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。     

辛伐他汀与氟伐他汀对高脂血症患者降脂疗效的对比观察

高脂血症是发生冠心病的独立危险因子 ,也是冠心病急性事件的重要诱发因素。大量的研究证实 ,调脂治疗可明显降低冠心病的发病率及死亡率〔1〕。在调脂治疗中 ,他汀类药物具有无可替代的主导作用 ,近几年来已广泛用于冠心病的 1、2级预防。本研究拟通过对 1 42例高胆固醇血症或混合型高脂血症患者 ,分别予辛伐他汀及氟伐他汀调脂治疗 ,观察和比较它们降脂治疗的有效性和安全性。1　对象与方法1 .1　对象将 1 42例高胆固醇血症或混合性高脂血症患者随机分为两组 ,辛伐他汀组 74例 (男 44例 ,女 30例 ) ,平均年龄 ( 5 8.8± 1 0 .9)岁 ;氟伐他…     

急性心肌梗死恢复期患者他汀类药应用的调查

目的：调查急性心肌梗死(AMI)恢复期患使用他汀类药物调脂的现状。方法：分析1998—2002年100例AMI患发病时及3月后血清胆固醇水平和他汀类药物调脂的情况。结果：1998—2002年AMI恢复期患服用他汀类调脂药物的比率呈逐年增高的趋势(14．3％一72．7％)，血清胆固醇水平达到我国制定的降脂目标值的患比率也呈逐年增高的趋势，但仍有51．1％的患未接受降脂治疗。结论：AMI恢复期患的高服固醇血症的治疗率很低，应该改进。     

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。     

高胆固醇血症临床控制状况多中心协作研究——达标率及影响因素

目的 了解在目前的临床治疗下我国高胆固醇血症控制状况。方法 在全国12个大城市的25家3级甲等医院中，对服用调脂药物已≥2个月的高胆固醇患者（服药前总胆固醇≥5.72mmol/L或低密度脂蛋白-胆固醇≥3.64mmol/L)测定血清脂质，根据我国《血脂异常防治建议》标准计算血脂控制达到控制目标的人数和达标率。结果 （1）临床所见高胆固醇血症患者中，60岁以上患者占63.4%,门诊患者占75.4%，心内科患者占66.4%，混合型高胆固醇血症患者占62.5% ,使用他汀类药物占70.3%，不控制饮食者占18.3%。（2）总达标率为26.5%，其中有动脉粥样硬化性疾病（ASD）患者为16.6%，无ASD有危险因素（RF）患者为31.7%，无ASD无RF患者为44.9%，有显著性差异（P=0.001)；使用他汀类调脂药物者达标率为30.1%，贝特类为19.7%，其他类为14.3%，有显著性差异（P=0.001)；同时控制饮食者达标率为28.3%，不控制饮食者为18.2%，有显著性差异（P=0.001)。此外，影响达标率的因素还有治疗前的血脂水平，合并危险因素数目及文化程度等。结论 我国目前临床高胆固醇血症控制状况与我国《血脂异常防治建议》的要求相差甚远。重视高胆固醇的治疗，加强健康教育，强调非药物治疗，正确选择药物种类和科学调整药物剂量是目前尽快改善我国高胆固醇血症控制状况的有效措施。     

微粒化力平脂治疗糖尿病合并高脂血症的疗效观察

观察微粒化力平脂在糖尿病高血脂病人中的降血脂作用。在入选的82例病人中，单纯高胆固醇血症者23例，单纯高甘油三酯血症者26例，高胆固醇血症和高甘油三酯血症混合型33例。入选时血糖为6．7±1．7mmol／L，且在整个治疗过程中保持稳定，服药前的TC、TG分别为5．8±1．4mmol／L、3．2±3．lmmol／L。服用方法每晚睡前200mg，一次顿服。在服药第四周，降至4．9±1．2mmol／L和1．7士1．lmmol／L，下降幅度分别为15．5土15．0％和46．9士29．0％，至第八周进一步降低至4．4土1．0mmol／L、1．5士0．8mmol／L，下降幅度分别为24．1士16．8％和53．1士26．6％，TG下降幅度皆明显高于TC下降幅度，说明此药对TG作用更为明显。在治疗期间，LDL－C水平则逐渐升高，分别为1．5士0·6mmol／L、l.6士0.6mmol／L和1.7士0．6mmol／L。ApoA和ApoB在整个治疗期间无明显变化，未见明显副作用。     

他汀类药物血压调节机制的研究进展

他汀类药物干预冠心病预防的各个方面和层面,是治疗高胆固醇血症的首选药物。近年来,临床研究发现他汀类药物可改善高血压合并血脂异常患者的血压,并且在很大程度上不依赖于其调脂作用。本文就他汀类药物调节血压的机制作一综述。     

