Large scale cohort study of the relationship between serum cholesterol concentration and coronary events with low-dose simvastatin therapy in Japanese patients with Hypercholesterolemia - Primary prevention cohort study of the Japan Lipid Intervention Trial (J-LIT)
Large scale cohort study of the relationship between serum cholesterol concentration and coronary events with low-dose simvastatin therapy in Japanese patients with Hypercholesterolemia - Primary prevention cohort study of the Japan Lipid Intervention Trial (J-LIT)
复制标题
DOI：
10.1253/circj.66.1087
复制
发表时间：
2002-12-01
影响因子：
3.3
通讯作者：
Itakura, H
中科院分区：
文献类型：
--
作者：
Matsuzaki, M;Kita, T;Itakura, H
高血压是原发性冠心病（CHD）的一个公认的危险因素。虽然辛伐他汀已知可降低血脂浓度，但在日本高胆固醇血症患者中尚未确定这种降脂治疗对原发性CHD的保护作用。日本脂质干预试验是一项为期6年的全国性队列研究，共有47，294例患者接受开放标签辛伐他汀（5-10 mg/天）治疗，并在标准临床条件下由医生监测。本研究旨在探讨小剂量辛伐他汀治疗期间血脂水平与冠心病发生的关系。辛伐他汀使血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）和甘油三酯（TG）浓度平均分别降低18.4%、26.8%和16.1%。当平均TC浓度大于或等于240 mg/dl且平均LDL-C浓度大于或等于160 mg/dl时，冠状动脉事件的风险较高。TG ≥ 300 mg/dl者冠心病事件发生率高于TG < 150 mg/dl者。高密度脂蛋白胆固醇（HDL-C）与冠状动脉事件风险呈负相关。观察到平均TC或LDL-C浓度与总死亡率之间存在J曲线相关性。恶性肿瘤是最常见的死亡原因。当低剂量他汀类药物治疗后TC和LDL-C浓度显著降低时，应密切监测患者的健康状况。在低剂量他汀类药物治疗下，日本无冠心病史的高胆固醇血症患者预防冠状动脉事件的合理策略可能是将血清脂质浓度至少调节至TC < 240 mg/dl，LDL-C < 160 mg/dl，TG < 300 mg/dl，HDL-C> 40 mg/dl。
Hyperlipidemia is a well-established risk factor for primary coronary heart disease (CHD). Although simvastatin is known to lower serum lipid concentrations, the protective effect of such lipid-lowering therapy against primary CHD has not been established in Japanese patients with hypercholesterolemia. The Japan Lipid Intervention Trial was a 6-year, nationwide cohort study of 47,294 patients treated with open-labeled simvastatin (5-10 mg/day) and monitored by physicians under standard clinical conditions. The aim of the study was to determine the relationship between the occurrence of CHD and the serum lipid concentrations during low-dose simvastatin treatment. Simvastatin reduced serum concentrations of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C) and triglyceride (TG), by 18.4%, 26.8% and 16.1% on average, respectively, during the treatment period. The risk of coronary events was higher when the average TC concentration was greater than or equal to 240 mg/dl and the average LDL-C concentration was greater than or equal to 160 mg/dl. The incidence of coronary events increased in the patients with TG concentration greater than or equal to 300 mg/dl compared with patients with TG concentration < 150 mg/dl. The high-density lipoprotein cholesterol (HDL-C) inversely correlated with the risk of coronary events. The J-curve association was observed between average TC or LDL-C concentrations and total mortality. Malignancy was the most prevalent cause of death. The health of patients should be monitored closely when there is a remarkable decrease in TC and LDL-C concentrations with low-dose statin. A reasonable strategy to prevent coronary events in Japanese hypercholesterolemic patients without prior CHD under low-dose statin treatment might be regulating the serum lipid concentrations to at least < 240 mg/dl for TC, < 160 mg/dl for LDL-C, < 300 mg/dl for TG, and > 40 mg/dl for HDL-C.