两种剂量辛伐他汀早期干预对急性冠脉综合征的有效性研究

目的 随机对比观察急性冠状动脉综合征（ACS）发生后24h内使用两种剂量辛伐他汀的疗效与安全性及对近期心血管事件的影响。方法 122例ACS患者随机分为二组，A组（62例）为常规药物治疗加辛伐他汀40mg／d，B组（60例）为常规药物治疗加辛伐他汀20mg／d，分别于用药前、用药后4、24周测定血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL—C）、甘油三酯（TG）及高敏C反应蛋白（hsCRP），随访24周，观察调脂疗效、达标率、抗炎及药敏不良反应，统计心脑血管缺血相关事件。结果 ①二组用药后TC、LDL—C、hsCRP水平较用药前明显降低（P〈0．01），HDL—C较用药前升高（P〈0．05），其中40mg剂量组的疗效明显优于20ms剂量组（P〈0．05）；②40mg剂量组累计心脑血管事件发生率较20mg剂量组明显减少（P〈0．05），两组每周心绞痛发作次数均有减少，但40mg剂量组更明显（P〈0．05）；③二组均无严重不良反应。结论 ACS患者早期应用辛伐他汀40mg／d，能安全更有效地调降血脂、提高达标率、明显抑制炎症因子，减少心脑血管缺血事件的发生率。     

辛伐他汀治疗高脂血症的疗效评价

目的：观察辛伐他汀治疗高脂血症的临床疗效。方法：对96例高脂血症患者给予辛伐他汀20mg，每晚睡前顿服，疗程8周，观察治疗前后血脂的变化。结果：治疗8周后总胆固醇（TC）、甘油三脂（TG）、低密度脂蛋白胆固醇（LDL—C）均较治疗前显著降低（P〈0．01），高密度脂蛋白胆固醇（HDL-C）也明显升高（P〈0．05）。结论：辛伐他汀降脂作用明显、安全。     

辛伐他汀联合阿司匹林对老年人颈动脉内膜-中层厚度及凝血系统的影响

目的观察辛伐他汀联合阿司匹林对老年高脂血症患者颈动脉内膜．中层厚度（IMT）和凝血系统的变化及其非调脂作用。方法将150例老年高脂血症患者随机分为观察组（75例）和对照组（75例），对照组患者口服辛伐他汀20mg，每日1次；观察组患者在对照组用药的基础上加用阿司匹林100mg，每日1次。治疗12周后复查两组患者颈动脉IMT、血清总胆固醇（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）、纤维蛋白原（FIB）水平和凝血时间（TT）、活化部分凝血酶时间（aPTT）、凝血酶原时间（PT）。结果与治疗前比较，治疗后两组患者颈动脉IMT均明显变薄（均为P〈0．01），TC、TG、LDL-C、FIB均显著降低（均为P〈0．01），HDL-C均明显升高（均为P〈0．01），TT、aPTT、PT均显著延长（均为P〈0．01）。与对照组治疗后比较，观察组TT、棚、PT显著延长（均为P〈0．01），FIB显著减低（P〈0．05），颈动脉IMT显著变薄（P〈0．01）。结论辛伐他汀在有效调脂同时可发挥其非调脂作用，能干预、延迟老年人颈动脉IMT增厚的进程，改善凝血系统，减低血液粘稠度。辛伐他汀联合阿司匹林，在防治老年动脉粥样硬化中能起到比单用辛伐他汀更显著的作用。     

小剂量辛伐他汀联合复方丹参滴丸治疗老年高胆固醇血症的疗效观察

目的：观察小剂量辛伐他汀联合复方丹参滴丸治疗老年高胆固醇血症的有效性和安全性。方法：选择老年高胆固醇血症患者100例,随机分为对照组和治疗组,每组50例。对照组单纯应用辛伐他汀,每次10mg,每日1次,疗程8周;治疗组应用辛伐他汀每次5mg,每日1次,复方丹参滴丸,每次10粒,每日3次,疗程8周。两组用药前后均检测血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）、三酰甘油（TG）、高密度日旨蛋白胆N醇（HDL-c）,同时检测患者血常规、尿常规、肝肾功能有无异常,并观察治疗期间两组患者出现的不良反应。结果：对照组。总有效率74．0％,治疗组。总有效率90．0％,两组比较差异有显著性（P〈0．05）;两组治疗后TC,TG和LDL—C均降低,HDL—C均升高,治疗组改善更为明显,毒副作用的发生率更低（P〈0．05）。结论：小剂量辛伐他汀伍用复方丹参滴丸治疗老年高胆固醇血症效果好,不良反应少,值得临床借鉴和使用。     

