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.     

阿托伐他汀联合普罗布考对急性心肌梗死患者血脂和高敏C反应蛋白的影响

【目的】评价阿托伐他汀联合普罗布考对急性心肌梗死（AMI）患者血脂和高敏c反应蛋白（hs～CRP）的影响。【方法】将53例AMI患者随机分为单独治疗组（n=27,阿托伐他汀20mg／d）和联合治疗组（n=26,普罗布考0．5g／d,阿托伐他汀20mg／d）。疗程均为4周。分别测量两组患者服药前和服药1个月后的外周血血脂和hs-CRP等指标变化。【结果】①血脂变化：经治疗4周后,两组总胆固醇（TC）水平均显著下降,其中联合治疗组TC水平下降更明显,两组间比较差异有显著性（P〈0．05）。两组甘油三酯（TG）,低密度脂蛋白胆固醇（LDL-C）水平在治疗4周后均显著下降,两组间无统计学差异。联合治疗组高密度脂蛋白胆固醇（HDL-C）水平显著下降（P〈0．01）;而单独治疗组HDL-C水平无明显变化。②两组患者治疗后血清hs-cRP水平较治疗前均明显降低（P〈0．01）,但联合治疗组降低的幅度较单独治疗组大（P〈0．05）。【结论】普罗布考联合阿托伐他汀与单用阿托伐他汀均可明显降低AMI患者近期TC、TG及LDL-C水平．联合治疗组同时降低HDL-C水平;联合治疗可显著降低血清hs-cRP水平抑制炎症反应。     

国产阿托伐他汀治疗高危冠心病患者的疗效和安全性

目的:观察国产阿托伐他汀强化降脂治疗对冠心病高危患者的疗效和其安全性。方法:选择临床确诊为冠心病高危患者104例,随机分为两组:阿托伐他汀10mg.d-1组(n=50);阿托伐他汀40mg.d-1组(n=54)。分别于用药前、用药1个月、3个月、6个月时测定血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C),高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)、血糖(GLU)、肝肾功能和肌酸激酶(CK),共治疗6个月。结果:(1)治疗6个月后,与治疗前相比,阿托伐他汀10mg.d-1组LDL-C、TC、TG水平分别降低38.04%、29.37%、20.74%,HDL水平升高了5.98%。40mg.d-1组LDL-C、TC、TG水平分别降低49.14%、37.69%、26.98%,HDL水平升高3.48%。10mg.d-1组LDL-C的达标率为54.00%,40mg.d-1组LDL-C的达标率为79.24%。两组间LDL-C的达标率有显著差异(P<0.01)。(2)两组间治疗前后肝肾功能和肌酸激酶等未见明显差异。结论:口服阿托伐他汀40mg.d-1较10mg.d-1治疗能更有效的降低LDL-C、TC和TG水平,使LDL-C水平达标率高,且两者的安全性一致。     

普罗布考与阿托伐他汀联合用药对高脂饮食自发性高血压大鼠血脂的影响

目的评价普罗布考和阿托伐他汀联合用药的调脂作用。方法将92只雄性自发性高血压大鼠随机分为普通饲料+生理盐水组(C组)、高脂饲料+生理盐水组(M组)、高脂饲料+普罗布考组(P组)、高脂饲料+阿托伐他汀组(A组)和高脂饲料+阿托伐他汀+普罗布考组(P+A组),实验8周后处死。实验前及实验结束时均抽血查血脂,包括总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C),以及肝功能,如谷丙转氨酶(GPT)和谷草转氨酶(GOT)。结果高脂饮食各组动物血清TC、LDL-C、HDL-C水平较实验前均明显升高(P<0.01),TG明显下降(P<0.01);各用药组动物(尤其是P+A组)TC、LDL-C均明显低于M组(P<0.01);P+A组血清HDL水平明显低于M组和A组(P<0.01),TG水平明显低于M组(P<0.01),并低于P组(P<0.05);A组TG水平亦明显低于M组(P<0.01)。高脂饮食各组动物血清GPT、GOT水平均较实验前明显升高(M组最高),且P+A组明显低于A组(均P<0.01)。结论高脂饮食可导致血脂紊乱及肝功能损害;普罗布考与阿托伐他汀联合用药可增强调脂作用,且较两者单独用药效果更佳;两者联合用药可减轻高脂饮食对肝功能的损害,并减轻阿托伐他汀的肝毒性。     

