某院短暂性脑缺血发作他汀类药物使用情况的分析

目的了解他汀类药物在我院短暂性脑缺血发作(TIA)患者中的使用情况,分析影响他汀类药物使用的可能原因。方法选择2017年10月至2018年10月在我院神经内科住院的TIA患者204例为研究对象,统计疾病的年龄分布,他汀类药物在各年龄段的使用情况,他汀类药物使用的种类、剂量、首次使用时间,他汀类药物在并发疾病、费别、医师等的使用情况。结果 204例TIA患者,入院后应用他汀类药物的比例是79.4%,TIA在61～70岁发病率最高,他汀类药物在51～60岁发病患者中使用率最高;使用的他汀类药物是阿托伐他汀钙和瑞舒伐他汀钙,20 mg阿托伐他汀钙和10 mg瑞舒伐他汀钙使用最多,40%患者入院当天给予他汀类药物,87.3%的患者在入院72 h给予;TIA并发高血压的比例最高,用药情况也最好,用药率占87.1%;市医保人员患病率高,新农合患者用药率最高(93.7%);医师用药率最高为100%,最低为50%。结论 TIA患者他汀类药物服药率未达到指南要求,服药剂量和时间不统一,年龄、费别、并发疾病及医师因素对他汀类药物使用都有影响。     

他汀类药物肝脏安全性的研究进展及合理选用

随着他汀类药物在临床上的广泛使用,他汀类药物的安全性问题也一直备受关注,最常见的问题是血清转氨酶升高。临床对他汀类药物肝脏安全性的认识不足可能限制他汀类药物的一级和二级预防和治疗应用。本文通过对他汀类药物的说明书、相关指南及文献的查阅和分析,总结了他汀类药物肝脏安全性的研究进展,为临床正确认识他汀类药物肝脏安全性及合理选用提供参考。     

他汀类药物的相互作用

目的介绍他汀类药物的相互作用,为临床合理用药提供参考。方法依据近年来公开发表的相关文献,综合、分析他汀类药物的相互作用。结果他汀类药物相互作用较多。结论应掌握他汀类药物的相互作用,合理使用他汀类药。     

他汀类药物的相互作用

目的介绍他汀类药物的相互作用,为临床合理用药提供参考。方法依据近年来公开发表的相关文献,综合、分析他汀类药物的相互作用。结果他汀类药物相互作用较多。结论应掌握他汀类药物的相互作用,合理使用他汀类药。     

文摘

他汀类药物或可降低前列腺癌死亡率 加拿大蒙特利尔犹太总医院的研究人员发现,前列腺癌确诊后使用他汀类药物与全因死亡率和前列腺癌相关死亡率下降相关。确诊前即开始使用他汀类药物的患者人群的风险降幅最大。该发现为他汀类药物潜在的抗前列腺癌效应增加了试验证据。     

他汀类药物的相互作用

目的介绍他汀类药物的相互作用,为临床合理用药提供参考。方法依据近年来公开发表的相关文献,综合、分析他汀类药物的相互作用。结果他汀类药物相互作用较多。结论应掌握他汀类药物的相互作用,合理使用他汀类药。     

我院110例高血脂患者他汀类药物使用调查与分析

目的:为高血脂患者合理使用他汀类药物提供参考。方法:随机抽取2012-2013年我院血脂检查异常并符合他汀类药物用药条件的患者110例,调查其对他汀类药物的使用情况或未使用该类药物的原因。6个月后统计患者的血脂达标情况。结果:110例患者中,按照医嘱服用他汀类药物患者46例(41.82%)在体检中30例(65.22%)达标;服用他汀类药物的剂量不足23例(20.91%),在体检中8例(34.78%)达标;使用其他调脂药24例(21.82%),在体检中8例(33.33%)达标;17例(15.45%)患者未使用调脂药,在体检中1例(5.88%)达标。共有64例患者未按照医嘱服用他汀类药物,主要原因包括患者因自身知识缺乏而担心药品不良反应、经济负担重和医师处方原因(处方中他汀类药物与其他药物有相互代谢作用)。结论:他汀类药物能明显改善血脂异常患者的血脂水平,医务人员应加强对患者的用药教育,以提高高血脂患者服用他汀类药物的依从性。     

