阿托伐他汀在低龄和高龄老年患者中应用的有效性和安全性比较

Efficacy and safety of Atorvastatin in the treatment between young-elderly and old-elderly patients with dyslipidemia

目的比较低龄老年和高龄老年患者应用阿托伐他汀的有效性和安全性。方法将88例未服用过他汀类药物的老年血脂异常患者分为低龄老年组(≥65岁,≤75岁)和高龄老年组(>75岁,≤85岁),每晚应用阿托伐他汀10 mg,每4周复查低密度脂蛋白胆固醇(LDL-C),未达标者剂量加倍,直至每晚40 mg,分别于治疗前、治疗后4周、8周和12周测定血脂及其他生化指标。结果 (1)12周时阿托伐他汀平均剂量18.5 mg,与治疗前比较,全部老年患者LDL-C水平下降36.3%(P<0.01)。高龄老年患者LDL-C水平下降幅度略高于低龄组,分别为37.8%和34.4%。12周时LDL-C达标率总体为78.7%。高龄老年患者LDL-C达标率高于低龄老年患者,分别为82.9%和73.5%。(2)与基线比较,高龄和低龄老年患者各治疗点的谷丙转氨酶(ALT)水平呈逐渐上升趋势,但未超过正常上限的3倍。肌酸激酶(CK)水平与基线比较无明显变化。结论高龄老年患者应用阿托伐他汀LDL-C降低幅度与达标率略高于低龄老年患者,安全性基本一致,老年患者用药期间应注意监测肝酶。

ObjectiveTo explore the Young-elderly and Old-elderly patients to apply the efficacy and safety of Atorvastatin.MethodsAll the 88 hyperlipidemia participants who never used statin were divided into two groups, the young-elderly （65-75 years） and old-elderly （76-85 years）. All patients were initiated on 10 mg atorvastatin daily, and reviewed low-density lipoprotein cholesterol （LDL-C） every 4 weeks. The dose should be doubled if it was ineffective in reducing LDL-C to the target levels, but not more than 40 mg daily. During 12 weeks of treatment, blood lipids and other biochemical parameters were tested before treatment and after 4 weeks, 8 weeks,12 weeks of treatment.Results （1）Atorvastatin average dose achieving 18.5 mg at 12 weeks. Compared with that before treatment, LDL-C levels of all Old-elderly was reduced by 36.3% （P〈0.01）. LDL-C levels of Old-elderly patients was marginally higher than Young-elderly group, 37.8% and 34.4%, respectively. LDL-C levels achieved target level at week 12 for 78.7%. Compliance of Old-elderly patients was higher than Young-elderly group, 82.9% and 73.5%, respectively.（2） Compared with baseline, the growth of alanine aminotransferase （ALT） levels were comparable between the two groups, achieved the highest at 12 weeks, which is not more than 3 times the upper limit of normal. Creatine kinase （CK） levels had no significant change. Conclusions Recommended dose of Atorvastatin could effectually reduce LDL-C levels of elderly patients.The reduction and compliance of LDL-C with Atorvastatin in Old-elderly patients is higher than that in the Young-elderly patients, and the security is identical between the two groups.Elderly patients should be monitored with liver enzymes.