三种不同剂量辛伐他汀对老年冠心病患者血脂和血管内皮功能的影响

目的 探讨三种不同剂量（10mg，20mg，40mg）辛伐他汀对老年冠心病患者血脂和血管内皮功能的影响。方法入选确诊的老年冠心病患者106例（男68例，女38例），随机分为3组：A组53例（男34例，女19例），B组51例（男33例，女18例），C组52例（男33例，女19例），D组（健康对照组）40例（男26例，女14例）。A组、B组、C组分别给予辛伐他汀10mg、20mg、40mg，每日1次口服。采用超声法检测血流介导的肱动脉内皮依赖性舒张功能（FMD），同时观察血脂水平的变化。结果A、B、C各组治疗后总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）水平均较治疗前显著降低（P〈0．05），各组治疗后4周、8周、12周和24周TC、LDL-C水平之间差异亦有显著性（P〈0．05），呈现C组〉B组〉A组趋势。各组辛伐他汀治疗4周后TC、LDL-C已有明显下降，随着治疗时间的延长，TC、LDL-C进一步降低，12周达高峰，至24周仍维持有效水平。辛伐他汀降低TC、LDL-C呈明显量效关系。辛伐他汀治疗可明显改善老年冠心病患者的血管内皮功能。A、B、C各组治疗前FMD较正常对照组（D组）明显降低（P〈0．05），随着治疗时间的延续，各组FMD较治疗前明显增加（P〈0．05），A组4、8、12、24周FMD分别增加24％、47％、74％、100％；B组分别增加48％、61％、97％、90％；C组分别增加47％、68％、116％、141％，说明动脉内皮功能明显改善。但FMD变化值在不同剂量辛伐他汀组（A、B、C组）之间差异无显著性（P〉0．05），说明辛伐他汀改善血管内皮功能与其剂量无关。所有患者耐受性好，但不良反应随剂量增加而增加。结论辛伐他汀治疗老年冠心病患者4周时，TC、LDL-C明显下降，同时血管内皮功能改善。长期治疗能达到调脂及持续改善血管内皮功能的效果。辛伐他汀20mg／d治疗老年高脂血症无论从调脂效果、安全性等方面为最佳选择。不同剂量辛伐他汀均可显著改善老年冠心病患者FMD，其改善程度无显著不同，可能独立于调脂作用之外。     

不同剂量辛伐他汀早期干预对急性冠状动脉综合征患者血清高敏C反应蛋白的影响

目的观察不同剂量辛伐他汀早期干预对急性冠状动脉综合征（ACS）患者血清高敏C反应蛋白（hs—CRP）水平的影响及调脂作用与安全性。方法60例ACS患者随机分为三组，A组为优化药物治疗，B组为优化药物治疗加辛伐他汀20mg／d，C组为优化药物治疗加辛伐他汀40mg／d，均治疗4周，健康对照组不予治疗。分别于用药前及疗程结束后查hs-CRP及血脂水平，同时观察用药安全性。结果①ACS患者hs—CRP、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）、三酰甘油（TG）含量显著高于健康对照组（P〈0．01）；②辛伐他汀20mg与40mg治疗4周后，均能显著降低hs—CRP、TC、LDL—C及TG水平（P均〈0．01），其中40mg剂量组的疗效明显优于20mg剂量组。结论ACS患者hs-CRP显著升高，存在明显的炎性反应，早期大剂量辛伐他汀调脂干预，更能安全有效地抑制此类炎性反应及脂质过氧化损伤，且呈剂量依赖性。     