复发性脑梗死患者他汀类药物用药依从性情况调查

目的对复发性脑梗死患者首次发病后使用他汀类药物情况进行调查,探讨引起其临床应用不规范的主要因素。方法从医院2007年9月至2013年12月住院的670例脑梗死患者中筛选出复发性动脉粥样硬化性血栓性脑梗死130例,调查其住院前使用他汀类药物的情况,分析他汀类药物使用不规范的原因。结果 95例（73.08%）患者出院后他汀类药物使用不规范,其中19例（14.62%）虽坚持服用但低密度脂蛋白胆固醇未达标,56例（43.08%）间断服用他汀类药物;20例（15.38%）未服用他汀类药物。他汀类药物使用不规范的主要原因为,患者担心不良反应（如长期服用导致肝功异常）;患者对脑梗死复发认识不足;患者或家属认为无效;患者未坚持内科门诊随访,未接受专科医生指导;门诊医生随访中忽略询问使用情况;患者嫌麻烦;患者因出现副作用而停药。结论相当多的脑梗死患者他汀类药物使用不规范及未能坚持长期服用,调脂达标率较低。应对脑梗死患者加强脑卒中二级预防健康教育,以提高他汀类药物的用药依从性。     

他汀类药物所致肝功能异常及其处理策略

他汀类药物是临床上防治心脑血管疾病的常用药物之一.近年来,他汀类药物的使用不断呈现上升趋势,肝功能异常作为他汀类药物的主要不良反应一直备受关注,其主要表现为血清转氨酶的升高.目前他汀类药物致肝功能异常的机制主要涉及线粒体功能障碍、细胞凋亡、药物相互作用等.合理应用他汀类药物、定期监测肝功能指标、密切关注慢性肝病患者使用...     

某院2011～2013年他汀类药物应用分析

目的:分析某院2011~2013年他汀类药物的临床使用情况,探讨其应用发展趋势,为临床合理使用提供依据。方法:利用HIS系统对某院2011~2013年他汀类药物的销售金额、用药比例及DDDs等指标进行分析。结果:他汀类药物的销售金额、DDDs不断增长。结论:某院他汀类药物使用基本合理,符合基本特性。     

非ST段抬高型急性冠状动脉综合征患者经皮冠状动脉介入术前强化他汀治疗对心血管事件的影响

目的 探讨非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者经皮冠状动脉介入(PCI)术前强化他汀治疗对心血管事件的影响.方法 100例NSTE-ACS患者完全随机分为2组,每组50例.常规他汀组PCI术前7 d给予辛伐他汀20 mg/d;强化他汀组PCI术前7 d给予阿托伐他汀40 ms/d.2组患者均接受其他常规治疗.比较2组在PCI前后心肌损伤标记物变化;观察随访1个月时患者主要心血管事件的发生率.结果 常规治疗组服药前、PCI术前及PCI术后肌酸激酶(CK-MB)分别为(18.94±24.35)、(13.57±6.42)、(15.39±10.08)μg/L;肌钙蛋白(TnI)分别为(0.82±3.09)、(0.46±1.38)、(0.82±2.52)μg/L;强化他汀组服药前、PCI术前及PCI术后CK-MB分别为(19.43±21.96)、(12.49±6.40)、(12.68±12.54)μg/L,Tnl分别为(3.18±9.53)、(0.61±2.51)、(0.72±0.47)μg/L.强化他汀组PCI术前较服药前下降,差异有统计学意义(P<0.05).NSIE-ACS患者PCI术前强化他汀治疗后CK-MB、ThI水平下降较常规他汀组更明显(P<0.05);PCI术后常规他汀组CK-MB、TnI水平的上升与强化他汀组差异有统计学意义(P<0.05).PCI术后随访1个月,常规他汀组心肌梗死1例(2.0%),靶血管再次血运重建2例(4.0%);强化他汀组无主要心血管事件发生.强化他汀组心血管事件发生率较常规他汀组低,但2组差异无统计学意义(P>0.05).结论 NSTE-ACS患者PCI术前强化他汀治疗较常规剂量他汀治疗能够减少术后心肌损伤.