不同调脂治疗方案对冠心病患者血脂和IL-6、TNF-α水平的影响

目的比较冠心病患者单用阿托伐他汀（40 mg/d）及阿托伐他汀（10 mg/d）和依折麦布（10 mg/d）联合治疗的调脂作用及安全性,并探讨其对白细胞介素-6（IL-6）和肿瘤坏死因子α（TNF-α）的影响。方法选取冠状动脉狭窄50%～70%的冠心病患者42例,均不植入支架,分为阿托伐他汀组（19例）和阿托伐他汀＋依折麦布组（23例）。在服药前、用药4周、用药12周时分别测定总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、肝功能、肾功能、肌酸激酶（CK）、IL-6和TNF-α水平。结果 2组均在用药后4周就可以明显降低患者的TC和LDL-C。12周时阿托伐他汀组的LDL-C为（1.94±0.49）mmol/L,较用药前下降37.82%,阿托伐他汀＋依折麦布组的LDL-C为（1.92±0.54）mmol/L,下降38.26%,2组之间比较无差异。2组患者的肝功能、肾功能、CK在用药后无明显异常。40 mg/d阿托伐他汀治疗12周时IL-6和TNF-α明显降低,而阿托伐他汀＋依折麦布组治疗前、后的差异无统计学意义。结论 2种治疗方案的降脂疗效无差异,且均没有引起患者肝、肾功能及CK异常。较大剂量阿托伐他汀（40 mg/d）治疗可引起血清IL-6和TNF-α降低,对冠状动脉狭窄的冠心病患者可能有稳定斑块的作用。     

48例冠心病患者血脂测定临床分析

目的调查冠心病(CHD)患者血脂代谢状况,探讨血脂变化在触发CHD发生发展中的作用及临床意义。方法用日立7020全自动生化分析仪检测48例CHD患者和50例健康对照者血清总胆固醇(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)和脂蛋白(a)[Lp(a)]水平。TC、TG测定采用氧化酶法,HDL-C、LDL-C测定采用直接法,Lp(a)测定采用胶乳增强免疫比浊法。结果 CHD患者TC(5.28±1.07)mmol/L、TG(1.83±0.60)mmol/L、LDL-C(3.41±1.29)mmol/L、Lp(a)(269±170)mg/L,明显比对照组[(4.25±0.93)mmol/L、(1.30±0.43)mmol/L、(2.51±0.87)mmol/L、(138±96)mg/L]高,差异有统计学意义(P0.001);而CHD患者HDL-C[(1.15±0.34)mmol/L]却比对照组[(1.32±0.43)mmol/L]低,差异也有统计学意义(P0.05)。结论 CHD患者存在不同程度的血脂代谢紊乱,TC、TG、LDL-C升高和HDL-C降低将触发CHD的发生和发展。     

阿托伐他汀对急性冠状动脉综合症患者血清sdLDL-C的影响

目的探讨阿托伐他汀对急性冠状动脉综合症（ACS）患者治疗前、后血清小而密低密度脂蛋白胆固醇（sdLDL—C）水平的影响。方法选取初发ACS患者131例及同期中老年健康体检者178名,记录受试者一般情况,给予ACS患者口服阿托伐他汀（10mg／d）调脂治疗,检测受试者治疗前、后血脂水平及血清sdLDL—C水平。统计分析受试者治疗前、后各指标的差异。结果健康对照人群血清sdLDL—C水平第95百分位数为0．62mmol／L。调脂治疗后,ACS患者血清总胆固醇（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）、非高密度脂蛋白胆固醇（non—HDL—C）、TC／HDL—C比值和sdLDL—C水平与治疗前比较差异有统计学意义（P〈0．05）。治疗后sdLDL—C降低程度与治疗前血清TC、TG、LDL—C和non—HDL—C水平显著相关[相关系数（r）分别为0．329（P〈0．001）、0．320（P〈0．001）、0．232（P=0．013）、0．385（P〈0．001）],与HDL—C水平和TC／HDL—C比值之间无相关性[r分别为一0．155（P=0．100）、0．046（P=0．624）]。LDL—C〈2．59mmol／L的ACS患者调脂治疗后血清sdLDL—C明显降低（P〈0．05）,sdLDL—C异常率由治疗前的26．9％下降到8．6％,二者比较差异有统计学意义（P〈0．05）。结论常规阿托伐他汀调脂治疗可降低ACS患者血清sdLDL—C水平,亦可明显降低血脂水平正常的冠心病患者sdLDL—C异常率。     