阿托伐他汀联合应用依折麦布治疗高胆固醇血症者

目的：观察联合应用阿托伐他汀与依折麦布治疗对严重高胆固醇血症患者的降脂疗效。方法：40例严重高胆固醇血症患者用阿托伐他汀（20mg·d^-1）治疗后低密度脂蛋白胆固醇（LDL-C）未达标（〈2．6mmol．L）的患者联合应用依折麦布（10mg·d^-1），观察治疗12周后的血脂水平，并观察对谷转氨酸（AST）、谷丙转氨醇（ALT）和肌酸激醇（CK）的影响。结果：全部患者的基线总胆固醇（TC）、低密度脂蛋白的胆固醇（LDL-C）、三酰甘油（TG）、载脂蛋白B（ApoB）、脂蛋白[α（Lp（a））]在服用阿托伐他汀后均有明显降低，高密度脂蛋白的胆固醇（HDL-C）有明显上升，P〈0．01。联用依折麦布后，TC、LDL-C、ApoB有进一步的下降，P〈0．01，TG、HDL-C和Lp（a）虽有下降但无统计学差异。治疗前后AST、ALT和CK均无明显异常变化。结论：阿托伐他汀联合应用依折麦布对高胆固醇血症患者有更好的降脂（LDL—C）效果，并提高降脂达标率。     

辛伐他汀对高脂血症兔肝脏病理形态学及PPARγ表达的影响

【目的】观察辛伐他汀对高脂血症兔肝脏病理形态学及PPARγ表达的影响。【方法】40只日本大耳白兔随机分为正常组、模型组及辛伐他汀组．高脂饲养建立兔高脂血症动物模型。实验结束时测定血脂浓度,取肝脏作病理形态学检查．用RT—PCR和蛋白质免疫印迹（Western blot）方法观察肝脏PPARγ基因和蛋白表达的变化。【结果】模型组兔血清总胆固醇（TC）、甘油三脂（TG）及低密度脂蛋白胆固醇（LDL-C）水平较正常组升高（P〈0．01）．肝脏脂肪变性程度最重（R=0．68）．肝脏重量、贮脂细胞数量较正常组均增加（P〈0．01）;辛伐他汀组血清TC、TG及LDL-C水平较模型组降低（P〈0．01）．肝脂变程度明显改善（R=0．48）．肝脏重量（P〈0．05）、贮脂细胞数量（P〈0．01）低于模型组。模型组兔肝脏PPARγ基因和蛋白表达水平较正常组增加（P〈0．05）,辛伐他汀组PPARγ基因和蛋白表达水平高于模型组（均P〈0．05）。【结论】辛伐他汀能减轻高脂血症兔肝脏脂肪变性程度．这一作用可能与其降脂同时上调肝脏PPARγ表达有关。     

益气活血解毒汤对实验性动脉粥样硬化家兔炎症细胞因子和血脂的影响

目的：观察中药复方益气活血解毒汤对实验性动脉粥样硬化（AS）家兔血脂及炎症细胞因子水平的影响，探讨该方防治AS的机制。方法：将24只日本雄性大耳白兔随机分为正常对照组、模型组、益气活血解毒汤组和辛伐他汀组，每组6只。采用高脂饲料喂饲建立兔AS模型，其中益气活血解毒汤组及辛伐他汀组在制模的同时分别给药，而正常对照组和模型组以等量蒸馏水灌胃。10周后测定各组空腹血清甘油三酯（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）、C-反应蛋白（CRP）、白细胞介素-6（IL-6）及肿瘤坏死因子-α（TNF-α）含量。结果：模型组TG、TC、LDL—C、CRP、IL-6及TNF-α均较正常对照组有不同程度的升高，HDL—C明显下降，差异均有显著性（P均〈O．01）。益气活血解毒汤组及辛伐他汀组TG、TC、LDL-C、CRP、IL-6及TNF-α均明显低于模型组．HDL—C则明显升高，差异均有显著性（P均〈0．01），而与正常对照组比较差异无显著性（P均〉0．05）。益气活血解毒汤组HDL—C较辛伐他汀组有所升高，差异有显著性（P〈0．05）。结论：益气活血解毒汤对AS有明显的预防和治疗作用；调节血脂和降低炎症细胞因子水平可能是其作用机制之一．     

非高密度脂蛋白胆固醇对冠心病的临床价值探讨

目的探讨血清非高密度脂蛋白胆固醇（non—HDL—C）对冠心病（cHD）的临床应用价值。方法选取96例CHD患者及75例健康对照者为研究对象，分别测定血清总胆固醇（Tc）、三酰甘油（TG）和高密度脂蛋白胆固醇（HDL-C），并计算低密度脂蛋白胆固醇（LDL-C）和non-HDL-C浓度值。结果血清non-HDL-C、LDL-C水平在cHD患者组均显著高于健康对照组（P〈0．01或P〈0．05）；36例CHD合并高TG血症患者non-HDL-C水平显著高于健康对照组（P〈0．01），而LDL-C水平则差异无统计学意义。结论作为冠心病事件的危险因素观察指标，non-HDL-C要优于LDL-C。     

