Attaining United States and European Guideline LDL-cholesterol Levels with Simvastatin in Patients with Coronary Heart Disease (the GOALLS Study)

Summary

The effectiveness and safety of simvastatin in reducing low-density lipoprotein cholesterol (LDL-C) to target levels in patients with coronary heart disease (CHD) were evaluated in the GOALLS (Getting to Appropriate LDL-C Levels with Simvastatin) study. This multinational, multicentre, prospective, open-label, study consisted of a six-week diet washout period followed by a 14-week titrate-to-goal treatment period with simvastatin. One hundred and ninety-eight men and women with documented CHD and a fasting LDL-C level between 115?mg/dl (3.0 mmol/l) and 180?mg/dl (4.7 mmol/l) and triglycerides (TGs) ≤ 400?mg/dl (4.5 mmol/l) were enrolled. The patients were started on 20 mg simvastatin with dose titration up to 80 mg if the LDL-C remained above 100?mg/dl at weeks 6 and 10. The key efficacy parameters were the percentage of patients achieving US and European LDL-C goals [≤ 100?mg/dl (2.6 mmol/l) and ≤ 115?mg/dl

(3.0 mmol/l), respectively]. Safety was evaluated by monitoring laboratory tests and recording adverse events.

After 14 weeks of simvastatin (20–80 mg) treatment, approximately 90% of the patients achieved LDL-C goals according to US (87%) and European (94%) guidelines. Most patients (72–93%) achieved target LDL-C levels on 20 mg simvastatin. An estimated 14% of the patients required titration to the 80 mg dose. Treatment with simvastatin (20–80 mg) produced statistically significant improvements in all measured lipid variables by the end of the study. The mean reductions in total cholesterol and LDL-C, and the median reduction in TG, were 28%, 41% and 16%, respectively. The increase in high-density lipoprotein cholesterol and apolipoprotein A-1 were 5% and 4%, respectively. Simvastatin was well tolerated across the dosage range.

In conclusion, simvastatin, 20–80?mg/day, was safe and highly effective at reducing LDL-C levels. The recommended US and European LDL-C treatment goals were achieved in approximately 90% of the patients. These goals were similarly achieved for a variety of high-risk sub-groups (hypertensives, diabetics and elderly patients).     

Attaining United States and European guideline LDL-cholesterol levels with simvastatin in patients with coronary heart disease (the GOALLS study)

The effectiveness and safety of simvastatin in reducing low-density lipoprotein cholesterol (LDL-C) to target levels in patients with coronary heart disease (CHD) were evaluated in the GOALLS (Getting to Appropriate LDL-C Levels with Simvastatin) study. This multinational, multicentre, prospective, open-label, study consisted of a six-week diet washout period followed by a 14-week titrate-to-goal treatment period with simvastatin. One hundred and ninety-eight men and women with documented CHD and a fasting LDL-C level between 115 mg/dl (3.0 mmol/l) and 180 mg/dl (4.7 mmol/l) and triglycerides (TGs) < or = 400 mg/dl (4.5 mmol/l) were enrolled. The patients were started on 20 mg simvastatin with dose titration up to 80 mg if the LDL-C remained above 100 mg/dl at weeks 6 and 10. The key efficacy parameters were the percentage of patients achieving US and European LDL-C goals [< or = 100 mg/dl (2.6 mmol/l) and < or = 115 mg/dl (3.0 mmol/l), respectively]. Safety was evaluated by monitoring laboratory tests and recording adverse events. After 14 weeks of simvastatin (20-80 mg) treatment, approximately 90% of the patients achieved LDL-C goals according to US (87%) and European (94%) guidelines. Most patients (72-93%) achieved target LDL-C levels on 20 mg simvastatin. An estimated 14% of the patients required titration to the 80 mg dose. Treatment with simvastatin (20-80 mg) produced statistically significant improvements in all measured lipid variables by the end of the study. The mean reductions in total cholesterol and LDL-C, and the median reduction in TG, were 28%, 41% and 16%, respectively. The increase in high-density lipoprotein cholesterol and apolipoprotein A-1 were 5% and 4%, respectively. Simvastatin was well tolerated across the dosage range. In conclusion, simvastatin, 20-80 mg/day, was safe and highly effective at reducing LDL-C levels. The recommended US and European LDL-C treatment goals were achieved in approximately 90% of the patients. These goals were similarly achieved for a variety of high-risk sub-groups (hypertensives, diabetics and elderly patients).     

