: Thirty-two patients with hypercholesterolaemia received atorvastatin 10 mg/day for 3 months. Serum lipid profiles, and levels of sCD40L, adiponectin and resistin, were assessed before and immediately after 3 months' statin therapy. Serum levels of sCD40L and adiponectin were also measured on the 3 consecutive days after statin withdrawal.After 3 months' statin therapy, levels of sCD40L (1.93 +/- 1.13 vs. 1.30 +/- 0.97 ng/mL), total cholesterol and low-density lipoprotein cholesterol (LDL-C) were all reduced significantly (p < 0.05). However, sCD40L level tended to increase towards baseline on the first and second days after statin withdrawal, but was not significantly elevated until the third day after withdrawal (1.89 +/- 1.28 vs. 1.30 +/- 0.97 ng/mL, p < 0.05).Total cholesterol and LDL-C levels did not increase during the 3 days of statin withdrawal. No significant changes of adiponectin and resistin levels were shown after statin therapy. CONCLUSIONS: These results indicate that the effect of statin on sCD40L level was abrogated after therapy withdrawal, and was independent of serum cholesterol level. Statin therapy did not significantly alter levels of adiponectin and resistin.     

The status of lipid management in 1,836 patients with coronary artery disease: a multicenter survey to evaluate the percentage of Japanese coronary artery disease patients achieving the target low-density lipoprotein cholesterol level specified by the Japan Atherosclerosis Society

To determine the status of lipid management in patients with coronary artery disease (CAD) in Japan, we assessed CAD patients who had been receiving lipid-lowering therapy for six months in a cross-sectional survey conducted between June 2001 and December 2002. We defined the achievement rate as the percentage of patients who achieved the target LDL-C level (< 100 mg/dl) specified by the Japan Atherosclerosis Society (JAS). A total of 1,836 Japanese CAD patients were enrolled. In total, 549 (29.9%) achieved the target level. The achievement rate among those receiving statin therapy was 41.3%, which was significantly higher than that (23.4%) among the patients not receiving statin (P < 0.0001). The rate differed with the type of statin; being 54.7% for atorvastatin, 24.8% for pravastatin, 37.1% for simvastatin, and 27.8% for fluvastatin. A multiple regression analysis revealed that atorvastatin use (P < 0.001), and simvastatin use (P = 0.004) significantly contributed to the achievement of the target LDL-C level. In conclusion, large proportions of CAD patients are not achieving the JAS target and the success rates are not similar among different statin therapies, suggesting that cardiologists should consider a more aggressive lipid-lowering therapy with the appropriate choice of statins in Japanese CAD patients.     

Apolipoprotein E genotype affects the response to lipid-lowering therapy in Chinese patients with type 2 diabetes mellitus

OBJECTIVE: To evaluate the effect of apolipoprotein E (apoE) genotype on baseline lipid levels and the response to hydroxy-methyl glutaryl coenzyme A reductase inhibitors (statins) therapy in Chinese patients with type 2 diabetes mellitus (DM). RESEARCH DESIGN AND METHODS: We consecutively recruited Chinese patients with type 2 DM requiring lipid-lowering therapy according to current guidelines. Patients were started on either simvastatin 10 mg daily or given an equivalent dose of lovastatin 20 mg. After 12 weeks of statin therapy, patients had fasting lipid profiles repeated. ApoE genotyping was performed by restriction fragment length polymorphism (RFLP). RESULTS: Ninety-six patients were studied. The epsilon3/epsilon3 genotype was in 62.5%, epsilon2/epsilon3 and epsilon3/epsilon4, 16.7 and 20.8%, respectively. After adjusting for confounding variables, baseline total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels were significantly higher in those with epsilon3/epsilon4 compared with epsilon2/epsilon3 genotype (6.7 vs. 5.5 mm for TC, 4.5 vs. 3.6 mm for LDL-C; p = 0.015 and p = 0.025, respectively). With statin therapy, epsilon3/epsilon4 patients had significantly greater LDL-C lowering compared with epsilon2/epsilon3 patients (48 vs. 27.7%; p = 0.04). There was no gender difference in baseline lipid parameters or response to statin therapy. CONCLUSIONS: ApoE genotype accounts for interindividual variability of baseline cholesterol levels, and response to statin therapy in Chinese patients with type 2 DM.     

