Perspectives in cholesterol-lowering therapy - The role of ezetimibe, a new selective inhibitor of intestinal cholesterol absorption
Perspectives in cholesterol-lowering therapy - The role of ezetimibe, a new selective inhibitor of intestinal cholesterol absorption
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DOI：
10.1161/01.cir.0000072345.98581.24
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发表时间：
2003-07-01
期刊：
影响因子：
37.8
通讯作者：
Tellier, P
中科院分区：
文献类型：
--
作者：
Bruckert, E;Giral, P;Tellier, P
3124例冠心病危险因素管理调查显示，接受降脂治疗的患者中只有一半达到了推荐的血脂治疗目标。3此外，另一项调查显示，在临床实践中使用他汀类药物导致观察到的LDL-C水平降低，显著低于包装说明书指南预测的水平。4不依从是治疗指南和现实生活中的治疗模式之间存在差异的原因之一。此外，当前调脂药物的潜在、已知或感知的耐受性和/或安全性问题可能导致治疗挑战，尤其是在较高剂量下。特别是，许多医生不愿意滴定他汀类药物治疗。另一方面，这类药物的最高剂量在最严重的血脂异常中缺乏足够的疗效并不罕见。虽然临床医生可以通过改善脂质管理来帮助减少治疗不足的患者数量，但需要额外的治疗来优化心血管疾病的预防和治疗。这一需求将研究导向新的机制，如抑制肠道胆固醇吸收，这是依折麦布的主要作用机制。结合药物对胆固醇代谢的不同途径的影响可能会导致一些好处，是补充和添加剂的他汀类药物。5
3124 survey of risk factor management with established CHD revealed that only half of those patients receiving lipidlowering therapy had attained recommended lipid treatment goals. 3 Moreover, another survey showed that the use of statins in clinical practice leads to observed reductions in LDL-C levels that are significantly less than those projected by package insert guidelines. 4 Non-compliance is one reason for the disparity between treatment guidelines and real-life treatment patterns. In addition, potential, known, or perceived issues of tolerability and/or safety of current lipid-altering drugs may result in therapeutic challenges, especially at the higher doses. In particular, many physicians are reluctant to titrate up statin treatment. On the other hand, it is not uncommon that the highest dosage of such drugs lacks sufficient efficacy in the most severe dyslipidemias. Although clinicians can help reduce the number of undertreated patients through improved lipid management, additional therapies are required to optimize prevention and treatment of cardiovascular diseases. This demand has directed research toward new mechanisms such as the inhibition of intestinal cholesterol absorption, which is the main mechanism of action of ezetimibe. Combining drugs with effects on different pathways of cholesterol metabolism may result in some benefits that are complementary and additive to those of the statins. 5