Comparative Haemodynamic Responses to the First Dose of Short- and Long-acting ACE Inhibitors in Patients with Congestive Heart Failure

Summary

Background: Angiotensin Converting Enzyme inhibitors (ACEi's) confer significant mortality and morbidity benefits in all functional grades of chronic heart failure (CHF). However, physicians' concerns regarding the possible occurrence of first-dose hypotension appear to be a contributing factor to their under-utilisation in both hospital and primary care settings. We investigated whether long-acting and short-acting ACEi's differ in their haemodynamic responses to the first-dose in patients with CHF.

Method: This was a multicentre, randomised, open, two-parallel-group study of captopril 6.25?mg and perindopril 2mg. 240 patients with CHF, age 68.9?±?8.9 years, of whom 66% were male, NYHAII—IV, with average blood pressure baseline values of 132.2?±?16.2/78.5?±?10.5mmHg for systolic and diastolic blood pressure, and left ventricular ejection fraction (LVEF) of 31.3?±?7.4% received either captopril (n?=?124) or perindopril (n?=?116). Blood pressure was continuously monitored during the 8?h following drug intake. Minimum levels and maximum decreases in systolic, diastolic and mean arterial pressures were measured, along with the incidence of hypotensive episodes defined as mean blood pressure (MBP) fall?>?20mmHg, whether symptomatic or not. Subgroups of patients distributed according to age, baseline blood pressure (BP) and LVEF were subsequently analysed.

Results: Overall, a statistically significant treatment effect in favour of perindopril was observed. First-dose hypotension was observed more frequently following captopril than perindopril administration, with lower MAP minimal levels (78.0?±?8.9 vs. 84.5?±?10.1?mmHg, p?<?0.0001), greater maximum falls (17.6?±?8.3 vs. 12.8?±?7.3mmHg, p?<?0.0001) and more frequent hypotensive episodes (42% vs. 15%, p?<?0.0001). The incidence of at least one symptomatic episode was also significantly higher with captopril (10 patients vs. one patient, p?=?0.029). Subgroup analyses according to age (< 70 years or > 70 years) or LVEF (< 30% or > 30%) reflected the main result.

Conclusion: Initiation of treatment with ACE inhibitors is associated with different haemodynamic and clinical tolerances in CHF patients, regardless of their risk for hypotension, with possible clinical implications.     

转化生长因子β_1单核苷酸多态性及血清水平与高血压左室肥厚的关系

目的研究转化生长因子β1(TGF-β1)基因+869、+915位点等位基因频率及基因型在高血压左室肥厚患者中的分布,初步分析其基因型及血清水平与高血压左室肥厚的关系。方法采用序列特异性引物聚合酶链反应(PCR-SSP),检测186例高血压患者(其中91例伴左室肥厚)及105名对照组TGF-β1基因+869T/C、+915G/C多态性,同时采用双抗体夹心ABC-酶联免疫吸附测定(ELISA)法测定血清TGF-β1水平。结果高血压左室肥厚组血清TGF-β1水平显著高于高血压非左室肥厚组和对照组(P均<0.05),TGF-β1+869T/C多态性在两组人群中的分布差异有统计学意义(P均<0.05),C等位基因携带者患高血压左室肥厚的风险是T等位基因的1.787倍(OR=1.787,95%CI:1.194~2.673),携带C等位基因的高血压左室肥厚患者血清TGF-β1水平高于不携带者(P<0.05)。结论TGF-β1基因+869T/C多态性与高血压左室肥厚的发病具有相关性,C等位基因可能是高血压左室肥厚发病的遗传易感基因;携带C等位基因的个体可能通过促进TGF-β1的高度表达,进而增加了高血压左室肥厚的发病风险。     

