The effects of beta-adrenergic blocking agents on atherosclerosis and its complications.
The effects of beta-adrenergic blocking agents on atherosclerosis and its complications.
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β-肾上腺素能阻断剂对动脉粥样硬化及其并发症的影响。
DOI：
10.1093/oxfordjournals.eurheartj.a062370
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发表时间：
1987
影响因子：
39.3
通讯作者：
Clarkson,TB
中科院分区：
文献类型：
--
作者：
Kaplan,JR;Manuck,SB;Adams,MR;Clarkson,TB
流行病学和实验数据进行审查，以确定是否与β-肾上腺素能受体阻滞剂（β受体阻滞剂）治疗可能是抗动脉粥样硬化。间接和直接证据都被考虑。间接证据来自β受体阻滞剂对动脉粥样硬化危险因素或动脉粥样硬化疾病后遗症的影响的研究。直接证据是指以动脉粥样硬化为终点的研究。关于间接证据，数据通常与β受体阻滞剂对动脉粥样硬化的延迟或中性作用一致。例如，当用β受体阻滞剂治疗高血压时，中风发病率降低。这些研究中约有一半还显示心肌梗死的发病率降低，心肌梗死是一种与动脉粥样硬化程度和严重程度可能比中风更密切相关的并发症，中风可能有非动脉粥样硬化的起源。β受体阻滞剂最重要的潜在负面影响发生在血清脂质浓度方面。然而，没有证据表明动脉粥样硬化恶化是由于胆固醇诱导的血脂改变。直接证据更清楚地表明β受体阻滞剂对动脉粥样硬化的阻滞作用，13项研究中有11项在这方面取得了成果。然而，这些研究的解释是复杂的，因为所有的数据都来自动物模型，其中一些在动脉粥样硬化的发展中与人类并不相似。此外，这些研究是多样化的，不仅在研究设计和使用的物种，而且在β受体阻滞剂的类型，β受体阻滞的程度，以及病变的解剖位置。总而言之。这些数据表明用β受体阻滞剂治疗可以延缓动脉粥样硬化。更明确的答案需要在两个方向上努力：（a）在选定的人群中进行动脉粥样硬化研究，使用血管造影或尸检材料;（B）在适当的动物模型中进行额外的、良好对照的研究。
Epidemiologic and experimental data are reviewed to determine whether treatment with beta-adrenergic blocking agents (‘beta blockers’) is likely to be antiatherogenic. Both indirect and direct evidence are considered. Indirect evidence is derived from studies of the effects of beta blockers on the risk factors for atherosclerosis, or on the disease sequelae of atherosclerosis. Direct evidence refers to studies in which atherosclerosis is an endpoint. Regarding indirect evidence, the data generally are consistent with a retarding or neutral effect of beta blockers on atherosclerosis. For example stroke incidence is reduced when hypertension is treated with beta blockers. About half of these same studies also show a reduction in the incidence of myocardial infarction, a complication that may be more closely related to atherosclerosis extent and severity than is stroke, which can have a nonatherosclerosis origin. The most important potential negative effect of beta blockers occurs with respect to serum lipid concentrations. However, there is no evidence that atherosclerosis is worsened as a result of pharmacologically induced alterations of serum lipids. The direct evidence more clearly indicates a retarding effect of beta blockers on atherosclerosis, with 11 of 13 studies having outcomes in this direction. However, interpretation of these studies is complicated by the fact that all of the data are derived from animal models, some of which are not similar to human beings in the development of atherosclerosis. Also, the studies are diverse, not only in the research designs and species utilized, but also in the type of beta blocker employed, the degree of beta blockade acheived, and the anatomic location of lesions. In summary. the data suggest that treatment with beta blockers may retard atherosclerosis. A more definitive answer requires efforts in two directions: (a) studies on atherosclerosis in selected populations of human beings, using cineangiography or autopsy material; and (b) additional, well-controlled studies in appropriate animal models.