Abstract：

Objective To observe the impact of aggressive statin treatment prior to percutaneous coronary intervention (PCI) in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) on cardiovascular events.Methods One hundred NSTE-ACS patients were enroned and randomized into 2 groups:standard and aggressive statin treatment.The standard group received simvastatin 20 mg per day and the aggressive statin treatment group received atorvastatin 40 mg per day for 7 days prior to PCI,respectively.Both groups received other standard medical therapy.Biomarkers of cardiac injury were measured and compared before and after PCI.Major cardiovascular adverse events were evaluated during one month period of follow-up.Results Both CK-MB and TnI levels were significantly reduced after aggressive statin treatment compared to standard dose(P<0.05).After PCI,CKMB and TnI levels were significantly elevated in NSTE-ACS patients with standard dose than in patients with aggressive statin treatment(P<0.05).Major cardiovascular adverse events were reduced in aggressive statin treatment group,however,no statistical difference was observed between the two groups.Conclusion Aggressive statin treatment prior to PCI may be more effective in reducing post-PCI myocardial injury than normal dose of statin therapy in NSTE-ACS patients.     

他汀类药物联合依折麦布用于冠心病患者治疗的有效性和安全性评价

目的:研究中强度他汀联用依折麦布在冠状动脉粥样硬化性心脏病患者中与中、高强度他汀单用的有效性与安全性差异。方法:检索北京安贞医院HIS系统中2018年1月至2019年4月门诊及住院数据库,筛选出住院就诊记录后3~5周有门诊复查记录的病例。根据病例所使用的他汀类药物分为中强度他汀组、中强度他汀联用依折麦布组及高强度他汀组。比较门诊记录与住院记录血脂指标变化及变化率,并以门诊记录的低密度脂蛋白胆固醇(LDL-C)值,评估病例降脂目标达成率,对比各组降脂疗效的差距。以门诊记录病例中谷草转氨酶(AST)、谷丙转氨酶(ALT)以及肌酸激酶(CK)值超过正常上限2倍及3倍的人数,评估各组安全性差异。结果:共有371例患者纳入研究。联用组降脂目标达成率显著高于中、高强度他汀组;联用组LDL-C绝对变化、相对变化均显著优于中、高强度他汀组(P＞0.05);安全性无显著差异(P＜0.05)。结论:对于冠状动脉粥样硬化性心脏病患者的降脂治疗,中强度他汀联用依折麦布治疗方案降脂效果优于中、高强度他汀单用,且安全性无显著差异。     

Expert opinion: the therapeutic challenges faced by statin intolerance

Introduction: Statin intolerance is largely defined by muscle related symptoms, leading to intolerability and cessation. The nocebo effect coupled with the challenges of diagnosing statin myopathy undermines drug adherence that is critical for achieving the benefits of lipid-lowering and cardiovascular risk reduction. A temporal relationship should be made between the initiation of therapy and development of symptoms to aid in diagnosis. The mainstay of treatment is statin cessation or statin dose reduction and evaluation of alternative causes for muscle related symptoms. Most symptoms usually resolve within 2 weeks of discontinuing therapy. The patient can be re-challenged with the same statin at a lower dose or an alternative statin. Non-statin lipid lowering therapies offer an alternative to patients who cannot tolerate statins.

Areas covered: We discuss current guideline-focused management of patients with statin intolerance.

Expert opinion: When initiating statin therapy, attention to risk factors for statin intolerance is strongly recommended. Most patients will tolerate some degree of statin therapy; thus statin re-challenge is advisable. If alternative dosing regimens are not tolerated, non-statin medications are acceptable alternatives. To limit errors in the diagnosis of statin intolerance, improvements in clinician-patient communication about the side effects and benefits of statins should be attempted.     