高密度脂蛋白胆固醇、低密度脂蛋白胆固醇及其比值检测在中老年冠心病患者诊断和临床治疗中的意义

目的 探讨血清高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、LDL-C/HDL-C检测在中老年冠心病(CHD)患者中的意义.方法 分析经冠状动脉造影确诊为冠状动脉粥样硬化(药物治疗组)83例、CHD(支架植入组)163例及冠状动脉造影阴性(对照组)44例中老年病例的血清HDL-C、LDL-C、LDL-C/HDL-C比值与冠状动脉病变程度之间的关系.并比较各组间男女血脂水平的差异.结果 药物治疗组、支架植入组与对照组总胆固醇(T()、LDL-C、LDL C/HDL-C比值水平差异有统计学意义(P＜0.05或＜0.01).支架植入组TC、LDL-C、TC/HDLC比值水平明显高于药物治疗组及对照组(P＜0.05或＜0.01).支架植入组HDL-C显著低于药物治疗组及对照组(P＜0.05).药物治疗组女性HDL-C水平高于男性(P＜0.05),但女性TC/H DL-C比值、LDL-C/HDL-C比值低于男性(P ＜0.05).支架植入组女性TC和HDL-C高于男性(P＜0.05).对照组女性TC、HDL-C高于男性(P＜0.05),但女性TG/HDL C、LDLC/HDL-C低于男性(P＜0.05).结论 血清HDL-C、LDL-C、LDL-C/HDL-C比值与冠状动脉病变相关,对中老年CHD患者的诊断及临床治疗有使用价值.     

Effects of low doses of simvastatin and atorvastatin on high-density lipoprotein cholesterol levels in patients with hypercholesterolemia.

BACKGROUND: Simvastatin 40 to 80 mg/d has been found to increase high-density lipoprotein cholesterol (HDL-C) levels significantly more than atorvastatin at equipotent doses (ie, 20-80 mg/d). Data on the effects of lower doses of the 2 drugs on HDL-C levels are conflicting. OBJECTIVE: The purpose of this study was to investigate the effects of simvastatin 20 mg/d and atorvastatin 10 mg/d on HDL-C levels in patients with hypercholesterolemia. METHODS: Patients with primary hypercholesterolemia (total cholesterol [TC] >250 mg/dL) who were not taking any lipid-lowering agents and who were following a low-fat diet were randomized to receive 1 of 2 treatments: simvastatin 20 mg/d or atorvastatin 10 mg/d. Serum TC, triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and HDL-C levels were measured using standard methods after 2 months of therapy. In a secondary analysis, lipids and lipoprotein cholesterol were measured after 1 year in patients who continued treatment. RESULTS: Of the 240 patients enrolled (108 men and 132 women; age range, 23-77 years, mean [SEM] 56.7 [0.69]), 235 completed the study. After 2 months of therapy, TC, LDL-C, and serum TG levels decreased significantly versus baseline in both groups (P < 0.001), with no significant differences between treatment groups. HDL-C levels increased by 9.0% (P < 0.001 vs baseline) in the simvastatin group and by 4.3% (P < 0.02) in the atorvastatin group. The difference between the 2 groups in the percentage increase in HDL-C was statistically significant (P < 0.05). In 113 patients who continued treatment, HDL-C levels at 1 year were still significantly higher than baseline levels in the simvastatin group (6.3%, P = 0.034), but not in the atorvastatin group (2.8%, P = 0.587). CONCLUSIONS: The findings from this study suggest that the HDL-C-increasing effect of simvastatin 20 mg is significantly greater than that of atorvastatin 10 mg. Since increasing HDL-C levels is thought to lower the risk for atherosclerosis and coronary heart disease, these results warrant further investigation.     

