《新英格兰医学杂志》（New England Journal of Medi-cine）在2012年3月22日发表了一项关于PCSK9的一种单克隆抗体对LDL胆固醇影响的研究。该项研究表明：在3项1期试验中，PCSK9的一种单克隆抗体可显著地降低健康志愿者和有家族性或非...《新英格兰医学杂志》（New England Journal of Medi-cine）在2012年3月22日发表了一项关于PCSK9的一种单克隆抗体对LDL胆固醇影响的研究。该项研究表明：在3项1期试验中，PCSK9的一种单克隆抗体可显著地降低健康志愿者和有家族性或非家族性高胆固醇血症的研究对象的LDL胆固醇水平（NEngl J Med，2012，366：1108-1118）。展开更多
BACKGROUND: Recent trials have demonstrated better outcomes with intensive than with moderate statin treatment. Intensive treatment produced greater reductions in both low-density lipoprotein(LDL)cholesterol and C-rea...BACKGROUND: Recent trials have demonstrated better outcomes with intensive than with moderate statin treatment. Intensive treatment produced greater reductions in both low-density lipoprotein(LDL)cholesterol and C-reactive protein(CRP), suggesting a relationship between these two biomarkers and disease progression. METHODS: We performed intravascular ultrasonography in 502 patients with angiographically documented coronary disease. Patients were randomly assigned to receive moderate treatment(40 mg of pravastatin orally per day)-or intensive treatment(80 mg of atorvastatin orally per day). Ultrasonography was repeated after 18 months to measure the progression of atherosclerosis. Lipoprotein and CRP levels were measured at baseline and followup. RESULTS: In the group as a whole, the mean LDL cholesterol level was reduced from 150.2 mg per deciliter(3.88 mmol per liter)at baseline to 94.5 mg per deciliter(2.44 mmol per liter)at 18 months(P< 0.001), and the geometric mean CRP level decreased from 2.9 to 2.3 mg per liter(P< 0.001). The correlation between the reduction in LDL cholesterol levels and that in CRP levels was weak but significant in the group as a whole(r=0.13, P=0.005), but not in either treatment group alone. In univariate analyses, the percent change in the levels of LDL cholesterol, CRP, apolipoprotein B-100, and nonhigh-density lipoprotein cholesterol were related to the rate of progression of atherosclerosis. After adjustment for the reduction in these lipid levels, the decrease in CRP levels was independently and significantly correlated with the rate of progression. Patients with reductions in both LDL cholesterol and CRP that were greater than the median had significantly slower rates of progression than patients with reductions in both biomarkers that were less than the median(P=0.001). CONCLUSIONS: For patients with coronary artery disease, the reduced rate of progression of atherosclerosis associated with intensive statin treatment, as compared with moderate statin treatment, is significantly related to greater reductions in the levels of both atherogenic lipoproteins and CRP.展开更多
The majority of patients with myocardial infarction(MI) and hypercholesterolaemia does not achieve guideline recommended low-density lipoprotein cholesterol(LDL) levels. Suboptimal dosages of statins explain this dile...The majority of patients with myocardial infarction(MI) and hypercholesterolaemia does not achieve guideline recommended low-density lipoprotein cholesterol(LDL) levels. Suboptimal dosages of statins explain this dilemma in most patients. Design and setting: We evaluated the relationship between statin treatment quality(optimal: LDL< 115 mg/dl, suboptimal: LDL≥ 115 mg/dl, no statin therapy despite hypercholesterolaemia) and the subsequent incidence of coronary events(coronary death, nonfatal MI, bypass surgery) over a 30 months follow- up in a large cohort of post MI patients with hypercholesterolaemia(n=2045). Analysis was performed in a nested case-control manner comparing 173 cases with a coronary event and 346 matched controls. Results: Patients who developed a coronary event were treated optimally in 11.0% , suboptimally in 43.4% (p< 0.05 vs. optimal treatment) and were untreated in 45.7% (p< 0.001 vs. optimal treatment). Respective numbers in event-free patients were 21.4% , 47.7% , and 30.9% . After adjustment for most potential confounders, including all cardiovascular risk factors and medication, the relative risk of future non-fatal MI and coronary death associated with a suboptimal statin treatment was 2.02(95% CI 1.04 to 4.18) compared to optimal statin treatment. Moreover, the statin equivalent dose in optimally treated individuals was significantly higher than in suboptimally treated individuals(0.85± 0.03 vs. 0.78± 0.02, p< 0.05). Conclusion: In this community-based study, a lipid lowering therapy with statins into the recommended target range of LDL levels may be associated with decreased cardiovascular risk compared to a statin therapy without titrating the LDL level below 115 mg/dl. Thus, the quality of statin treatment was identified as an independent predictor of coronary events in post MI patients.展开更多