氟伐他汀对家兔颈动脉粥样斑块巨噬细胞和基质金属蛋白酶的影响

目的观察高胆固醇血症家兔颈动脉粥样斑块内炎性巨噬细胞与MMP-2、MMP-9的表达情况，并研究氟伐他汀干预对巨噬细胞聚集和基质金属蛋白酶（MMPs）表达的影响，探索他汀类药物在稳定颈动脉斑块中的作用及机制。方法24只家兔随机分为对照组、高脂组和治疗组，每组8只，分别给予普通饲料、高脂饲料和高脂饲料加氟伐他汀喂养，测定不同时间点血清总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）水平。喂养第12月时处死动物，取颈动脉进行石蜡切片，测量并计算颈动脉I／M比值，SP法进行CD68、MMP-2和MMP-9免疫组织化学染色。结果治疗组血清TC、LDL-C浓度明显低于高脂组（P〈0．01）。治疗组I／M比值明显低于高脂组（P〈0．01）。高脂组颈动脉斑块中见大量CD68阳性细胞，而治疗组CD68阳性细胞数显著少于高脂组（P〈0．01）。颈动脉斑块中MMP-2、MMP-9阳性细胞和染色强度明显增加，治疗组MMP-2和MMP-9的表达较高脂组显著减少（P=0．002和P=0．016）。结论氟伐他汀治疗可以抑制高胆固醇血症家兔颈动脉粥样斑块的形成．减轻斑块内巨噬细胞的浸润并抑制MMP-2和MMP-9的产生，从而起到稳定斑块的作用。     

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多廿烷醇是一种新型调脂药,可以抑制胆固醇合成及提高低密度脂蛋白的血液清除率.降脂效果与他汀类药物相似,对于特殊人群如老年人、肝病患者,其临床有效性、安全性和耐受性已经为多个临床研究证实.与他汀类、贝特类药物联合应用安全性良好.可作为高胆固醇血症、高低密度脂蛋白胆固醇血症或低高密度脂蛋白胆固醇血症患者一级预防治疗用药和不能耐受其他降脂药物的二级预防治疗用药.多廿烷醇对动脉粥样硬化危险因素的长期临床作用还需要进一步研究.     

氟伐他汀和辛伐他汀调旨疗效、不良反应及价—效关系比较研究

采用不同剂量的氟伐他汀对高脂血症患者进行治疗 ,并以辛伐他汀作对照评价其调脂疗效、不良反应情况及价格 效益关系。资料与方法　　 1999年 12月～ 2 0 0 0年 12月收集原发性高脂血症 (包括高胆固醇血症及混合型高脂血症 )患者94例 ,分成治疗组及对照组平行研究。治疗组 5 6例 ,其中男 33例 ,女 2 3例 ,平均年龄 (5 9 6 6± 9 18)岁。对照组 2 5例 ,其中男 13例 ,女 12例 ,平均年龄(5 8 2 8± 10 6 2 )岁。所有入选病例治疗前至少 2次血脂检查符合“心血管药物临床试验评价方法建议”[1] 推荐的血脂治疗标准 ;饮食控制至少 2周。排…     

老年血脂异常患者调脂治疗的现状分析

目的分析老年血脂异常患者调脂治疗情况及影响血脂LDL-C达标率的可能因素。方法应用统一的调查表,调查2007年8月～2008年8月在我院住院的607例患者调脂治疗情况,按年龄分老年组(≥60岁,403例)和非老年组(60岁,204例)。对患者进行血脂异常危险分层,以LDL-C为判断标准,计算血脂控制达标率。结果与非老年组LDL-C达标率(36.8%)比较,老年组LDL-C达标率为42.4%,差异无统计学意义(P0.05)。老年组患者中低危、中危、高危和极高危LDL-C达标率分别为100%、77.4%、45.7%和21.5%,差异有统计学意义(P0.01)。血脂异常危险分层、医疗付费方式、有无合并疾病与血脂控制达标率显著相关。结论老年血脂异常患者调脂治疗与2007年新指南标准仍有差距,危险分层越高,达标率相对越低。     

超声检测椎动脉支架置入后再狭窄及其影响因素的分析

目的通过彩色多普勒超声评估残余狭窄、支架类型、降脂类药物等因素对椎动脉起始段支架置入术(VAOS)后再狭窄发生率的影响。方法前瞻性纳入2009年1月—2011年9月,因椎动脉起始段粥样硬化性狭窄行支架置入术的患者共177例(192枚支架),15例为双侧椎动脉起始段置入支架。采用彩色多普勒血流显像(CDFI)检测支架置入术前、术后1年患侧椎动脉的管径和血流动力学参数,判断1年的再狭窄发生率。分析椎动脉支架置入后再狭窄发生率的相关因素。结果①术后1周残余狭窄的检出率为22.4%(43/192)。术后1年的再狭窄发生率为42.7%(82/192)。②术后残余狭窄者再狭窄发生率为76.7%(33/43),明显高于无残余狭窄患者的32.9%(49/149),差异有统计学意义(P=0.000)。药物涂层支架再狭窄的发生率明显低于裸支架(30.3%比49.2%),差异有统计学意义(P=0.012)。③服用降脂类药物者再狭窄发生率低于未服用者(46.7%比65.2%,P=0.047),其中高脂血症患者术后服用他汀类降脂药者VAOS的再狭窄发生率低于未服用者(41.7%比77.8%),差异有统计学意义(P=0.019)。结论 VAOS后1年的再狭窄率较高,术后残余狭窄是再狭窄的危险因素,药物涂层支架及术后规律性降脂类药物的应用,可有效降低支架内再狭窄的发生率。     

