Effective and safe modification of multiple atherosclerotic risk factors in patients with peripheral arterial disease.
Effective and safe modification of multiple atherosclerotic risk factors in patients with peripheral arterial disease.
复制标题
有效且安全地改变外周动脉疾病患者的多种动脉粥样硬化危险因素。
DOI：
10.1067/mhj.2000.110090
复制
发表时间：
2000
影响因子：
4.8
通讯作者：
Applegate,WB
中科院分区：
文献类型：
--
作者：
Garg,R;Elam,MB;Crouse3rd,JR;Davis,KB;Kennedy,JW;Egan,D;Herd,JA;Hunninghake,DB;Johnson,WC;Kostis,JB;Sheps,DS;Applegate,WB
背景：外周动脉疾病(PAD)患者心血管死亡率和发病率增加，因此是评估积极的多因素干预对动脉粥样硬化性血管疾病危险因素的可行性和效果的极佳群体。动脉疾病多因素干预试验(ADADE)旨在确定多因素治疗对PAD患者动脉粥样硬化性疾病危险因素的有效性、安全性和依从性。方法采用2×2×2析因设计，将符合条件的受试者(N=468)随机分配到小剂量华法林、抗氧化剂维生素、烟酸或其相应的安慰剂，并随访1年。所有参与者都被鼓励使用阿司匹林。普伐他汀被添加到药物方案中，用于那些需要将低密度脂蛋白胆固醇降低到推荐水平的人。结果烟酸可使高密度脂蛋白胆固醇水平升高30%，其中以500 mg·d-2剂量作用最明显。华法林具有抗凝作用。抗氧化维生素导致血浆中维生素E、C和β-胡萝卜素水平显著增加。总体而言，依从性很高，几乎没有不良反应报告。结论ADAM证实了在PAD患者强化联合治疗中有效地改变多种动脉粥样硬化性疾病危险因素是可行和安全的。(美国心脏杂志2000；140：792-803。)
Background Patients with peripheral arterial disease (PAD) are at an increased risk of cardiovascular mortality and morbidity and thus are an excellent group in whom to evaluate the feasibility and the effect of an aggressive multifactorial intervention on atherosclerotic vascular disease risk factors. The Arterial Disease Multiple Intervention Trial (ADMIT) was designed to determine the efficacy, safety, and compliance of an multifactorial therapy on selected atherosclerotic disease risk factors in patients with PAD. Methods By a 2 × 2 × 2 factorial design, eligible participants (N = 468) were randomly assigned to low-dose warfarin, antioxidant vitamins, and niacin or its corresponding placebo, and followed up for 1 year. All participants were encouraged to use aspirin. Pravastatin was added to the drug regimen for those who needed to reduce LDL cholesterol to recommended levels. Results Niacin increased HDL cholesterol levels by 30%, with the majority of effect achieved at a dosage of 500 mg twice daily. Warfarin had an anticoagulant effect. The antioxidant vitamins resulted in a significant increase in vitamin E, C, and beta-carotene plasma levels. Overall, compliance was high and few adverse effects were reported. Conclusions ADMIT demonstrates that it is both feasible and safe to modify multiple atherosclerotic disease risk factors effectively with intensive combination therapy in patients with PAD. (Am Heart J 2000;140:792-803.)