强化治疗与中度降脂治疗对冠状动脉样硬化的进展的影响:一项随机对照试验
Steven E Nissen1, E Murat Tuzcu, Paul Schoenhagen
1Department of Cardiovascular Medicine, Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio 44195, USA. nissens@ccf.org
JAMA
|March 5, 2004
概括
与中度普拉瓦斯塔丁治疗相比,使用阿托瓦斯塔丁强化降低脂质显著降低了冠状动脉样硬化进展. 阿托瓦斯塔丁稳定了动脉瘤负担,而普拉瓦斯塔丁显示进展,突出了积极的他类药物治疗的好处.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 医疗成像医学成像
背景情况:
- 达丁类药物治疗有效降低心血管风险因素,但最佳的降脂策略仍在研究中.
- 亚太原性脂蛋白和心血管事件被他类药物减少,但目标水平和治疗强度需要进一步澄清.
研究的目的:
- 为了比较强化与中度降脂方案对冠状动脉动脉瘤负担及其进展的影响.
- 这项研究旨在评估不同强度的他类药物治疗在治疗动脉样硬化的有效性.
主要方法:
- 一个双盲,随机,多中心试验 (REVERSAL) 涉及654名患者超过18个月.
- 患者接受了40毫克普拉瓦斯塔丁 (中度) 或80毫克阿托瓦斯塔丁 (强度),通过血管内超声波评估动脉样硬化的进展.
主要成果:
- 强化阿托瓦斯塔丁治疗显著降低低密度脂蛋白胆固醇 (LDL-C) 到79 mg/dL,而普拉瓦斯塔丁治疗为110 mg/dL.
- 阿托瓦斯塔丁治疗导致C-反应蛋白减少了36.4%,而普拉瓦斯塔丁治疗则降低了5.2% (P<.001).
- 冠状动脉样硬化进展在阿托瓦斯塔丁治疗中停止 (-0.4%),但在普拉瓦斯塔丁治疗中继续 (2.7%),在动脉瘤体积变化中观察到显著差异.
结论:
- 与中度普拉瓦斯塔丁治疗相比,使用阿托瓦斯塔丁强化降脂有效降低了冠状动脉样硬化进展.
- 阿托瓦斯塔丁稳定了动脉瘤负担,而普拉瓦斯塔丁导致了进展,这表明积极的脂质管理有好处.
- 动脉样硬化进展的观察到的差异可能解释了动脉样蛋白和C-反应蛋白的较大减少.
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