文摘《新英格兰医学杂志》（New England Journal of Medi-cine）在2012年3月22日发表了一项关于PCSK9的一种单克隆抗体对LDL胆固醇影响的研究。该项研究表明：在3项1期试验中，PCSK9的一种单克隆抗体可显著地降低健康志愿者和有家族性或非家族性高胆固醇血症的研究对象的LDL胆固醇水平（NEngl J Med，2012，366：1108-1118）。
文摘BACKGROUND: Recent trials have demonstrated better outcomes with intensive than with moderate statin treatment. Intensive treatment produced greater reductions in both low-density lipoprotein(LDL)cholesterol and C-reactive protein(CRP), suggesting a relationship between these two biomarkers and disease progression. METHODS: We performed intravascular ultrasonography in 502 patients with angiographically documented coronary disease. Patients were randomly assigned to receive moderate treatment(40 mg of pravastatin orally per day)-or intensive treatment(80 mg of atorvastatin orally per day). Ultrasonography was repeated after 18 months to measure the progression of atherosclerosis. Lipoprotein and CRP levels were measured at baseline and followup. RESULTS: In the group as a whole, the mean LDL cholesterol level was reduced from 150.2 mg per deciliter(3.88 mmol per liter)at baseline to 94.5 mg per deciliter(2.44 mmol per liter)at 18 months(P< 0.001), and the geometric mean CRP level decreased from 2.9 to 2.3 mg per liter(P< 0.001). The correlation between the reduction in LDL cholesterol levels and that in CRP levels was weak but significant in the group as a whole(r=0.13, P=0.005), but not in either treatment group alone. In univariate analyses, the percent change in the levels of LDL cholesterol, CRP, apolipoprotein B-100, and nonhigh-density lipoprotein cholesterol were related to the rate of progression of atherosclerosis. After adjustment for the reduction in these lipid levels, the decrease in CRP levels was independently and significantly correlated with the rate of progression. Patients with reductions in both LDL cholesterol and CRP that were greater than the median had significantly slower rates of progression than patients with reductions in both biomarkers that were less than the median(P=0.001). CONCLUSIONS: For patients with coronary artery disease, the reduced rate of progression of atherosclerosis associated with intensive statin treatment, as compared with moderate statin treatment, is significantly related to greater reductions in the levels of both atherogenic lipoproteins and CRP.
文摘The majority of patients with myocardial infarction(MI) and hypercholesterolaemia does not achieve guideline recommended low-density lipoprotein cholesterol(LDL) levels. Suboptimal dosages of statins explain this dilemma in most patients. Design and setting: We evaluated the relationship between statin treatment quality(optimal: LDL< 115 mg/dl, suboptimal: LDL≥ 115 mg/dl, no statin therapy despite hypercholesterolaemia) and the subsequent incidence of coronary events(coronary death, nonfatal MI, bypass surgery) over a 30 months follow- up in a large cohort of post MI patients with hypercholesterolaemia(n=2045). Analysis was performed in a nested case-control manner comparing 173 cases with a coronary event and 346 matched controls. Results: Patients who developed a coronary event were treated optimally in 11.0% , suboptimally in 43.4% (p< 0.05 vs. optimal treatment) and were untreated in 45.7% (p< 0.001 vs. optimal treatment). Respective numbers in event-free patients were 21.4% , 47.7% , and 30.9% . After adjustment for most potential confounders, including all cardiovascular risk factors and medication, the relative risk of future non-fatal MI and coronary death associated with a suboptimal statin treatment was 2.02(95% CI 1.04 to 4.18) compared to optimal statin treatment. Moreover, the statin equivalent dose in optimally treated individuals was significantly higher than in suboptimally treated individuals(0.85± 0.03 vs. 0.78± 0.02, p< 0.05). Conclusion: In this community-based study, a lipid lowering therapy with statins into the recommended target range of LDL levels may be associated with decreased cardiovascular risk compared to a statin therapy without titrating the LDL level below 115 mg/dl. Thus, the quality of statin treatment was identified as an independent predictor of coronary events in post MI patients.