Effect of lovastatin on serum lipids in patients with nonfamilial primary hypercholesterolemia

The effect of lovastatin on serum lipids and its tolerability in patients with non-familial primary hypercholesterolemia (type II-A and type II-B) during a six-month period were evaluated in this open-label study. Thirty-eight patients were enrolled in the study; tolerability was assessed in all 38 patients. Thirty patients completed the study, and the effect of lovastatin on serum lipids in these patients was assessed. Some patients had been treated for hypercholesterolemia with long-term dietary and other non-pharmacologic means before entry into the study. All patients were unresponsive to a six-week program of intensive dietary therapy and other nonpharmacologic treatment to lower their blood cholesterol levels before receiving lovastatin. While maintaining intensive dietary therapy, administration of lovastatin was instituted at a dosage of 20 mg/day, which was increased by 20-mg increments monthly, as necessary, to a maximum of 80 mg/day. In an effort to achieve goal levels of low-density lipoprotein cholesterol (LDL-C), ten patients received a daily dosage of 20 mg, 12 patients received 40 mg, seven patients 60 mg, and one patient 80 mg. Twenty-nine of the 30 patients achieved significant lowering of serum levels of total cholesterol (TC), LDL-C, and apolipoprotein (apo) B-I; this was demonstrated after the first month of therapy with lovastatin and was maintained throughout the six-month treatment period. One patient failed to demonstrate lowering of these serum lipids, despite receiving the maximum recommended dosage of lovastatin of 80 mg/day. Comparative measurements of serum lipids during dietary therapy alone and after six months of diet plus lovastatin therapy were as follows: TC, 289 +/- 5 versus 216 +/- 9 mg/dl (P less than 0.0005); LDL-C, 206 +/- 4 versus 141 +/- 5 mg/dl (P less than 0.0005); and apo B-I, 112 +/- 3 versus 89 +/- 2 mg/dl (P less than 0.0005). Serum levels of very-low-density lipoprotein cholesterol (VLDL-C) and triglycerides decreased slightly during lovastatin therapy, but the changes were not statistically significant. There were slight but statistically insignificant increases in serum levels of high-density lipoprotein cholesterol (HDL-C), apo A-I, and apo A-II.(ABSTRACT TRUNCATED AT 400 WORDS)     

冠心病患者血清内脂素和脂联素水平的变化及临床意义

目的结合C反应蛋白(CRP),探讨血清内脂素、脂联素与冠心病的关系及可能的作用机制。方法将经冠状动脉造影确诊的270例冠心病患者根据临床表现分为3组:稳定性心绞痛(SAP)组125例、不稳定性心绞痛(UAP)组109例、急性心肌梗死(AMI)组36例。另选取健康体检者20名作为对照组。采用酶联免疫吸附试验(ELISA)测定血清内脂素、脂联素水平。同时检测CRP、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、尿素氮(BUN)及肌酐(Cr)水平。采用多元相关分析方法分析内脂素、脂联素与其他指标之间的相关性。结果冠心病组血清CRP、内脂素水平均明显高于对照组(P均﹤0.01);脂联素水平则低于对照组(P<0.01)。AMI组、UAP组及SAP组间血清CRP、内脂素和脂联素差异均有统计学意义(P均﹤0.05)。多元相关分析显示,血清内脂素与CRP、TG、LDL-C呈正相关(r分别为0.929、0.756、0.793,P均<0.001),与脂联素及HDL-C呈负相关(r分别为-0.351、-0.699,P均<0.001);脂联素与CRP、TG及LDL-C呈负相关(r分别为-0.873、-0.639、-0.799,P均﹤0.001);与HDL-C呈正相关(r=0.681,P<0.001)。结论血清内脂素、脂联素均可能是冠心病的危险因素,推测二者可能与CRP相互作用、共同参与了冠心病的发生发展。     

