他汀类药物在急性冠状动脉综合征中的抗炎作用

急性冠状动脉综合征是常见的冠状动脉粥样硬化性心脏病的急症,炎症在动脉粥样硬化过程中起重要作用。3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂他汀类药物现已广泛应用于冠心病的一级、二级预防,越来越多的证据显示他汀类药物具有显著抗炎作用。     

他汀类药物在急性冠状动脉综合征的早期应用

急性冠状动脉综合征（acute coronary syndrome,ACS）是冠心病的严重临床类型,是导致冠心病患者死亡和致残的主要原因,其病理基础是冠状动脉内不稳定的动脉粥样斑块出血或破裂,血管内皮损伤,血栓形成,动脉腔迅速出现严重的狭窄或堵塞。研究发现ACS早期使用他汀类降脂药物（羟甲基戊二酸单酰辅酶A还原酶抑制剂）,可使患者心血管事件复发（如再缺血、再梗死）危险性迅速减少及死亡率降低,并能改善患者长期服药的依从性,     

他汀类药物在急性冠状动脉综合征中的抗炎地位

临床试验证实，羟甲基戊二酰辅酶A(HMG CoA)还原酶抑制剂，即他汀类药物，可减少心血管事件的发生，这种结果是不能完全用降低基线低密度脂蛋白(LDL)胆固醇水平来解释的。国际大规模研究显示，他汀类药物对临床事件的有益作用涉及非调脂机制，这些机制包括改善内皮功能、抗炎症反应、稳定斑块和抑制血栓形成等。     

论急性冠状动脉综合征他汀类药物早期应用的益处

急性冠状动脉综合征 (ａｃａｔｅｃｏｒｏｎａｒｙｓｙｎｄｒｏｍｅｓ ,ＡＣＳ)如心肌梗死、不稳定性心绞痛为发达国家及我国人群致死致残主要原因之一。动脉粥样硬化(ａｔｈｅｒｏｓｃｌｅｒｏｓｉｓ ,ＡＳ)是个隐匿发展的慢性过程 ,为发生ＡＣＳ的基本原因。现有充分证据说明ＡＳ病人发生ＡＣＳ的关键因素为冠状动脉内粥样斑块破裂。ＨＭＧ ＣｏＡ还原酶抑制剂 (他汀类 )具有明显的抗ＡＳ、降低ＡＣＳ发生的效应。一、动脉粥样硬化的形成和急性冠状动脉综合征粥样斑块的特点动脉粥样硬化的发生发展是复杂的动态过程。始动步骤很可能是动脉…     

急性冠状动脉综合征早期他汀类药物的应用价值

许多大规模、前瞻性的临床试验一致证实了他汀类药物在冠心病一级和二级预防中的重要作用。近年来，大量研究进一步显示，他汀类药物在急性冠脉综合征(ACS)早期应用可快速减少复发事件的危险性，降低死亡率。有关他汀类药物对ACS的作用机制进行过大量研究，认为其具有迅速改善内皮功能，拮抗炎症反应，稳定斑块，抑制血栓形成等多向性效应。越来越多的证据支持他汀类药物在ACS早期应用的价值。     

急性冠状动脉综合征患者应尽早服用他汀类药物

~~急性冠状动脉综合征患者应尽早服用他汀类药物@赵水平$中南大学湘雅第二医院心内科!长沙4100111 Stenestrand U, Wallentin L. Early statin treatment following acute myocardial infarction and 1-year survival. JAMA, 2001, 288 : 430-436. 2 Thompso FT. Clinical relevance of statins: instituting treatment early in caute coronary syndrome patients. Atherosclerosis, 2001, 2 Suppl: 15-19. 3 Aronow HD, Topol EJ, Roe MT, et al. Effects of lipid-lowering therpay on early …     

他汀类药物在急性冠状动脉综合征的应用

他汀类药物用于冠心病一级预防 (WOSCOPS)和二级预防 (如 4S ,CARE ,LIPID等 )大规模临床试验显示其可明显降低冠心病事件的发生率 ,即使在平均胆固醇水平的冠心病患者也可收到显著裨益。临床研究结果显示 ,他汀类药物治疗时低密度脂蛋白胆固醇 (LDL C)基线水平及治疗后水平如何 ,对心脑血管事件的发生只产生很少影响。他汀类药物的非降脂作用如稳定斑块 ,改善内皮功能 ,减少炎症反应和抑制血栓形成等作用 ,显然也与心脑血管事件的降低相联系。急性冠状动脉综合征 (ACS)的病理生理基础是冠状动脉粥样硬化斑块破裂和血栓形成 ,各种…     

他汀类药物早期强化治疗在急性冠脉综合征中的价值

负荷量他汀强化治疗已是冠心病一级预防和二级预防中不可缺少的重要手段,可明显降低心血管疾病的患病率和死亡率,改善接受介入治疗（percutaneous coronary intervention,PCI）的急性冠脉综合征患者术后心肌梗死和心血管危险事件的发生率[1].     

