他汀联合烟酸类药物的临床试验评价

Combination of statin and niacin in clinical trials

在他汀治疗使低密度脂蛋白胆固醇(LDL-C)达标的后,对高密度脂蛋白胆固醇(HDL-C)降低的患者加用烟酸,可以升高HDL-C并降低甘油三酯,显著改善血脂谱。尽管小规模临床试验显示在他汀基础上联合烟酸可以延缓冠状动脉斑块或颈动脉内膜中层厚度的进展,但他汀联合烟酸的疗效至今仍然没有在大规模临床试验中得到证实。单纯升高HDL-C血浆水平而不关注HDL-C的清除是目前针对HDL-C干预治疗的问题所在,他汀联合烟酸的有效性和安全性有待于进一步证实。

After statin treatment keeps low density lipoprotein cholesterol （LDL-C） under control, niacin can be used to raise HDL-C level, decrease triglyceride and improve lipid profile markedly. In some small studies, niacin, with the background treatment of statins, significantly attenuated the progression of coronary artery plaque or carotid intimal medial thickness. However, therapeutic efficacy of niacin has never been demonstrated in large-scale, prospective clinical trials. Raising plasma HDL-C level without paying attention to its elimination is a misunderstanding of HDL metabolism. The efficacy and safety of statin/niasin combination need to be verified in the future.