Positive correlation between in vivo oxidized LDL and LDL immune complexes

OBJECTIVES: To investigate the possible relationship between oxidized low-density lipoprotein (ox-LDL) and LDL immune complexes (IC). METHODS: Both LDL-IC and ox-LDL were detected by sandwich ELISA. The levels were also studied in 60 patients with coronary heart disease (CHD) and 50 control subjects. RESULTS: Compared to controls, both the plasma ox-LDL concentrations (595.5 +/- 194.8 vs. 440.3 +/- 175.0 microg/l, P < 0.001) and LDL-IC levels (2.74 +/- 0.73 vs. 1.38 +/- 0.78 AU, P < 0.001) in the patients with CHD were significantly increased. The relationships between LDL-IC, ox-LDL levels, and other lipid parameters in all the studied subjects (n = 100) were analyzed. LDL-IC levels were positively correlated with TC, TG, LDL-C, lipoprotein(a) [Lp(a)], and apolipoprotein B (apoB) concentration, while negatively correlated with apoA1 concentration, respectively. Similarly, ox-LDL levels were also found positively correlated with TC, LDL-C, and apoB concentrations, respectively. Furthermore, a significantly positive correlation between ox-LDL and LDL-IC levels was found (r = 0.313, P < 0.005). CONCLUSION: In vivo oxidized LDL positively correlates with circulating levels of LDL immune complexes.     

A Multicenter, Placebo-Controlled, Dose-Ranging Study of Atorvastatin

BACKGROUND: Coronary heart disease (CHD) is the number one cause of death in Western societies. Elevated levels of plasma low-density lipoprotein (LDL) cholesterol and triglycerides (TG) increase the risk for CHD. 3-Hydroxy-3-methylglutaryl conenzyme A (HMG-CoA) reductase inhibitors effectively reduce plasma cholesterol levels in patients with hypercholesterolemia. This study assesses the safety and dose-related effects of atorvastatin calcium on lipoprotein fractions in patients with LDL cholesterol levels between 160 mg/dL (4.1 mM) and 250 mg/dL (6.5 mM) or less and TG levels of 400 mg/dL (4.5 mM) or less. METHODS AND RESULTS: Sixty-five patients were enrolled in a 6-week, randomized, placebo-controlled, parallel-group study. Patients received placebo or atorvastatin 10, 20, 40, 60, or 80 mg once daily. Adjusted mean decreases in LDL cholesterol for patients receiving atorvastatin 10, 20, 40, 60, and 80 mg were 37%, 42%, 50%, 52%, and 59%, respectively, compared with a mean increase of 0.3% for patients receiving placebo; the differences between each of the atorvastatin dose groups and placebo were statistically significant (P =.0001). Total cholesterol, triglycerides, and apolipoprotein B were significantly reduced in atorvastatin groups (P =.0001). Adverse events were similar in the placebo and atorvastatin treatment groups. No patient had a serious adverse event or withdrew because of an adverse event during this study. CONCLUSIONS: Atorvastatin effectively lowered plasma LDL cholesterol, triglycerides, and apoB levels in a dose-related manner. Atorvastatin was well tolerated in hyperlipidemic patients over a 6-week period.     

血清脂质、脂蛋白胆固醇和载脂蛋白在冠心病中的临床意义

目的研究冠心病患者的血清脂质、脂蛋白胆固醇和载脂蛋白的变化、辨别力和诊断价值。方法测定64例冠心病(CHD)患者和60例正常人的血脂、脂蛋白胆固醇和载脂蛋白,并比较计算其辨别力和诊断价值。结果和结论冠心病患者的TC(女)、TG、LDL-C、ApoB、LDL-C/HDL-C和ApoB/ApoAI明显高于正常人(P<0.05),HDL2-C、HDL3-C、HDL-C、ApoAI和HDL-C/TC明显低于正常人(P<0.05)。由HDL-C、TC和TG血脂三项可代替HDL-C、LDL-C、VLDL-C、TC和TG血脂五项,对冠心病的诊断目前有应用价值,若加上HDL2-C和HDL3-C或ApoAI和ApoB,则对冠心病的诊断更有意义。     

Metabolic effects of fluvastatin extended release 80 mg and atorvastatin 20 mg in patients with type 2 diabetes mellitus and low serum high-density lipoprotein cholesterol levels: a 4-month, prospective, open-label, randomized, blinded—end point (probe) trial

Background

Diabetic dyslipidemia is characterized by greater triglyceridation of all lipoproteins and low levels of plasma high-density lipoprotein cholesterol (HDL-C). In this condition, the serum level of low-density lipoprotein cholesterol (LDL-C) is only slightly elevated. The central role of decreased serum HDL-C level in diabetic cardiovascular disease has prompted the establishment of a target of ≥50 mg/dL in patients with diabetes mellitus (DM).

