血脂领域临床研究新进展

Progress in clinical trials of lipid-regulating therapies

血脂异常是最为重要的心血管病危险因素之一。近年的临床研究表明,在无心血管病的中危人群中应用他汀一级预防可以显著降低心血管事件风险;中国择期经皮冠状动脉介入术(PCI)患者术前序贯他汀治疗未能进一步改善临床预后。在他汀治疗的基础上,联用依折麦布或前蛋白转化酶枯草溶菌素9(PCSK-9)抑制剂降低低密度脂蛋白胆固醇(LDL-C)能进一步减少主要不良心血管事件;联用贝特类或烟酸虽能显著降低三酰甘油、升高高密度脂蛋白胆固醇(HDL-C)水平却未显示出明确的心血管临床获益。胆固醇酯转运蛋白(CETP)抑制剂虽能显著升高HDL-C,但未能使主要心血管终点事件减少。这些临床研究不仅为血脂领域的临床实践提供了循证医学新证据,也对血脂管理策略的制定具有积极的指导意义。

Dyslipidemia has been proved to be one of the most important risk factor of cardiovascular diseases.Recently,accumulating clinical trials have demonstrated that the treatment with statin for primary prevention in intermediate-risk persons without cardiovascular disease could result in a significantly lower risk of cardiovascular events.Serial intensive statin therapy did not improve the clinical outcome among Chinese patients undergoing elective PCI.Base on statin therapy,additional combination with ezetimibe or proprotein convertase subtilisin/kexin type 9（PCSK-9）inhibitors to further reduce low-density lipoprotein cholesterol（LDL-C）level can significantly reduce major adverse cardiac events.However,although combined statin with fibrates or niacin could significantly reduce triglyceride level accompanied with elevated high-density lipoprotein cholesterol（HDL-C）,but patients can＇t achieve further improvement with cardiovascular outcomes.Although cholesteryl ester transfer protein（CETP）inhibitors increased HDL-C level but did not reduce the risk of recurrent cardiovascular events.These clinical trials not only provided new evidences for clinical practice of lipid-regulating therapies,but also be helpful to determine lipids managing strategy.