Ezetimibe/Simvastatin: A Guide to its Clinical Use in Hypercholesterolemia

Ezetimibe/simvastatin therapy combines two lipid-lowering compounds with complementary mechanisms of action, thereby blocking the two sources of plasma cholesterol and improving lipid profiles. Ezetimibe/simvastatin is an effective and generally well tolerated adjunct to dietary therapy for markedly reducing low-density lipoprotein cholesterol (LDL-C) levels and improving other lipid parameters across diverse patient populations. Dual treatment with ezetimibe/simvastatin is more effective than monotherapy with an HMG-CoA reductase inhibitor (statin), and the addition of ezetimibe to current statin therapy is more effective than doubling the statin dose.     

The role of a new formulation of fenofibric acid in the treatment of mixed dyslipidemia in type 2 diabetes

Diabetes, due to its multifactorial effects, increases the risk of developing cardiovascular disease. Dyslipidemia is an important modifiable risk factor. Mixed dyslipidemia (low high-density lipoprotein cholesterol [HDL-C], elevated triglycerides and a high percentage of small, dense lowdensity lipoprotein cholesterol [LDL-C]) is a common lipid disorder in diabetics and is considered especially atherogenic. Research suggests that in patients with dyslipidemia, combination therapy with fibrates and statins may be more effective than statin monotherapy alone. The choline salt of fenofibric acid (choline fibrate) is indicated for the treatment of mixed dyslipidemia, either as a single treatment or in combination with statin therapy. It does not require first-pass metabolism, but dissociates in the gastrointestinal tract into the pharmacologically active fenofibric acid. This new formulation of fenofibric acid in combination with a low or moderate dose of statin has been shown to be effective in increasing HDL-C and lowering triglycerides beyond that provided by statin monotherapy alone. The ACCORD trial failed to show a mortality or morbidity benefit after combination therapy, although the data suggested that combination therapy may benefit patients with mixed dyslipidemia.     

强化他汀类药物治疗对非ST段抬高急性冠状动脉综合征患者经皮冠状动脉介入治疗围术期炎症反应和内皮损伤的影响

目的观察经皮冠状动脉介入（PCI）术前短期强化他汀类药物治疗对非ST段抬高急性冠状动脉综合征（NSTE—ACS）患者高敏C反应蛋白（hs—CRP）和血管性皿友病因子（vWF）的影响。方法入选符合标准的NSTE—ACS行PCI患者100例,完全随机分为研究组和对照组,各50例。对照组和研究组均接受标准药物治疗,并分别于PCI术前开始7d开始服用辛伐他汀20mg／次、1次／d和阿托伐他汀40mg／次、1次／d,连用7d。术后2组均服用阿托伐他汀20mg／次,1次／d。术日,患者均按标准程序行冠状动脉造影和PCI。检测并记录入院次日、手术当日、术后24h血hs—CRP和vwF水平。结果①PCI术当日,2组hs—CRP均较本组治疗前下降;与对照组比较,研究组hs—CRP下降幅度更明显,组间差异有统计学意义[（2．1±1．6）mg／L比（3．4±2．3）mg／L,P〈0．05]。PCI术后24h,2组hs—CRP均较本组PCI术当日上升;研究组与对照组间的差异有统计学意义[（2．5±1．9）mg／L比（3．7±3．4）mg／L,P〈0．05]。②PCI术后24h,对照组vWF值较本组他汀类药物治疗前和PCI术当日均明显升高,与治疗后的差异有统计意义（P〈0．05）;研究组vWF值较对照组明显降低,组间差异有统计学意义[（151±54）μg／L比（204±125）Ixg／L,P〈0．05]。结论PCI术前短期强化他汀类药物治疗能够减低NSTE—ACS患者围术期hs—CRP水平,并减少内皮损伤。     