Heart rate variability after long-term treatment with atorvastatin in hypercholesterolaemic patients with or without coronary artery disease

Low heart rate variability (HRV) level, indicative of impaired autonomic function, is associated with an increased risk of cardiovascular morbidity and mortality and is negatively affected by hypercholesterolaemia. In order to test the hypothesis that significant low density lipoprotein (LDL) cholesterol reduction after treatment with a statin will have a beneficial effect on HRV level in hypercholesterolaemic patients with or without coronary artery disease (CAD), forty consecutive patients (28 men and 12 women) with a median age of 61, range (17--70) years were studied. Twenty had stable CAD and 20 were free of CAD at baseline. Twenty healthy volunteers, of similar age and gender as the patients, were used as controls. Patients were treated with atorvastatin (20 mg/day) for 2 years. Changes in lipid parameters and HRV indices were assessed at baseline and 2 years later in all subjects. In both patient subgroups a significant beneficial change in all lipid parameters (more pronounced in the CAD+ subgroup) and a significant beneficial modification in HRV time and frequency domain indices was recorded (more pronounced in the CAD- subgroup), while lipid parameters and HRV indices remained unchanged in the control group. A correlation between LDL concentrations and most of the HRV indices was found at baseline in both patient subgroups, while no such correlation was found between values or their percent changes after hypolipidaemic treatment. These data suggest that treatment with atorvastatin improves autonomic function, as reflected by an increase in HRV level, and this may be a likely mechanism, at least in part, for the reduction in clinical events reported by the landmark survival studies with statins in primary and secondary CAD prevention. Perhaps, if this finding is confirmed by larger studies, HRV level may prove to be a useful tool for risk-stratification and treatment guide in high-risk patients with hypercholesterolaemia, regardless of CAD.     

The effect of simvastatin therapy on hemorheological profile in coronary heart desease (CHD) patients

This study was designed to examine changes of hemorheological parameters in patients with CHD and hypercholesterolaemia (wide range of plasma total cholesterol level from 5.6 to 9.8 mmol.l-1) subjected to lipid lowering therapy with statins (simvastatin, 10.0-20.0 mg/day, dosage was dependent on an initial level of total cholesterol). Twenty female subjects were enrolled in this research program. Both prior to and following drug treatment for eight weeks, hemorheological measurements included plasma viscosity, high and low shear whole blood viscosity, hematocrit, RBC aggregation and rigidity. Treatment with simvastatin significantly (p<0.05) reduced total cholesterol, total triglycerides and low-density lipoprotein cholesterol (LDL-C). However, the hemorheological effects of lipid lowering therapy differed markedly between macro- and microrheological groups of parameters: plasma and whole blood viscosity were not significantly changed whereas RBC aggregation and its rigidity were decreased significantly after statin treatment. These results thus suggest that the rheologic effect of lipid lowering therapy concerned mainly the microrheological parameters: red cell aggregation and deformability.     

Statins and plaque stability

3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors are now the standard of care for patients with hypercholesterolaemia. This class of inhibitors, known as 'statins', has been shown to reduce cardiovascular morbidity and mortality. Accumulating data demonstrates a variety of mechanisms in which HMG-CoA reductase inhibition benefits the cardiovascular system. This review will discuss the pharmacology, clinical trials, and mechanisms, besides lipid lowering, of statin therapy.     

Chronic pre-treatment of statins is associated with the reduction of the no-reflow phenomenon in the patients with reperfused acute myocardial infarction.

AIMS: Early statin treatment has beneficial effects on prognosis after acute coronary syndrome. The no-reflow phenomenon determines the prognosis after acute myocardial infarction. We investigated the effects of statin treatment before admission on the development of the no-reflow after infarction. METHODS AND RESULTS: We performed intracoronary myocardial contrast echocardiography in 293 consecutive patients with acute myocardial infarction undergoing successful primary percutaneous coronary intervention. There were no significant differences in the incidence of the no-reflow between the patients with and without hypercholesterolaemia. The 33 patients receiving chronic statin treatment before admission had lower incidence of the no-reflow than those without it (9.1 and 34.6%, P=0.003). They also showed better wall motion, smaller left ventricular dimensions, and better ejection fraction at 4.9+/-2.2 months later. Multivariable logistic regression analysis revealed that statin pre-treatment was a significant predictor of the no-reflow along with anterior wall infarction, ejection fraction on admission, and additional ST-elevation after reperfusion, whereas total cholesterol was not. CONCLUSION: Chronic pre-treatment with statins could preserve the microvascular integrity after acute myocardial infarction independent of lipid lowering, leading to better functional recovery.