辛伐他汀对急性冠脉综合征患者颈动脉粥样硬化的影响

目的：探讨辛伐他汀对急性冠脉综合征患者颈动脉粥样硬化的影响及其机制。方法：80例急性冠脉综合征患者随机分成辛伐他汀20 mg组（40例）和辛伐他汀40 mg组（40例）,于治疗前及治疗6个月后分别测定血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）及高密度脂蛋白胆固醇（HDL-C）水平,并超声检测颈动脉内-中膜厚度（IMT）及颈动脉斑块面积。结果：两组治疗后TC、TG、LDL-C水平均明显降低（P〈0.01）,HDL-C明显升高（P〈0.01）;而辛伐他汀40 mg组较20 mg组作用更为明显（P〈0.05）。治疗6个月后IMT及颈动脉斑块面积明显缩小（P〈0.01）,且辛伐他汀40 mg组作用更显著（P〈0.01）。结论：辛伐他汀对急性冠脉综合征患者颈动脉粥样硬化斑块具有延缓和稳定作用。     

老年代谢综合征患者动脉弹性变化分析及护理对策

目的 探讨老年代谢综合征患者动脉弹性功能变化情况及其影响因素.方法 对221例老年代谢综合征患者(实验组)采用CVProfilorDO-2020系统进行了大动脉弹性(C1)和小动脉弹性(C2)的检测,并与206例老年健康者(对照组)的相应检测值进行了比较,分析大小动脉弹性与收缩压(SBp)、舒张压(DBp)、平均压(MBp)、脉压(Pp)、体重指数(BMI)、体脂含量、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)和空腹血糖(FBG)等指标的相关性.结果 (1)与对照组比较,实验组C1和C2明显降低,SBp、DBp、MBp、Pp、BMI和体脂均明显升高.(2)与对照组比较,实验组的血清TC、TG、LDL-C和FBG水平明显升高,而HDL-C明显降低.(3)C1、C2与年龄、SBp、DBp、MBp、Pp以及血清TC、LDL-C、FBG浓度呈显著的负相关,但与体重指数呈正相关,与体脂、血清TG浓度及血清HDL-C浓度无明显的相关性.C1与C2之间呈显著的正相关.结论 老年代谢综合征患者的动脉弹性明显降低,动脉弹性功能检测为临床评价血管结构和功能损害及其危险分层提供了一种替代方法.     

匹伐他汀钙治疗高胆固醇血症的有效性和安全性

目的观察匹伐他汀钙治疗高胆固醇血症的安全性和有效性。方法采用随机、双盲、阳性药物平行对照方法,将入选的高胆固醇血症48例经4周停用降血脂药物处理后,随机接受A药(匹伐他汀钙每日1 mg,A组)、B药(匹伐他汀钙每日2 mg,B组)和C药(辛伐他汀胶囊每日20 mg,C组)治疗,疗程8周。分别于治疗前、治疗4周及8周末检测计算血清低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)改变百分数,并记录血常规、尿常规、心电图、血生化检测结果及不良反应发生情况,分析降脂效果和安全性,并对3组进行比较。结果治疗前3组年龄、性别、身高、体重、收缩压、舒张压、心率以及LDL-C、TC、TG水平比较差异均无统计学意义(P>0.05);HDL-C水平比较差异有统计学意义(P<0.05),行Kruskal-Wallis检验,发现B组与C组比较差异有统计学意义(P<0.05)。与治疗前比较,治疗4周和8周末3组LDL-C、TG、TC水平均下降,差异有统计学意义(P<0.05)。3组血脂改变百分数比较差异均无统计学意义(P>0.05)。3组均未出现严重不良反应及紧急破盲事件,且无未预知的不良反应发生。结论临床使用匹伐他汀钙每日1～2 mg治疗高胆固醇血症,能有效降低LDL-C、TC、TG水平,效果确切、安全。     