Ezetimibe: a first-in-class, novel cholesterol absorption inhibitor

Significant numbers of patients at risk for coronary heart disease (CHD) fail to reach National Cholesterol Education Program (NCEP)-designated low density lipoprotein cholesterol (LDL-C) goals in spite of the wide range of currently available treatments, including combination therapies. Ezetimibe, the first in a class of novel cholesterol absorption inhibitors, demonstrated lipid-lowering and antiatherosclerotic activity in experimental and clinical hypercholesterolemia. Studies in hypercholesterolemic dogs showed that ezetimibe coadministered with statins caused greater lipid-lowering effects compared to either drug alone. These effects were confirmed in clinical studies of patients with primary hypercholesterolemia where initiation of treatment with ezetimibe plus a statin, or addition of ezetimibe to ongoing statin therapy, produced significant incremental reductions in LDL-C, as well as incremental increases in high-density lipoprotein cholesterol (HDL-C) and reductions in triglyceride levels. Combination therapy also significantly increased the number of patients attaining LDL-C goal at the end of treatment, compared to statin monotherapy. In studies using simvastatin, atorvastatin, pravastatin, and lovastatin, addition of ezetimibe to low dose statin was as effective as a 2- to 3-fold upward titration of the corresponding statin dose. Ezetimibe-statin combination therapy provided similar improvements in patients with primary hypercholesterolemia, as well as with heterozygous and homozygous familial hypercholesterolemia. Ezetimibe monotherapy effectively reduced plasma campesterol and sitosterol in patients with homozygous sitosterolemia. Clinical studies showed that ezetimibe was well tolerated, with a safety profile comparable to placebo when administered as monotherapy and comparable to statin alone when coadministered with a statin. These data provide strong evidence that, through their complementary lipid-lowering mechanisms, ezetimibe coadministered with a statin offers an effective combination treatment option for patients with hypercholesterolemia, including those with genetically inherited disease.     

比索洛尔联合瑞舒伐他汀对冠状动脉慢血流患者内皮功能及炎症的影响

目的 研究比索洛尔联合瑞舒伐他汀对冠状动脉慢血流（CSF）患者内皮功能和炎症的影响。 方法 选取 2014 年 8 月—2015 年 10 月收治的 90 例 CSF 患者, 按随机数字表法分为对照组、他汀组和联合组, 每组 30 例。 对照组给予常规药物治疗（拜阿司匹林肠溶片 100 mg/d 和单硝酸异山梨酯缓释片 60 mg/d）, 他汀组采用常规治疗加瑞舒伐他汀 10 mg/d, 联合组在他汀组的基础上加用比索洛尔 5 mg/d。 分别检测治疗前和治疗 8 周后患者血清一氧化氮（NO）、内皮素-1（ET-1）、超敏 C 反应蛋白（hs-CRP）、白细胞介素-6（IL-6）水平, 同时评价患者心绞痛的改善情况。 结果 经过 8 周治疗后, 联合组和他汀组患者较治疗前 NO 水平升高, ET-1、hs-CRP、IL-6 水平降低（P＜ 0.05）;治疗后对照组、他汀组和联合组 NO 水平依次升高, ET-1、hs-CRP、IL-6 水平均依次降低, 组间多重比较差异均有统计学意义（P＜ 0.05）。 联合组患者心绞痛的有效率（90.0%）高于对照组（56.7%）, 但与他汀组（83.3%）相比差异无统计学意义。 结论 比索洛尔联合瑞舒伐他汀可改善 CSF 患者血管内皮功能并具有抗炎特性。     

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

Statins are one of the most commonly prescribed drugs in clinical practice. They are usually well tolerated and effectively prevent cardiovascular events. Most adverse effects associated with statin therapy are muscle-related. The recent statement of the European Atherosclerosis Society (EAS) has focused on statin-associated muscle symptoms (SAMS), and avoided the use of the term ‘statin intolerance’. Although muscle syndromes are the most common adverse effects observed after statin therapy, excluding other side effects might underestimate the number of patients with statin intolerance, which might be observed in 10 – 15% of patients.

In clinical practice, statin intolerance limits effective treatment of patients at risk of, or with, cardiovascular disease. Knowledge of the most common adverse effects of statin therapy that might cause statin intolerance and the clear definition of this phenomenon is crucial to effectively treat patients with lipid disorders. Therefore, the aim of this position paper was to suggest a unified definition of statin intolerance, and to complement the recent EAS statement on SAMS, where the pathophysiology, diagnosis and the management were comprehensively presented.