摘要
背景:国家胆固醇教育计划(NCEP)成人治疗组III(ATP III)指南对冠心病高危患者设定的低密度脂蛋白胆固醇(LDL-C)目标水平是【1000mg/L,通过饮食控制和当前的治疗难以达到该目标。方法:在一项为期16周的多国试验中,随机分配1993例高危患者服用瑞舒伐他汀20mg、阿托伐他汀10mg、阿托伐他汀20mg、辛伐他汀20mg或辛伐他汀40mg治疗共8周。
Background: National Cholestesrol Education Program Adult Treatment Panel III guidelines for patients at a high risk of coronary heart disease set a low-density lipoprotein cholesterol(LDL-C) target of<100 mg/dL. This target can be difficult to attain with diet and current therapy. Methods: In a 16-week multinational trial, 1993 high-risk patients were randomized to rosuvastatin 20 mg, atorvastatin 10 mg, atorvastatin 20 mg, simvastatin 20 mg, or simvastatin 40 mg for 8 weeks. Patients either remained on starting treatment or switched to lower or milligram-equivalent doses of rosuvastatin for 8 more weeks. Results: At 16 weeks, more patients achieved their LDL-C target by switching to rosuvastatin 10 mg than staying on atorvastatin 10 mg(66%vs 42%, P< .001) or simvastatin 20 mg(73%vs 32%, P< .001). Changing to rosuvastatin 20 mg brought more patients to their LDL-C target than staying on atorvastatin 20 mg(79%vs 64%,P< .001) or simvastatin 40 mg(84%vs 56%, P< .001). More very high risk patients achieved an LDL-C target of< 70 mg/dL when changed to rosuvastatin from atorvastatin or simvastatin(within-arm comparisons P< .01). More hypertriglyceridemic patients(triglycerides ≥200 mg/dL) met LDL-C, non-high-density lipoprotein cholesterol(non-HDL-C), and apolipoprotein B targets by changing to rosuvastatin. Switching to rosuvastatin produced greater reductions in LDL-C, total cholesterol, non-HDL-C, apolipoprotein B, and lipid ratios. All treatments were well tolerated, with no differences among treatment groups in skeletal muscle, hepatic, or renal toxicity. Conclusion: Rosuvastatin 10 or 20 mg is an effective and safe therapeutic option for high-risk patients to achieve their lipid and apolipoprotein targets.
