A Summary and Critical Assessment of the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease Risk in Adults: Filling the Gaps

The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines has recently released the new cholesterol treatment guideline. This update was based on a systematic review of the evidence and replaces the previous guidelines from 2002 that were widely accepted and implemented in clinical practice. The new cholesterol treatment guideline emphasizes matching the intensity of statin treatment to the level of atherosclerotic cardiovascular disease (ASCVD) risk and replaces the old paradigm of pursuing low-density lipoprotein cholesterol targets. The new guideline also emphasizes the primacy of the evidence base for statin therapy for ASCVD risk reduction and lists several patient groups that will not benefit from statin treatment despite their high cardiovascular risk, such as those with heart failure (New York Heart Association class II-IV) and patients undergoing hemodialysis. The guideline has been received with mixed reviews and significant controversy. Because of the evidence-based nature of the guideline, there is room for several questions and uncertainties on when and how to use lipid-lowering therapy in clinical practice. The goal of the Mayo Clinic Task Force in the assessment, interpretation, and expansion of the ACC/AHA cholesterol treatment guideline is to address gaps in information and some of the controversial aspects of the newly released cholesterol management guideline using additional sources of evidence and expert opinion as needed to guide clinicians on key aspects of ASCVD risk reduction.     

他汀类药物对缺血性脑血管疾病炎性标志物的影响

动脉粥样硬化是缺血性脑血疾病发生发展的主要病理基础,而动脉粥样硬化临床症状的出现与炎症活动密切相关。他汀类药物独立于降脂之外的抗炎作用已被逐渐认识,本文就他汀类药物对缺血性脑血管疾病炎性标志物的影响予以综述。     

Statins: Do They Aggravate or Ameliorate Neuropathic Pain?

Neuropathic pain is a debilitating condition caused by a lesion or disease of the somatosensory nervous system. Statins inhibit the rate-limiting step in cholesterol biosynthesis by blocking 3-hydroxy-3-methyl glutaryl coenzyme A reductase. Apart from the cholesterol-reducing actions of statins, recent studies have shown their pleiotropic actions; accordingly, their usefulness in attenuating different disease states has been described in preclinical studies. Studies in animals have also suggested their beneficial effects in attenuating neuropathic pain in various animal models of neuropathy. In these studies, their usefulness has been ascribed to cholesterol-independent actions, including anti-inflammatory, antioxidant, and neuromodulatory effects. On the contrary, clinical evidence suggests that statin administration in patients is associated with development of neuropathy, suggesting the dichotomous role of statins in neuropathic pain. The present review discusses the pain-attenuating as well as pain-inducing role of statins in preclinical and clinical studies, respectively. Furthermore, the review provides mechanistic insight to explain the paradoxical nature of this class of drugs in neuropathy in preclinical and clinical studies.PerspectiveThe article reviews the pain-inducing role of statins in clinical studies and its neuropathic pain–attenuating role in preclinical studies with possible mechanisms. Understanding key differences in mechanisms may help to attenuate pain induction in the clinical setting and may possibly project statins as neuropathic pain–attenuating agents.     

常用血脂指标与静脉血栓的相关性分析

静脉血栓(VTE)是一种受多种遗传因素及环境因素影响的严重性血管疾病。VTE具有一定的致死性,主要包括深静脉血栓和肺动脉栓塞。一些临床大样本人群研究指出了血脂相关指标与VTE发生率之间的潜在相关性,他汀类降脂药物可在一定程度上降低VTE发生的风险。该文旨在从生物学及临床的角度就现有研究结果对血脂与静脉血栓之间可能存在的相关性进行综述,为VTE的预测、诊断及治疗提供新的理论依据。     

