THE INFLUENCE OF CHANGES IN LIPID VALUES INDUCED BY CHOLESTYRAMINE AND DIET ON PROGRESSION OF CORONARY-ARTERY DISEASE - RESULTS OF THE NHLBI TYPE-II CORONARY INTERVENTION STUDY
THE INFLUENCE OF CHANGES IN LIPID VALUES INDUCED BY CHOLESTYRAMINE AND DIET ON PROGRESSION OF CORONARY-ARTERY DISEASE - RESULTS OF THE NHLBI TYPE-II CORONARY INTERVENTION STUDY
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DOI：
10.1161/01.cir.69.2.325
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发表时间：
1984-01-01
期刊：
影响因子：
37.8
通讯作者：
DETRE, KM
中科院分区：
文献类型：
--
作者：
LEVY, RI;BRENSIKE, JF;DETRE, KM
国家心脏、肺和血液研究所II型冠状动脉干预研究是一项双盲、安慰剂对照试验，评估了胆胺诱导的胆固醇水平降低对冠状动脉疾病（CAD）进展的疗效。用消胆胺加饮食治疗的患者与用安慰剂加饮食治疗的患者的冠心病进展率进行比较。通过血管造影确定冠心病的进展。研究结果显示，乙酰胆胺可显著降低总胆固醇（TC）和低密度脂蛋白胆固醇（LDLc），增加高密度脂蛋白胆固醇（HDLc），以及HDLc/TC和HDLc/LDLc比值。HDLc的变化是由于HDL2A和HDL2B的增加。当独立于特定治疗组检查CAD进展与脂质变化之间的关系时，发现5年的进展与HDLc的增加和LDLc的减少之间存在显著的反比关系；HDLc/TC和HDLc/LDLc的变化是CAD变化的最佳预测因子。虽然测试这些独立于治疗组的关系不是最初研究设计的一部分，但在安慰剂治疗组和胆甾胺治疗组中都观察到了这种趋势。此外，通过多变量分析，在回归模型中加入HDLc/TC的变化，消除了胆胺治疗对CAD进展的影响。显然，HDLc的增加和TC（或LDLc）的减少可以预防或延缓CAD的进展。
The National Heart, Lung and Blood Institute Type II Coronary Intevention Study, a double-blind, placebo-controlled trial, evaluated the efficacy of reduction in cholesterol levels induced by cholestyramine on progression of coronary artery disease (CAD). The rate of CAD progression in patients treated with cholestyramine plus diet was compared with that of patients treated with placebo plus diet. CAD progression was defined angiographically. Significant decrease in total cholesterol (TC) and low density lipoprotein cholesterol (LDLc) and increases in high density lipoprotein cholesterol (HDLc), as well as in HDLc/TC and HDLc/LDLc ratios, were observed with cholestyramine. HDLc change was due to increase in HDL2A and HDL2B. When the relationship between CAD progression and lipid changes was examined independent of specific treatment group, a significant inverse relationship was found between progression at 5 yr and the combination of an increase in HDLc and a decrease in LDLc; changes in HDLc/TC and HDLc/LDLc were the best predictors of CAD change. While testing of these relationships independent of treatment group was not part of the initial study design, the trends were observed in both the placebo-treated and cholestyramine-treated groups. Moreover, with multivariate analysis, the effect of cholestyramine treatment on CAD progression was eliminated by adding changes in HDLc/TC to the regression model. Evidently, increases in HDLc and decreases in TC (or LDLc) can prevent or delay CAD progression.