他汀类药物治疗急性冠状动脉综合征现状及血脂管理分析

目的通过回顾分析急性冠状动脉综合征患者(ACS)他汀类药物使用及血脂管理情况,为指导临床更合理使用他汀类药物提供依据。方法选取230例ACS患者,调查他汀药物使用情况,其中随访资料完整198例,根据他汀类药物使用剂量分为低剂量他汀治疗组(103例)和较大剂量组(95例),并采用SPSS16.0统计学软件,对治疗前、治疗后1个月及6个月血脂情况进行统计分析。结果 (1)急性期未启动大剂量他汀治疗,45.65%患者采用相对大剂量他汀治疗,强化他汀持续时间为1~2个月。(2)治疗1个月,两组患者TC、LDL-C较治疗前均明显降低(P0.05);较大剂量组较低剂量组在降低LDL-C更显著[1.59±0.55mmol/L比1.95±0.53mmol/L,P0.05],首要达标率、总达标率更高[71.57%比45.63%,75.79%比48.54%,P0.05]。(3)治疗6个月血脂监测显示LDL-C(1.82±0.42)mmol/L,首要达标率43.24%,总达标率44.59%。结论 ACS患者强化他汀类药物治疗比例低,强化持续时间短,未根据血脂管理调整他汀类剂量,低剂量他汀达标率低,较大剂量他汀降低LDL-C更显著,达标率可观。     

他汀类药物的抗炎作用

他汀类药物是目前临床应用最广泛的调脂药物，但是其调脂作用并不能解释其全部临床收益。越来越多的临床和基础实验研究证明，他汀类药物有直接的抗炎作用。本文将从其抑制炎症细胞生长、活性、细胞因子分泌，抑制炎症细胞向炎症区域聚集、浸润等方面加以。     

Lipid-independent pleiotropic effects of statins in the management of acute coronary coronary syndromes

Opinion statement Acute coronary syndromes involve a complex interplay between the vessel wall, inflammatory cells, and the coagulation cascade. Statins possess beneficial effects that are independent of low-density lipoprotein cholesterol lowering and that have favorable effects on inflammation, the endothelium, and the coagulation cascade. There is now accumulating evidence that these lipid-independent pleiotropic effects are clinically relevant in the management of acute coronary syndromes.     

Role of statins in acute coronary syndromes

Statins reduce major coronary events and all-cause mortality in patients with coronary artery disease. Statin therapy has a proven track record for the secondary prevention of coronary artery disease. The extension of the benefit to patients with acute coronary syndromes can be expected. Apart from their lipid-lowering effects, statins significantly and favourably alter the natural history of acute coronary syndromes. Promotion of plaque stability, improvement of endothelial dysfunction and reversal of coagulation and platelet abnormalities are only some of the effects which are beneficial in the management of these patients. Early potential clinical benefits further strengthen the rationale for starting statin treatment as soon as possible after acute coronary events particularly in patients in whom invasive intervention is planned. This review examines their role in acute coronary syndromes and emphasizes the benefits of early statin therapy.     

Early use of statins in acute coronary syndromes

This review examines the use of statin medications early in the clinical course of acute coronary syndrome (ACS). Available data demonstrate that there are clear clinical benefits to this practice. Numerous previous studies have documented the primary and secondary benefits of statins in the prevention of coronary events. Recent trials show that when statins are used during hospital admissions for ACS, patients experience decreased recurrent myocardial infarction, lower death rates, and fewer repeat hospitalizations for ischemia or revascularization. Several studies suggest that the positive effects of statins on plaque stabilization, inflammation, thrombosis, and endothelial function may be independent of lipid levels. There is also an emerging view that beneficial lipid-lowering with statins in high-risk patients has no lower limit. This information suggests that all patients admitted for ACS should be treated with statins, regardless of cholesterol levels.     

Early use of statins in acute coronary syndromes

This review examines the use of HMG-CoA reductase inhibitor (statin) medications early in the clinical course of acute coronary syndrome. Available data demonstrate that there are clear clinical benefits to this practice. Numerous previous studies have documented the primary and secondary benefits of statins in the prevention of coronary events. Recent trials show that when statins are used during hospital admissions for acute coronary syndrome (ACS), patients experience decreased recurrent myocardial infarction, lower death rates, and fewer repeat hospitalizations for ischemia or revascularization. Several studies suggest that the positive effects of statins on plaque stabilization, inflammation, thrombosis, and endothelial function may be independent of lipid levels. There is also an emerging view that beneficial lipid-lowering with statins in high-risk patients has no lower limit. This information suggests that all patients admitted for ACS should be treated with statins, regardless of cholesterol levels.     

Mechanisms of acute coronary syndromes and the potential role of statins

The conventional concepts of the pathogenesis of acute coronary syndromes are changing. High-risk lesions are not necessarily the angiographicaly 'tight' stenoses. Rather, vulnerable lesions are those that are unstable, with a large lipid core and a thin fibrous cap. Plaque instability is closely related to the development of inflammation within the intima and acute coronary syndromes result from rupture of a vulnerable atherosclerotic plaque. Stabilization of lesions by modification of structure and content, rather than simple improvement in the luminal diameter, provides a new therapeutic target. Stabilization may be accomplished through lifestyle changes and appropriate pharmacologic therapy. In the past few years, it has become evident that a major beneficial effect of statins is to induce plaque stability and regression. In fact, statins, in addition to lowering low-density lipoprotein cholesterol, have a variety of pleiotropic, or cholesterol-independent, effects that make them a particularly suitable choice in patients with acute coronary syndromes. Among these are improvements in endothelial function, smooth muscle cells, thrombus formation/platelet function, and inflammation.