银杏叶制剂联合他汀类药物对高脂血症患者血脂水平影响的Meta分析

目的系统评价银杏叶制剂联合他汀类药物对高脂血症患者血脂水平的影响。方法计算机检索MEDLINE、EMbase、Cochrane Central Register of Controlled Trials（CENTRAL）、Ovid、万方数据库（Wanfang Data）、维普数据库（Vl P）、中国知网（CNKI）和中国生物医学文献数据库（CBM）中关于银杏叶制剂联合他汀类药物协同作用于高脂血症患者的研究,同时追索纳入其参考文献。检索时限均为从建库至2012年12月。根据GRADE分级方法评价纳入研究质量,用Rev Man 5.1软件进行Meta分析。结果由于银杏叶制剂属于中成药,未搜到相关外文文献。故共纳入9项研究,合计798例患者。对照组单独服用他汀类药物,实验组在服用他汀类药物的基础上加服银杏叶制剂。Meta分析结果显示：治疗后,实验组与对照组血脂水平（总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇）比较,差异均具有统计学意义[WMD（95%CI）分别为-0.39（-0.49,-0.29）、-0.06（-0.08,-0.05）、-0.26（-0.34,-0.17）、0.19（0.16,0.23）]。结论银杏叶制剂联合他汀类药物治疗高脂血症可显著降低患者血脂水平,临床疗效优于单用他汀类药物组。     

CABG术前单次他汀负荷对心肌特异性miRNA的调控作用

目的：探讨CABG术前单次他汀负荷对心肌特异miRNA（miRNA-1、miRNA-133、miRNA-208、miRNA-499）表达的影响。方法 CABG患者术前12h随机分为两组：A组常规服用20 mg阿托伐他汀,B组术前单次服用80 mg阿托伐他汀。术中随机获取右心耳组织,A组5例,B组3例,健康人右心耳组织4例作为C组,荧光定量聚合酶链式反应检测心脏特异性miRNA的表达量（miRNA-1,miRNA-133,miRNA-208和miRNA-499）。结果miRNA-1,miRNA-133a,miRNA-133b,miRNA-208a,miRNA-208b,miRNA-499a-3p,miRNA-499a-5p,和 miRNA-499b-3p在三组中的表达无差异。与A组和C组相比,miRNA-499b-5p在B组中明显高表达。结论 CABG术前单次大剂量他汀负荷的心肌保护作用,其机制之一可能通过上调miRNA-499b-5p实现。     

他汀类药物治疗高血压的研究进展

近年来随着人们物质生活水平的提高,高血压、血脂异常、糖尿病、吸烟、肥胖等心血管疾病的危险因素逐渐增多,动脉粥样硬化性心血管疾病已经成为现在人类主要死亡原因之一。众所周知,他汀类药物是治疗高血脂疾病的首选药物,随着科研的进步,越来越多的实验数据表明,他汀类药物具有独立的降压作用,它主要通过改善细胞内皮功能,下调血管紧张素Ⅰ型受体,调节细胞色素P450酶的代谢途径从而达到降压的效果。     

Statins

Hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitors, otherwise known as statins, are the most common class of lipid lowering medications prescribed today. Although this class of medications is contraindicated in pregnant women and those trying to conceive, there are many individuals who would benefit from these medications. Multiple randomized controlled trials have demonstrated that statins are effective in both primary and secondary prevention of coronary artery disease. Simple risk stratification tools can identify the women who would benefit.     

他汀类联合心血管药物治疗冠心病67例临床观察

目的：观察他汀类联合心血管药物治疗冠心病的临床效果。方法：选取本院2013年1-8月收治的134例冠心病患者,按照随机数字表法将其分为对照组和治疗组各67例。对照组给予常规心血管药物治疗,治疗组在此基础上联用他汀类药物进行治疗,观察比较两组患者的临床治疗效果及血脂改善情况。结果：经治疗,治疗组的总有效率明显优于对照组,比较差异有统计学意义（X2=9.307,P〈0.05）。对照组治疗前后的血脂改善情况比较差异无统计学意义（P〉0.05）;治疗组治疗后的血脂指标TC、TG、HDL-C和LDL-C均明显低于治疗前及对照组,比较差异均有统计学意义（P〈0.05）。结论：在冠心病患者的临床治疗中,他汀类联合心血管药物治疗的疗效理想,血脂改善情况良好,值得在临床中进一步推广和应用。     

The 2013 American College of Cardiology/American Heart Association guidelines for the treatment of dyslipidemia: mind the gaps!

The ACC/AHA lipid guidelines need to be reconsidered before full implementation. A new cardiovascular disease (CVD) risk estimation, preferably based in interventional multiethnic studies, will be ideal. Specific LDL-C targets may also be necessary because there are data pointing out that they are useful and pragmatic. The risk/benefit ratio should be a key issue because medicine is all about this concept (Hippocrates 460 – c. 370 BC: “first do not harm”; and then in the Hippocratic Oath: “I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous”).