Objective

The aim of the study was to assess the effects of once-daily administration of fluvastatin extended release (XL) 80 mg or atorvastatin 20 mg on serum HDL-C levels in patients with type 2 DM and low levels of serum HDL-C.

Methods

This 4-month, prospective, open-label, randomized, blinded—end point (PROBE) trial was conducted at Endocrinology and Diabetology Service, L. Sacco-Polo University Hospital (Milan, Italy). Patients aged 45 to 71 years with type 2 DM receiving standard oral antidiabetic therapy, with serum HDL-C levels <50 mg/dL, and with moderately high serum levels of LDL-C and triglycerides (TG) were enrolled. After 1 month of lifestyle modification and dietary intervention, patients who were still showing a decreased HDL-C level were randomized, using a 1:1 ratio, to receive fluvastatin XL 80-mg tablets or atorvastatin 20-mg tablets, for 3 months. Lipoprotein metabolism was assessed by measuring serum levels of LDL-C, HDL-C, TG, apolipoprotein (apo) A-I (the lipoprotein that carries HDL), and apo B (the lipoprotein that binds very low-density lipoprotein cholesterol, intermediate-density lipoprotein, and LDL on a molar basis). Patients were assessed every 2 weeks for treatment compliance and subjective adverse events. Serum creatine phosphokinase and liver enzymes were assessed before the run-in period, at the start of the trial, and at 1 and 3 months during the study.

Results

One hundred patients were enrolled (50 patients per treatment group; fluvastatin XL group: 33 men, 17 women; mean [SD] age, 58 [12] years; atorvastatin group: 39 men, 11 women; mean [SD] age, 59 [11] years). In the fluvastatin group after 3 months of treatment, mean (SD) LDL-C decreased from 149 (33) to 95 (25) mg/dL (36%; P < 0.01), TG decreased from 437 (287) to 261 (164) mg/dL (40%; P < 0.01), and HDL-C increased from 41 (7) to 46 (10) mg/dL (12%; P < 0.05). In addition, apo A-I increased from 118 (18) to 124 (15) mg/dL (5%; P < 0.05) and apo B decreased from 139 (27) to 97 (19) mg/dL (30%; P < 0.05). In the atorvastatin group, LDL-C decreased from 141 (25) to 84 (23) mg/dL (40%; P < 0.01) and TG decreased from 411 (271) to 221 (87) mg/dL (46%; P < 0.01). Neither HDL-C (41 [7] vs 40 [6] mg/dL; 2%) nor apo A-I (117 [19] vs 114 [19] mg/dL; 3%) changed significantly. However, apo B decreased significantly, from 131 (20) to 92 (17) mg/dL (30%; P < 0.05). Mean changes in HDL-C (+5 [8] vs −1 [2] mg/dL; P < 0.01) and apo A-I (+6 [18] mg/dL vs −3 [21] mg/dL; P < 0.01) were significantly greater in the fluvastatin group than in the atorvastatin group, respectively. However, the decreases in LDL-C (54 [31] vs 57 [32] mg/ dL), TG (177 [219] vs 190 [65] mg/dL), and apo B (42 [26] vs 39 [14] mg/dL) were not significantly different between the fluvastatin and atorvastatin groups, respectively. No severe adverse events were reported.

Conclusions

Fluvastatin XL 80 mg and atorvastatin 20 mg achieved mean serum LDL-C (≤ 100 mg/dL) and apo B target levels (≤ 100 mg/dL) in the majority of this population of patients with type 2 DM, but mean serum HDL-C level was increased significantly only with fluvastatin—16 patients (32%) in the fluvastatin group compared with none in the atorvastatin group achieved HDL-C levels ≥50 mg/dL. The increase in HDL-C in the fluvastatin-treated patients was associated with an increase in apo A-I, suggesting a potential pleiotropic and selective effect in patients with low HDL-C levels.     