EECP联合高压氧对不稳定型心绞痛患者血清TSP-1、Cat S和IL-1β水平的影响

目的观察增强型体外反搏(EECP)联合高压氧治疗不稳定型心绞痛的疗效,以及对血清血小板反应蛋白-1(TSP-1)、组织蛋白酶S(Cat S)和白细胞介素(IL)-1β水平的影响。方法选择2017年1月至2019年12月在上海市闵行区中西医结合医院诊治的不稳定型心绞痛患者106例,根据随机数字表法将患者分为观察组和对照组,每组53例。对照组予以高压氧治疗,观察组在对照组的基础上使用EECP治疗。观察两组治疗后的疗效,治疗前后症状、总胆固醇(TG)、三酰甘油(TC)和低密度脂蛋白胆固醇(LDL-C)、肱动脉血流介导性舒张功能(FMD)、肱-踝动脉脉搏波传导速度(baPWV)、颈-股动脉脉搏波传导速度(cfPWV)、TSP-1、Cat S和IL-1β水平的变化。结果观察组的总有效率为90.57%,对照组的总有效率为71.70%,观察组的疗效明显优于对照组(P<0.05)。两组治疗前心绞痛持续时间、心绞痛发作频率、心肌缺血总负荷、TG、TC、LDL-C、肱动脉FMD、baPWV、cfPWV、TSP-1、Cat S和IL-1β水平差异无统计学意义(P>0.05),治疗后两组的心绞痛持续时间缩短(P<0.05),心绞痛发作频率、心肌缺血总负荷、TG、TC、LDL-C、baPWV、cfPWV、TSP-1、Cat S和IL-1β水平较治疗前明显降低(P<0.05),两组肱动脉FMD较治疗前明显升高(P<0.05),观察组与对照组比较,改变更加明显(P<0.05)。结论EECP联合高压氧治疗不稳定型心绞痛的疗效显著,能够降低血脂水平,改善动脉血管弹性,可能与降低血清TSP-1、Cat S和IL-1β水平有关。     

Hemostatic effects of atorvastatin versus simvastatin

OBJECTIVE: To compare the effects of simvastatin and atorvastatin on hemostatic parameters. METHODS: Sixty-one patients with primary hypercholesterolemia without coronary heart disease were treated with atorvastatin 10-20 mg/d or simvastatin 10-20 mg/d. At baseline, 4, 12, and 24 weeks, lipid levels such as low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), very-low-density lipoprotein cholesterol (VLDL-C), triglycerides (TGs), and hemostatic parameters such as platelet counts, partial thromboplastin time (PTT) prothrombin time (PT), and fibrinogen levels were measured. RESULTS: At 12 weeks, the doses of the statins were increased to 20 mg/d in 10 of 35 (28.5%) patients treated with atorvastatin and 18 of 26 (69.2%) patients treated with simvastatin when the target level of LDL-C (130 mg/dL) was not reached. Mean doses were atorvastatin 12.8 mg/d and simvastatin 16.9 mg/d. After 24 weeks, 5 patients (14.3%) in the atorvastatin group and 4 patients (15.3%) in the simvastatin group had not reached the goal. In patients with diabetes, target level (LDL-C <100 mg/dL) was not reached in 35.7% of patients in the atorvastatin group and 44.4% of patients in the simvastatin group. Both simvastatin and atorvastatin were effective in lowering TC and LDL-C levels (p < 0.001). Atorvastatin lowered TGs significantly (p < 0.01). Neither atorvastatin nor simvastatin significantly reduced VLDL-C levels. HDL-C levels increased with atorvastatin, but there was no significant difference between the 2 groups. Platelet counts decreased with both statins nonsignificantly. Moreover, fibrinogen levels decreased with simvastatin and atorvastatin, but these reductions were significant only for simvastatin (p < 0.05). We detected prolongation of the PT with both drugs (p < 0.05); however, prolongation of the PTT was significant only with simvastatin (p < 0.001). Effectiveness of both statins on lipid and hemostatic parameters was dose related. Adverse effects were seen in 5 patients (14.2%) treated with atorvastatin and 3 patients (11.5%) treated with simvastatin. Elevations in serum transaminase levels >3 times the upper limit of normal and in creatine phosphokinase >5 times the upper limit of normal were not observed in any group. CONCLUSIONS: Atorvastatin was more effective than simvastatin on lipid parameters, although statistically insignificantly, while simvastatin produced more significant changes than atorvastatin on hemostatic parameters. The mean dose of simvastatin was greater than that of atorvastatin. Both statins had increased effects on lipid and hemostatic parameters when doses were increased. Atorvastatin and simvastatin were well tolerated. Different effects of statins on lipid levels and on coagulation parameters should be considered in patients with hypercholesterolemia and tendency to coagulation, especially in preventing thrombotic events. Further studies in larger trials are needed to confirm these observations.     