高血压伴LVH心力衰竭的Apelin测定分析

研究原发性高血压伴LVH心力衰竭患者治疗前后血浆Apelin的水平,探讨原发性高血压伴LVH早期心衰与血浆Apelin的关系。选取原发性高血压伴LVH无心衰患者66例（无心衰组）,原发性高血压伴LVH早期心衰(NYHA心功能分级Ⅰ～Ⅱ级)患者65例（早期心衰组）,选取经体检筛查身体健康的中老年体检者30例作为正常组（对照组）。用双抗体夹心法分别测定3组患者血浆Apelin水平和血浆N末端脑钠肽原（NT-proBNP）含量,用超声仪测量左室射血分数（LVEF）。对照组EF、NT-proBNP 和无心衰组、早期心衰组比较有显著性差异（P＜0.05）,无心衰组和早期心衰组比较有显著性差异（P＜0.05）;无心衰期组血浆Apelin水平分别低于对照组和早期心衰组,早期心衰组Apelin水平高于对照组,有显著性差异;无心衰组及早期心衰组患者Apelin水平与EF 呈正相关,而无心衰组患者Apelin水平与proBNP呈负相关。无心衰组治疗后的Apelin水平较治疗前高,早期心衰组治疗后的Apelin的水平较治疗前下降,但无显著性差异（P＞0.05）,提示血压下降、心功能改善与血浆Apelin水平相关,但不同组别降压方法对患者血浆Apelin的水平均无明显影响。血浆Apelin水平在高血压伴LVH时降低,当出现早期心衰时上升,监测Apelin水平可预测心衰的发生,Apelin可作为观察心功能状况和预后的辅助指标。     

男性冠心病患者脂蛋白(a)和纤维蛋白原水平临床分析

目的：探讨脂蛋白（a）[Lp（a）]和纤维蛋白原（Fib）在男性冠心病发病中的作用。方法：测定经冠状动脉造影确诊的159例男性冠心病患者（冠心病组）及74例男性无冠脉病变者（对照组）血浆中Lp（a）和Fib水平。结果：冠心病组Lp（a）和Fib水平明显高于对照组（P〈0.05）。冠心病不同病变支数组之间Lp（a）和Fib水平比较差异也有统计学意义（P〈0.05）。多元Logistic回归分析表明Lp（a）和Fib是冠心病发病的独立危险因素。结论：Lp（a）和Fib与男性冠心病发生和发展密切相关,二者对于冠心病的发生具有一定的临床预测价值。     

高血压性左心室肥厚及射血分数保留的心力衰竭(HF-PEF)患者左心室同步性变化对心功能的影响

目的:探讨高血压性左心室肥厚及射血分数保留的心力衰竭(HF-PEF)患者左心室同步性变化状况及其对心功能的影响。方法:对某院2016年5月~2018年5月收治的110例高血压性左心室肥厚(左心室肥厚组)患者、110例高血压性HF-PEF(HF-PEF组)患者进行观察研究,对所有患者均进行心脏超声检查、血清B型尿钠肽(BNP)检查,分析总结不同患者检测结果。结果:HF-PEF组患者LVEF与左心室肥厚组对比无明显差异(P>0.05);HF-PEF组患者E/A值、PFR明显低于左心室肥厚组,LVEDD、LAD、BNP明显高于左心室肥厚组(P<0.05);HF-PEF组BNP与E/A值、PFR呈负相关性(P<0.05);HF-PEF组BNP与LVEDD、LAD呈正相关性(P<0.05)。结论:高血压性HF-PEF患者左心室呈现明显同步性异常,且与患者心功能存在相关性。     

冠心病患者血浆同型半胱氨酸与血脂水平的关系

探讨冠心病患者血浆同型半胱氨酸(Hcy)水平与冠脉病变程度及血脂水平的关系。方法应用高压液相色谱法测定174例经冠状动脉造影证实为冠心病的患者及128例无冠脉病变的对照者的血浆Hcy,并检测血清胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、脂蛋白a[Lp(a)]。根据冠脉造影结果将冠心病组分为单支、2支和3支组,观察冠脉病变程度与Hcy的关系。结果冠心病组血浆Hcy和血脂水平明显高于对照组(P＜0.05),且Hcy及血脂(HDL降低)水平随冠脉病变程度的加重而升高(P＜0.01),Hcy与冠脉病变程度呈正相关(r=0.5165,P＜0.01),而与血脂无明显相关性(P＞0.05)。结论Hcy是引起冠状动脉疾病的一个新的重要危险因素,与血脂水平无明显相关性。     

Blood pressure reduction and antihypertensive medication use in the losartan intervention for endpoint reduction in hypertension (LIFE) study in patients with hypertension and left ventricular hypertrophy

ABSTRACT

Objective: To compare blood pressure response and antihypertensive medication use visit-by-visit from baseline in patients receiving losartan-based or atenolol-based therapy in the LIFE study.