Comparative effects of simvastatin and atorvastatin in hypercholesterolemic patients with characteristics of metabolic syndrome

BACKGROUND: Hypercholesterolemic patients with metabolic syndrome (MS) are at high risk for coronary heart disease. The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines provide the option of aggressively lowering low-density lipoprotein cholesterol (LDL-C) in hypercholesterolemic patients with MS. OBJECTIVE: The lipid-modifying efficacy of simvastatin and atorvastatin in hypercholesterolemic patients with MS as defined by NCEP ATP III was assessed. METHODS: A post hoc subgroup analysis was performed on data from a 36-week, multicenter (54 sites worldwide), randomized, double-blind, parallel-group, dose-escalation (forced-titration) study designed to assess the effects of simvastatin (40-80 mg) and atorvastatin (20-80 mg) on high-density lipoprotein cholesterol (HDL-C) and apolipoprotein (apo) A-I levels in patients with LDL-C > or = 160 mg/dL. Patients were classified as having MS if they met >/=3 of the following criteria: (1) triglyceride (TG) level > or =150 mg/dL; (2) HDL-C <40 mg/dL (men) or <50 mg/dL (women); (3) secondary diagnosis of type 2 diabetes mellitus and/or taking antidiabetic medication and/or fasting serum glucose (FSG) level > or =110 mg/dL; (4) secondary diagnosis of hypertension and/or taking antihypertensive medication and/or systolic blood pressure (SBP)/diastolic blood pressure (DBP) > or =130/ > or =85 mm Hg; and (5) body mass index (BMI) > or =30 kg/m(2) (surrogate for waist circumference). RESULTS: Of 808 evaluable patients, 212 (26.2%) were classified as having MS at baseline. Compared with the non-MS subgroup, MS patients were slightly older and more likely to be female. They also had higher BMI, SBP/DBP, FSG, and TG levels, and lower HDL-C and apo A-I levels than non-MS patients. The simvastatin group contained 99 patients; the atorvastatin group, 113 patients. Both drugs produced large reductions in total cholesterol, LDL-C, non-HDL-C, TG, and apo B, with atorvastatin producing slightly greater reductions in TG. However, simvastatin consistently produced larger increases in HDL-C and apo A-I than atorvastatin, especially at higher doses. After 36 weeks of treatment, 47.7% and 48.5% in the simvastatin and atorvastatin groups, respectively, no longer met > or =3 of the MS criteria. CONCLUSIONS: In hypercholesterolemic patients with characteristics of MS, simvastatin and atorvastatin had comparable beneficial effects on apo B-containing atherogenic lipids and lipoproteins, and MS status was effectively modified by both drugs. However, although atorvastatin produced slightly larger decreases in TG, simvastatin produced larger increases in HDL-C.     

Lipoproteins and apolipoproteins in young nonobese Arab women with NIDDM treated with insulin

The effects of insulin on the lipid values of nonobese non-insulin-dependent diabetic (NIDDM) Arab women requiring insulin was investigated to find whether these patients have the same coronary artery risk factor related to lipid levels. In this study, 55 NIDDM women on insulin therapy (mean age 28 +/- 8.1 yr and duration of disease 5 +/- 1.2 yr) and 70 control subjects (matched for sex, age, and body mass index) were studied for their plasma levels of lipids, lipoproteins, and apolipoproteins. Concentrations of total cholesterol, very-low-density lipoprotein cholesterol, low-density lipoprotein (LDL) cholesterol, triglyceride (TG), LDL TG, high-density lipoprotein triglyceride (HDL TG), phospholipid, glucose, glycosylated hemoglobin (HbAtc), apolipoprotein B (apoB), LDL-apoB, and apoB/apoAl were significantly elevated in diabetic women compared with control subjects. There was no significant change in the levels of apoAll in plasma and lipoprotein fractions. Concentrations of HDL cholesterol (chol), HDL2-chol, HDL3-chol, plasma apoAl, HDL2-apoAl, HDL3-apoAl, and HDL-apoAl were significantly lower in diabetic women than in control subjects. There was no significant correlation between glucose or HbAtc and most of the lipids, lipoprotein lipids, and apolipoproteins measured. Despite normal body weight and insulin therapy, abnormalities in lipids, lipoprotein lipids, and apoB persisted in NIDDM patients compared with control subjects. Our data may favor an enhanced affinity toward atherosclerosis in these patients.     

