冠状动脉斑块消退的调脂治疗策略

Strategy of lipid-regulating therapy in regression of coronary atherosclerotic plaque

4项他汀类药物治疗冠心病患者,以血管内超声评价冠状动脉(冠脉)斑块变化的临床试验(RE-VERSAL、ASTEROID、COSMOS和SATURN)结果一致显示,他汀治疗显著降低LDL-C,同时升高Apo-A1和HDL-C,才能观察到冠脉粥样硬化斑块的消退。适度调脂指通过他汀类药物治疗,达到减少胆固醇流入斑块的目标值:降低LDL-C>45%(达到1.81～2.46mmol/L),同时达到增加胆固醇流出斑块的目标值:升高Apo-A1>9%(达到3.50～3.89mmol/L)和HDL-C>8%(达到1.17～1.42mmol/L),实现冠脉斑块的消退。

Four clinical trials（REVERSAL,ASTEROID,COSMOS,and SATURN） which evaluated the change of coronary atherosclerotic plaque regulated by statins in patients with coronary heart disease,have consistently shown that regression of the coronary atherosclerotic plaque is observed only when statin therapy significantly reduce LDL-C and increase Apo-A1 and HDL-C.Moderate lipid-regulating therapy is to achieve the target value of reducing cholesterol entry into the plaque with statins,which means lowering LDL-C by more than 45% to 1.81-2.46 mmol/L,as well as to achieve the target value of increasing cholesterol efflux from the plaque,which means increasing Apo-A1 by more than 9% to 3.50-3.89 mmol/L and HDL-C by more than 8% to 1.17-1.42 mmol/L,in order to cause regression of the coronary atherosclerotic plaque.