Research design: LIFE was a randomized, double-blind trial comparing losartan-based and atenolol-based treatment regimens on the primary composite endpoint of death, myocardial infarction (MI), or stroke in 9193 patients aged 55–80 years with hypertension and left ventricular hypertrophy. Systolic and diastolic, pulse, and mean arterial pressures, blood pressure responder rates, distribution of open-label antihypertensive agents utilized, and the proportion of patients on randomized treatment were determined for each group at each clinic visit over a follow-up period of at least 4 years.

Results: Overall blood pressure reductions were comparable in the losartan-based and atenolol-based treatment groups. The mean reductions in sitting trough systolic and diastolic blood pressures from baseline to the end of follow-up (or last visit before a primary endpoint event) were 30.2/16.6?mmHg in the losartan group and 29.1/16.8?mmHg in the atenolol group. The time-averaged difference in overall mean arterial pressure was similar between groups. The proportion of patients on individual dose combinations varied visit by visit but was generally comparable between groups. During the entire study, 56% (2579/4605) of losartan-treated patients received at least one dose of the combination of losartan 100?mg plus hydrochlorothiazide 12.5?mg and 51% of atenolol-treated patients received 100?mg of atenolol plus hydrochlorothiazide 12.5?mg at some time during the study.

Conclusions: Differences in blood pressure or distribution of add-on medications between treatment groups were not evident in the LIFE trial and, thus, cannot account for the observed outcome difference in the primary endpoint of risk reduction of the composite of cardiovascular death, stroke and MI favoring losartan.     

二维超声心动图与左室造影用于曲美他嗪治疗冠心病左心功能不全疗效评价

目的探讨二维超声心动图与左室造影在评价曲美他嗪治疗冠状动脉粥样硬化心脏病(简称冠心病)左心功能不全疗效中的应用效果。方法选取石家庄市第一医院2017年11月至2018年11月用曲美他嗪治疗的冠心病左心功能不全患者80例,分别应用二维超声心动图与左室造影检查并评价疗效。结果80例患者中显效27例,有效45例,无效8例,总有效率为90.00%。二维超声心动图测得患者治疗后的E/A值和左心室射血分数(LVEF)显著高于治疗前,左室舒张末期容积(LVEDV)和左室收缩末期容积(LVESV)显著低于治疗前(P<0.05);左室造影测得患者治疗后的心排出量(CO)、心脏指数(CI)和每搏输出量(SV)显著高于治疗前(P<0.05)。患者治疗后的每周心绞痛发病次数、N末端B型脑钠肽(NT-proBNP)水平均显著低于治疗前,6 min步行距离(6MWT)显著长于治疗前(P<0.05);患者治疗过程中均未出现明显不良反应。结论应用曲美他嗪治疗冠心病左心功能不全有一定疗效,且应用二维超声心动图与左室造影检测心功能准确性较高。     

Attaining United Kingdom-European Atherosclerosis Society Low-density Lipoprotein Cholesterol Guideline Target Values in the GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) Study

Summary

The GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) Study compared two standards (structured vs. usual care) of lipid lowering treatment in 1600 patients with coronary heart disease (CHD). Structured care aimed at achieving (with atorvastatin 10-80?mg) the low-density lipoprotein cholesterol (LDL-C) (2.6?mmol/l; 100?mg/dl) goal described in the NCEP ATP II and III guidelines for patients with CHD. Structured care was associated with a significant reduction in overall mortality and coronary events compared to usual care.

In the present brief report we interpret the results of GREACE using the United Kingdom (UK) and European Atherosclerosis Society (EAS) treatment goal for LDL-C in secondary CHD prevention (3.0?mmol/l; 115?mg/dl). The mean dose of atorvastatin decreased from 24?mg to 22?mg/day. More patients achieved the UK and EAS LDL-C target (95.6 vs. 95%) in the structured care arm of the trial; 90% of the patients achieved this target with 10 or 20?mg atorvastatin.

These findings may have cost implications, especially if the LDL-C target for high-risk patients will fall below those described above.     