藏族人群血尿酸与颈动脉内中膜厚度的关系：阿托伐他汀干预后血尿酸的变化

背景:迄今为止,他汀类药物对藏族这一特定民族的高尿酸血症合并高胆固醇血症患者的疗效尚未得到充分研究。目的:分析血尿酸与颈动脉内中膜厚度的关系,观察阿托伐他汀对高尿酸血症合并高胆固醇血症患者血脂、血尿酸及肝、肾功能指标的影响。设计:前后对照实验。单位:解放军总医院心内科,解放军西藏军区总医院心内科。对象:选择2005-08/2006-08在解放军西藏军区总医院心内科住院的高尿酸血症合并高胆固醇血症患者80例,年龄45～61岁。均来自拉萨市娘热乡;为藏族男性;均对检测项目知情同意。方法:①所有患者每晚口服阿托伐他汀20mg,连续12周。②在服药前及治疗后12周使用日立7600型全自动生化检测仪测定血尿酸、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿素氮、肌酐、谷丙转氨酶水平。B型超声测量颈动脉内中膜厚度。主要观察指标:①用药前后血脂、血尿酸及肝、肾功能指标比较。②心血管疾病危险因素与颈动脉内中膜厚度的关系。结果:总共80例患者入选本试验。①阿托伐他汀用药后总胆固醇、三酰甘油、低密度脂蛋白胆固醇和血尿酸水平分别降低33.8%,24.9%,12.2%,12.6%,差异有显著性意义(t=13.1534,3.8373,3.2201,2.7883,P<0.01)。用药前后高密度脂蛋白胆固醇、尿素氮、肌酐、转氨酶无明显变化(P>0.05),说明他汀类药物对肝肾功能无损伤。②用药前总胆固醇,三酰甘油,低、高密度脂蛋白胆固醇、血尿酸与内中膜厚度相关(β值=0.178,0.145,0.189,-0.181,0.284,P<0.05～0.01),其中血尿酸的(β值最高,表明血尿酸在颈动脉粥样硬化发生中所起的作用最大。结论:①血尿酸在颈动脉粥样硬化发生中起的作用最大。②阿托伐他汀可有效调血脂、降血尿酸,且无肝肾功能损害。     

Plasma lipid composition and LDL oxidation.

Low-density lipoprotein (LDL) oxidation in vivo depends on lipid composition and on plasma antioxidant status. The aim of our study was to investigate the relationship between plasma lipid composition and LDL oxidation and, in particular, to explore whether LDL-cholesterol/triglycerides ratio (LDL-C/TG) and LDL-cholesterol/high-density lipoprotein (HDL)-cholesterol ratio (LDL-C/HDL-C) can be used as predictive parameters of LDL oxidation in vivo. In 87 volunteers over a wide range of age plasma lipids and LDL oxidation were studied. Blood was collected after 12 h overnight fast. LDL oxidation was estimated by the level of conjugated diene (BDC) in the lipid fraction isolated from plasma after gradient ultra-centrifugation. The results were expressed as micromol/l (BDC/l) to evaluate the level of oxidized LDL, and as nmol of BDC for mg of LDL-cholesterol (BDC/LDL-C) for the evaluation of LDL oxidation degree. BDC/l correlated significantly with age, total and LDL-C, apolipoprotein B and TG, while BDC/LDL-C negatively correlated with total cholesterol, apolipoprotein B, LDL/TG and LDL/HDL ratios. Age of subjects significantly correlated with total and LDL-C and apolipoprotein B. TG have a significant inverse correlation with HDL-C. Our results support the hypothesis that among the several factors involved in LDL oxidation the most important determinants are LDL/TG. Plasma triglycerides appear to be very important even when circulating cholesterol levels are within normal limits. Moreover, we found that the LDL/HDL ratio is also very important with regard to the putative protective role of HDL against LDL oxidation in vivo. In conclusion, plasma lipid parameters must be evaluated not only for their absolute values but also for their mutual ratios as expression of plasma lipid homeostasis. Both LDL/TG and LDL/HDL ratios can be used as predictive parameters of in vivo LDL oxidation.     