Lipid-lowering drug use is associated with reduced prevalence of atrial fibrillation in patients with left ventricular systolic dysfunction

BACKGROUND: Inflammation and oxidative stress have been implicated in the pathogenesis of atrial fibrillation (AF). Lipid-lowering drugs, particularly statins and fibrates, possess anti-inflammatory and antioxidant properties. OBJECTIVES: The purpose of this study was to assess the impact of lipid-lowering drug use on AF prevalence in patients with reduced left ventricular ejection fraction (LVEF). METHODS: Data were obtained from ADVANCENT(SM), a multicenter registry of patients with reduced LVEF (相似文献   

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.     

Medikamentöse Therapie der HyperlipidämieAktuelle Lage in Deutschland

BACKGROUND: Hyperlipidemia is an important, maybe the most important, risk factor for coronary artery disease (CAD). Therefore lowering elevated cholesterol is crucial for primary and secondary prevention. Dietary treatment but also drug therapy is frequently used to lower cholesterol in our days. STATINS: Drug therapy with statins has shown to be beneficial in clinical studies. Patients at a high risk for CAD will benefit mostly of drug treatment with a statin and in one out of 13 high-risk patients statin treatment will prevent one serious cardiovascular event [NNT (number needed to treat) = 13]. This is the reason for the success story of statins in the last decade. In Germany more than 700 million defined daily doses of lipid-lowering drugs are prescribed per year, which is sufficient for continuous treatment of 1.9 million patients. However, the broad use of statins came along with some thoughtlessness towards side effects. Safety laboratory values were not determined, contraindications were not considered to be serious enough and the lack of clinical endpoint studies was neglected. In addition there was an attempt to disregulate statins as "over the counter drugs" in the US--an attempt which was stopped by the intervention of the FDA. This practice ended in a series of severe side effects and led to the withdrawal of cerivastatin, a new statin from the market. If this will influence the drug treatment of hyperlipidemia needs to be seen.     

Dyslipidemia in patients with angiographically confirmed coronary artery disease--an opportunity for improvement

BACKGROUND: There are few data about lipid profiles in unselected patients with angiographically confirmed coronary artery disease (CAD). HYPOTHESIS: The study was undertaken to investigate the demographics, clinical characteristics, angiographic findings, and baseline lipid status of 1,000 consecutive unselected patients with angiographically confirmed CAD. METHODS: Between April 2001 and July 2002, we obtained informed consent and prospectively collected clinical characteristics, fasting lipid profiles, and angiographic results from 1,000 sequential patients with CAD confirmed by angiography. RESULTS: In these patients with confirmed CAD, 78% had history of hyperlipidemia. Although 62% were receiving lipid-lowering therapy, only 46% had a low-density lipoprotein target of < 100 mg/dl, and only 20% had achieved all four National Cholesterol Education Program-recommended lipid targets. CONCLUSIONS: Better strategies to ensure optimal lipid levels are required. One such method using computerized workflow is being evaluated in this population.     

Prevalence of dyslipidaemia in statin-treated patients in South Africa: results of the DYSlipidaemia International Study (DYSIS)

Introduction and objectives

Cardiovascular disease (CVD) is the leading cause of mortality worldwide and increased levels of low-density lipoprotein cholesterol (LDL-C) are an important modifiable risk factor. Statins lower LDL-C levels and have been shown to reduce CVD risk. Despite the widespread availability of statins, many patients do not reach the lipid targets recommended by guidelines. We evaluated lipid goal attainment in statin-treated patients in South Africa and analysed variables contributing to poor goal attainment as part of the DYSlipidaemia International Study (DYSIS).

Methods

This cross-sectional, observational study enrolled 1 029 consecutive South African patients consulting officebased physicians. Patients were at least 45 years old, had to be treated with a stable dose of statins for at least three months and had been fasting for 12 hours. We evaluated lipid goal attainment and examined variables associated with residual dyslipidaemia [abnormal levels of LDL-C, highdensity lipoprotein cholesterol (HDL-C) and/or triglycerides (TG)].

Results

We found that 50.3% of the patients overall did not achieve target LDL-C levels and 73.5% of patients were at very high cardiovascular risk. In addition, 33.7% had low levels of HDL-C, while 45.3% had elevated TG levels despite statin therapy. Asian and mixed-ancestry patients but not black (vs Caucasian ethnicity), as well as obese individuals in South Africa were more likely to still have dyslipidaemia involving all three lipid fractions.

Conclusions

We observed that many patients in South Africa experienced persistent dyslipidaemia despite statin treatment, supporting the concept that there is a need for more intensive statin therapy or the development of novel treatment strategies. Measures aimed at combating obesity and other lifestyle-related risk factors are also vital for effectively controlling dyslipidaemia and reducing the burden of CVD.