超声TVI技术评价冠心病合并糖尿病患者心室舒缩同步性的研究

目的:应用超声组织速度显像(TVI)技术检测冠心病合并糖尿病患者心肌的同步性运动。方法:59例冠心病患者为对照组,68例冠心病合并糖尿病患者为研究组,超声TVI模式下测量收缩期和舒张早期左、右室基底段和中间段共12节段的收缩(Ts)和舒张达峰(Te)时间,并计算左室12节段舒缩达峰时间的平均值(Ts-12-LV、Te-12-LV)、标准差(Ts-12-SD)和最大差值(Ts-12-diff、Te-12-diff)及右室2节段舒缩达峰时间平均值(Ts-2-RV、Te-2-RV)。结果:研究组左右室12个节段Ts-12-LV、Ts-2-RV及Ts-12-SD与对照组比较差异无统计学意义(P>0.05),以Ts-12-SD>33ms为标准,研究组达此标准者占17例(25.00%),对照组为11例(18.64%);以Ts-12-diff>100ms为标准,研究组和对照组不同步者比例分别为50%(34/68)和28.8%(17/59),差异有统计学意义(P<0.05)。以Te-12-diff>100ms为室内舒张不同步标准,研究组和对照组分别占47.1%和25.4%(P<0.01)。结论:冠心病患者心脏的收缩及舒张同步性减低,糖尿病可使其加重。     

冠心病患者脂蛋白（a）水平与肾脏早期损害

为探讨冠心病（ＣＨＤ）患者脂蛋白（ａ）〖Ｌｐ（ａ）〗水平与肾脏早期损害的关系,应用ＥＬＩＳＡ法及化学显色终点法分别检测３６例ＣＨＤ患者血清Ｌｐ（ａ）水平和尿氨基葡萄糖苷酶（ＮＡＧ）活力。结果,ＣＨＤ组血Ｌｐ（ａ）及尿ＮＡＣ均明显 正常对照组,且Ｌｐ（ａ）值与民水ＮＡＣ活力呈正相关（ｒ＝０．４２,Ｐ〈０．０１）。提示,ＣＨＤ患者Ｌｐ（ａ）水平与肾脏早期损害可能有关。     

银杏叶制剂对老年冠心病患者血栓素及前列环素水平的影响

目的　探讨银杏叶制剂对老年冠心病患者血栓素 (TXB2 )及前列环素 (6 keto PGF1α)水平的影响。方法　 用放免法测定 30例老年冠心病患者及 2 6例健康老人TXB2 与 6 keto PGF1α水平 ,并观察银杏叶制剂对其影响。 结果　 冠心病组与对照组比较TXB2 明显升高 ,6 keto PGF1α明显降低 ,应用银杏叶制剂后TXB2 显著下降 ,6 keto PGF1α显著上升。 结论　银杏叶制剂能抑制血栓素的释放 ,刺激前列环素的合成 ,从而调节血栓素与前列环素的失衡     

冠心宁片对冠心病舒张性心力衰竭患者穿透素3及相关性血细胞分析数值水平的影响

目的 观察冠心宁片对冠心病舒张性心力衰竭（diastolic heart failure,DHF）患者穿透素3（pentraxin-3,PTX-3）及相关性血细胞分析数值水平的影响。方法 选取2018年11月—2019年11月在丽水市中医院就诊的80例冠心病DHF血瘀证患者作为研究对象,采用随机数字表法分为对照组和治疗组,各40例,对照组予以西药治疗,治疗组在对照组基础上加用冠心宁片,连续治疗4周。观察2组中医证候积分、临床疗效、舒张早期的二尖瓣血流峰速度/舒张早期的二尖瓣舒张速度比值（E/E'）、氨基末端B型脑利钠肽前体（N-terminal pro-brain natriuretic peptide,NT-proBNP）、PTX-3及相关性血细胞分析数值水平[包括红细胞分布宽度（red blood cell distribution width,RDW）、血小板/淋巴细胞比值（platelet to lymphocyte ratio,PLR）、单核细胞/淋巴细胞比值（monocyte to lymphocyte ratio,MLR）、中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）]的变化,评估冠心病DHF血瘀证患者的治疗效果。结果 治疗组总有效率为90.0%,明显优于对照组的77.5%（P<0.05）。治疗前,2组中医证候积分、E/E'、NT-proBNP、PTX-3、RDW、PLR、MLR和NLR比较,差异无统计学意义;治疗后,2组中医证候积分、E/E'、NT-proBNP、PTX-3、RDW、PLR、MLR和NLR明显低于治疗前（P<0.05）,且治疗组各指标低于对照组（P<0.05）;并且治疗后2组均未见不良反应。结论 冠心宁片治疗冠心病DHF患者能够有效改善临床症状,降低中医证候积分、E/E'、NT-proBNP、PTX-3及相关性血细胞分析数值水平,提高临床疗效。     