辅酶Q10与阿托伐他汀联合应用对冠心病伴血脂增高患者肝脏酶活性及血脂水平的影响

【目的】观察辅酶Q10（CoQ10）与阿托伐他汀联合应用对冠心病伴血脂增高患者肝脏酶活性及血脂水平的影响。【方法150例冠心病伴血脂水平增高的患者,随机分为对照组（n=25）和试验组（n=25）。对照组患者给予阿托伐他汀20mg／d,睡前服用。试验组患者在上述治疗基础上加用CoQ10 30mg／d,分3次服用。连续用药3个月,观察两组患者治疗前后体内CoQ10水平,丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）以及总胆固醇（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（HDLc）的变化。【结果】试验组治疗前后体内CoQ10含量增高,差异有显著性（P〈O．05）;ALT、AST未见显著性增高（P〉0．05）;TC、TG、LDL-C水平明显下降（P〈0．01）,HDL-C水平增高,差异有显著性（P〈0．01）。对照组治疗前后体内CoQ10含量显著性降低（P〈0．01）,ALT、AST水平增高,差异有显著性（P〈0．01）;血脂水平除LDL-C明显降低（P〈0．05）外,其余指标治疗后较治疗前有不同程度改变,但差异无显著性（P〉0．05）。两组治疗后CoQ10及血清转氨酶、血脂水平组间比较,差异均有显著性（P〈0．05）。【结论】外源性补充CoQ10可避免阿托伐他汀引起的转氨酶增高,并能增强他汀的降脂作用。     

不同剂量阿托伐他汀对ACS患者脂蛋白相关性磷脂酶A2的影响

【目的】观察不同剂量阿托伐他汀对急性冠脉综合征（ACS）患者血浆脂蛋白相关性磷脂酶A2（Lp—PLA2）水平的影响。【方法】将46例ACS患者随机分为常规剂量组（常规治疗加阿托伐他汀20mg／d,23例）和强化治疗组（常规治疗加阿托伐他汀40mg／d,23例）,治疗前及治疗10d后清晨空腹采血,以酶联免疫吸附法测定血浆中Lp—PLA2水平,并检测血脂各项指标;同时选用23例健康体检者作为正常对照。【结果】①ACS患者血浆LpPLA2水平明显高于正常对照组（P〈0．001）;②20mg／d和40mg／d阿托伐他汀治疗10d后Lp-PLA2水平较治疗前均有显著下降（P〈0．01）,而强化治疗组下降更为明显（P〈0．01）;③spearman等级相关分析显示,ACS患者血浆Lp-PLA2水平与总胆固醇（TC）及低密度脂蛋白胆固醇（LDL—C）相关,与甘油三酯（TG）和高密度脂蛋白胆固醇（HDL—C）不相关。【结论】ACS患者血浆Lp—PLA2水平增高,短期阿托伐他汀治疗能降低ACS患者Lp-PLA2水平,且呈剂量依赖性。     

曲美他嗪联合阿托伐他汀对冠心病患者血脂及心功能的影响

目的探讨曲美他嗪联合阿托伐他汀对冠心病患者血脂、心功能的影响。方法将178例冠心病患者按随机数字法分为2组,每组89例。对照组给予阿托伐他汀,观察组在此基础上加用曲美他嗪组。治疗后,比较两组血脂[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)]、心绞痛情况(发作次数、每次持续时间)、心功能[左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)]、不良反应情况。结果治疗后,两组TC、TG、LDL-C水平显著改善(P0.05),且观察组TC、TG、LDL-C水平显著低于对照组(P0.05)。治疗后,两组心绞痛发作次数、每次持续时间均显著减少(P0.05),且观察组心绞痛发作次数、每次持续时间显著低于对照组(P0.05)。治疗后,观察组LVEDD、LVESD水平显著低于对照组(P0.05),而观察组LVEF水平显著高于对照组(P0.05)。结论曲美他嗪联合阿托伐他汀可有效改善冠心病患者血脂和心功能。