Effects of orlistat, simvastatin, and orlistat + simvastatin in obese patients with hypercholesterolemia: a randomized, open-label trial

Background: Many obese patients have comorbidities that worsen their prognoses, particularly if hypercholesterolemia is present. In these patients, dietary restrictions are not sufficient to reduce hypercholesterolemia and lose body weight.Objective: This 1-year, single-center, randomized, open-label study assessed the effects of diet and exercise plus treatment with orlistat, simvastatin, and orlistat + simvastatin on lipid profile, body composition, and blood pressure in obese patients with hypercholesterolemia.Methods: Obese, normotensive patients with hypercholesterolemia aged > 45 years were eligible. Patients were prescribed a restricted-calorie diet and were randomized to receive orlistat 120 mg TID (group O), Simvastatin 20 mg/d (group S), or orlistat 120 mg TID plus simvastatin 20 mg/d (group OS) for 1 year. Serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), highdensity lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels; body mass index (BMI); waist-circumference reduction (WCR); body weight loss (BWL); and diastolic blood pressure (DBF) and systolic blood pressure (SBP) were measured at baseline and after 6 months and 1 year of treatment.Results: We enrolled 87 patients (45 women, 42 men; mean age, 55 years). Four patients dropped out due to nontransient adverse events. After 1 year of treatment, significant improvements were found in all measured parameters in all treatment groups versus baseline values, except for HDL-C in group O. Significant between-group differences at 1 year included the following: TC, LDL-C, and TG levels and BMI, WCR, and BWL were significantly decreased in group OS versus groups O and S; DBP was significantly decreased in group OS versus group O; SBP and DBF were significantly decreased in group OS versus group S. HDL-C was significantly increased in group OS but not in groups O and S. Five patients in group O and 1 patient in group OS experienced transient gastrointestinal adverse events.Conclusions: In this study population, all 3 treatments produced significant improvements in most measured parameters from baseline. The combination treatment showed significantly greater reductions in serum TC and LDL-C levels, BMI, WCR, and BWL than with either orlistat or simvastatin alone. Small but significant differences in blood pressure were found with combination treatment.     

Sex-related differences in response of plasma lipids to simvastatin: the Saitama Postmenopausal Lipid Intervention Study. S-POLIS Group

The Saitama Postmenopausal Lipid Intervention Study was a multicenter, uncontrolled, collaborative study that investigated tolerability and sex-related differences in the response of serum lipids to simvastatin administered for 12 months in 122 postmenopausal women and 55 men with serum total cholesterol (TC) levels > or =220 mg/dL. With simvastatin treatment, TC and low-density lipoprotein cholesterol (LDL-C) levels decreased significantly at 1 month in both groups, and these decreased levels were maintained throughout treatment (P < 0.001). A significant decrease in triglyceride (TG) levels was also observed in both groups (P < 0.05). The mean percentage decreases in TC and LDL-C levels in women (20% and 28%, respectively) were significantly greater than those in men (15% and 20%, respectively) (P < 0.001). Mean percentage changes in TC and LDL-C levels in subgroups defined by stratification for baseline TC and LDL-C levels were also greater in women. There were no sex-related differences in the percentage changes in TG or high-density cholesterol levels, although the changes were influenced by baseline levels. Although the median dose of simvastatin (milligrams per kilogram of body weight) in women was significantly higher than in men (P < 0.001), the percentage changes in serum lipids were not correlated with the doses of simvastatin calibrated by body weight. Adverse reactions occurred in 8 men and 7 women, so there appeared to be no significant sex-related difference. Eleven patients had abnormal laboratory values. Simvastatin therapy for 12 months is well tolerated and effective for both women and men with hypercholesterolemia. Sex-related differences occurred in the response to simvastatin therapy of serum lipids, especially TC and LDL-C, with greater changes in lipid levels occurring in women.     

2型糖尿病患者血清超敏C反应蛋白及血脂检测的临床意义

目的探讨血清超敏C反应蛋白(hs-CRP)和血脂在2型糖尿病患者诊断中临床意义。方法观察80例2型糖尿病患者(观察组)和50例健康体检者(对照组)血清hs-CRP、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。分析观察组hs-CRP与血脂各项检测指标的相关性。结果与对照组比较,观察组血清TC、TG、LDL-C、hs-CRP水平明显高于对照组(P<0.01),HDL-C水平明显低于对照组(P<0.01)。观察组hs-CRP与TC、TG、LDL-C呈正相关(P<0.05或P<0.01),与HDL-C呈负相关(P<0.01)。结论血脂与炎症因子水平检测是糖尿病诊断的有效手段。