120例老年冠心病中医辨证分型与心电图的关系分析

目的:分析探讨老年人冠心病中医辨证分型与心电图的相关性。方法:120例于某院接受治疗的老年冠心病患者根据中医辨证分型分为若干组,设置50例健康人作为对照组,比较不同中医辨证分型下老年冠心病患者心电图异常的相关性。结果:老年冠心病患者心肌缺血检出率较高,心律失常次之。此外,相对于健康人群,老年冠心病患者的QTd值较高。结论:老年冠心病患者中医辨证分型与心电图存在一定的相关性,通过观察心电图的变化有助于临床对于老年冠心病患者的治疗。动态心电图的监测为临床老年冠心病的诊断与治疗提供一定的参考价值。     

不同剂量阿托伐他汀与瑞舒伐他汀对冠心病患者肝功能影响的回顾性研究

摘 要 目的： 评价不同剂量阿托伐他汀与瑞舒伐他汀对冠心病患者肝功能的影响。方法: 采用回顾性研究方法,收集中国医科大学附属第一医院2013年1月～2014年3月冠心病病例,按应用他汀类药物品种及剂量分为阿托伐他汀低剂量组（阿托伐他汀20 mg·d-1）,阿托伐他汀高剂量组（阿托伐他汀40 mg·d-1）;瑞舒伐他汀低剂量组（瑞舒伐他汀10 mg·d-1）,瑞舒伐他汀高剂量组（瑞舒伐他汀20 mg·d-1）。记录患者的基本信息、肝功能指标水平(ALT、AST、AKP、TBIL）、肝功能异常发生时间、处理对策及预后等,比较各组间肝功能异常发生率,评价肝功异常干预对策合理性及干预效果。结果: 共收集有效病例269例,其中149例患者发生不同程度肝功能异常,21例患者的ALT高于3倍正常上限。阿托伐他汀高剂量组ALT高于3倍正常上限的发生率明显高于阿托伐他汀低剂量组（P<0.05）。结论:高剂量阿托伐他汀（40 mg·d-1）较低剂量组发生严重肝功能异常的风险增加。     

冠心病患者血管性血友病因子基因多态性及其血浆蛋白水平的研究

目的：探讨血管性血友病因子(vWF)基因Thr789Ala多态性及其血浆水平与冠心病的关系。方法：应用限制性片段长度多态性分析法，分析201例汉族患者vWF基因Thr789Ala多态性特征和用免疫浊度法测血浆vWF水平。结果：(1)冠心病组vWF水平高于非冠心病组，用配对资料比较排除冠心病的相关危险因素对vWF的影响后，vWF水平在两组差别无统计学意义。(2)vWF基因多态性分析201例，其中Thr789纯合子型177例，Thr789Ala杂合子型24例，未见Ala789纯合子型。基因型分布、等位基因频率在冠心病组与非冠心病组差别无统计学意义。结论：冠心病患者血浆vWF水平升高不是vWF-Thr789Ala单位点变异的结果，可能与高血压、糖尿病、高脂血症、高纤维蛋白原血症、性别、吸烟及其他基因因素等综合作用有关。     

中低剂量瑞舒伐他汀治疗社区高龄冠心病合并高脂血症的疗效和安全性研究

摘 要 目的：观察中低剂量瑞舒伐他汀对社区高龄冠心病合并高脂血症的疗效和安全性。方法：将2020年1月至2022年7月期间我院收治的252例社区高龄冠心病合并高脂血症患者分为中剂量组（126例）和低剂量组（126例）。中剂量组给予10 mg·d-1瑞舒伐他汀,低剂量组给予5 mg·d-1瑞舒伐他汀,比较两组患者治疗3个月、6个月后总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、甘油三酯（TG）和高密度脂蛋白胆固醇（HDL-C）水平,血脂达标率,以及肝肾功能指标的变化。结果：中剂量组101例完成6个月随访,低剂量组104例患者6个月随访。治疗3个月、6个月后中剂量组TC和LDL-C水平较低剂量组改善更明显（P ＜ 0.05）,且高剂量组血脂达标率均高于低剂量组（P ＜ 0.05）。两组均未出现严重不良反应,且治疗前后肝肾功能各指标比较,差异无统计学意义（P ＞ 0.05）。结论：中低剂量瑞舒伐他汀治疗社区高龄冠心病合并高脂血症的安全性均良好,但中剂量（10 mg·d-1）给药可使患者血清TC和LDL-C水平下降更为明显。