不同起始剂量阿托伐他汀治疗高胆固醇血症的疗效与安全性

The Percentages of Achieving Lipid-lowing Targets and the Safety of Different Starting Doses of Atorvastatin in Hypercholesterol Patients of Different Cardiovascular Risk Stratifications

目的观察不同起始剂量阿托伐他汀治疗高胆固醇血症的达标率与安全性。方法入选2012年2月至7月在我院门诊就诊的高胆固醇血症患者122例作为实验组,患者按心血管病危险因素分为4组:低危组(29例)、中危组(33例)、高危组(32例)及极高危组(28例),根据心血管病危险分层及低密度脂蛋白胆固醇水平确定个体化阿托伐他汀起始剂量;另选同期39例高胆固醇血症患者作为对照组,常规给予阿托伐他汀治疗;6周后所有入选患者低密度脂蛋白胆固醇不达标者每天加阿托伐他汀10 mg;均观察12周,同时记录不良事件。结果实验组的低危组、中危组、高危组、极高危组患者在6周时低密度脂蛋白胆固醇达标率分别为75.9%、72.7%、71.9%、57.1%,12周时各组的达标率增至89.7%、81.8%、78.1%、71.4%;实验组患者低密度脂蛋白胆固醇总的达标率在6周及12周分别为69.7%及81.1%。对照组患者6周及12周达标率分别为48.7%及66.7%。实验组6周及12周达标率均显著高于对照组(分别为P<0.01,P<0.05)。所有患者均耐受治疗剂量。结论根据心血管病危险分层及低密度脂蛋白胆固醇水平个体化确定阿托伐他汀治疗起始剂量,患者的达标率显著高于常规治疗的对照组,安全有效,值得推广。

Aim To evaluate the percentages of achieving lipid-lowing targets and the safety of different doses of atorvastatin in hypercholesterol patients of different cardiovascular risk stratifications. Methods From February to July in 2012, we enrolled 122 patients who were diagnosed as hypercholesterolemia in outpatient of our hospital as experimental group, and they were 50 ~ 70 years old, 77 men and 45 female. All patients in experimental group were assigned in the low risk group （ n = 29 ）, intermediate risk group （ n = 33 ）, high risk group （ n = 32 ） and very high risk group （ n = 28 ） according to the stratifications of their cardiovascular risk factors. The patients in the above four groups were given differ- ent initial dosages of atorvastatin according to the low density lipoprotein cholesterol （LDLC） levels and their cardiovascular risk stratifications, and for those whose LDLC levels didn＇t achieve lipid-lowing targets after 6 weeks of treatment 10 mg atorvastatin would be added. There were 39 patients with hypercholesterolemia in that same period who were enrolled as control group, all of them were given routine dosage of atorvastatin every day, and for those whose LDLC didn＇t achieve lip- id-lowing targets 10 mg atovastatin would he added every day. The study period was 12 weeks. Results The total cholesterol and LDLC in four groups of experimental group decreased significantly in 6 weeks and 12weeks. The percent- age of achieving lipid-iowing targets were 75. 9% vs 89. 7%, 72. 7% vs 81.8%, 71.9% vs 78. 1%, 57. 1% vs 71.4% in the low risk group, intermediate risk group, high risk group and very high risk group respectively after 6 weeks and 12 weeks of treatment. The total percentages of achieving lipid-lowing targets was 69. 7% vs 81.1% after 6 weeks and 12 weeks of treatment in experimental group, while the percentages of achieving lipid-lowing targets were 48. 7% vs 66. 7% after 6 weeks and 12 weeks of treatment in control group. The percentage of achieving lipid-lowing target in experimental groups was higher significantly than that of the control group in 6 weeks and 12 weeks （P 〈 0.01, P 〈 0. 05, respectively）. Conclusion Different initial dosages of atovastatin according to patients＇ cardiovascular risk stratifications and cholesterol levels can improve significantly the percentages of achieving lipid-lowing targets, also the dosages of atovastatin are safe, so the regimes of patients-tailored lipid-lowing treatment should be popularized.