Atorvastatin 10mg plus ezetimibe 10mg compared with atorvastatin 20mg : Impact on the lipid profile in Japanese patients with abnormal glucose tolerance and coronary artery disease
Atorvastatin 10mg plus ezetimibe 10mg compared with atorvastatin 20mg : Impact on the lipid profile in Japanese patients with abnormal glucose tolerance and coronary artery disease
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阿托伐他汀 10 毫克加依折麦布 10 毫克与阿托伐他汀 20 毫克相比：对日本糖耐量异常和冠状动脉疾病患者血脂的影响
DOI：
10.1016/j.jjcc.2011.09.001
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发表时间：
2012
影响因子：
2.5
通讯作者：
Uemura Y
中科院分区：
文献类型：
--
作者：
Kumagai S;Matsubara T;Uemura Y
背景氧化低密度脂蛋白(LDL)胆固醇是预测动脉粥样硬化的敏感血脂标志物。据报道，依折麦布和他汀类药物可以降低低密度脂蛋白胆固醇和氧化低密度脂蛋白胆固醇。这项前瞻性随机开放交叉研究比较了阿托伐他汀加依折麦布联合治疗和大剂量阿托伐他汀单一治疗。方法和结果39例日本冠心病合并2型糖尿病或糖耐量低减患者服用阿托伐他汀10 mg/d(男30例，女9例，平均年龄67.8岁)。他们被随机分成两组，一组是先服用依折麦布(10毫克/天)，另一组是先接受阿托伐他汀单一治疗，剂量较大，为20毫克/天。这两种治疗方法都是以交叉的方式进行，每次为期12周。依折麦布显著降低丙二醛-低密度脂蛋白(109.0±31.9 mg/dl至87.70±29.4 mg/dl，p=0.0009)，而上滴定阿托伐他汀则无此作用。添加依折麦布的降幅明显大于阿托伐他汀的上滴定(p=0.0006)。两种治疗方法都能显著降低总胆固醇和低密度脂蛋白胆固醇，但添加依折麦布的降幅更大(p<；0.05)。两种治疗方法均能显著提高高密度脂蛋白胆固醇水平，两种治疗方法之间无显著差异。Ezetimibe仅能显著降低载脂蛋白B/载脂蛋白A-I比值和残存颗粒胆固醇。结论在日本2型糖尿病或糖耐量受损的冠心病患者中，在阿托伐他汀(10 mg/天)的基础上加用依折麦布(10 mg/天)，与阿托伐他汀单独治疗(20 mg/天)相比，可显著改善血脂状况。
BACKGROUNDOxidized low-density lipoprotein (LDL) cholesterol is a sensitive lipid marker for predicting atherosclerosis. Ezetimibe and statins are reported to decrease both LDL cholesterol and oxidized LDL cholesterol. This prospective randomized open-label crossover study compared combination therapy with atorvastatin plus ezetimibe versus high-dose atorvastatin monotherapy. Changes in serum lipids, including malondialdehyde-modified LDL (MDA-LDL) as a representative form of oxidized LDL cholesterol, and glucose metabolism were assessed.METHODS AND RESULTSThe subjects were 39 Japanese patients with coronary artery disease and type 2 diabetes or impaired glucose tolerance who were taking 10mg/day of atorvastatin (30 men and 9 women with a mean age of 67.8 years). They were randomized to a group that first received add-on ezetimibe (10mg/day) or a group that first received atorvastatin monotherapy at a higher dose of 20mg/day. Both treatments were given for 12 weeks each in a crossover fashion. Add-on ezetimibe significantly decreased MDA-LDL (109.0±31.9mg/dl to 87.7±29.4mg/dl, p=0.0009), while up-titration of atorvastatin did not. The decrease with add-on ezetimibe was significantly greater than with up-titration of atorvastatin (p=0.0006). Total cholesterol and LDL cholesterol were significantly decreased by both treatments, but the percent reduction with add-on ezetimibe was significantly greater (p<0.05). High-density lipoprotein cholesterol was significantly increased by both treatments and there was no significant difference between them. The apolipoprotein B/apolipoprotein A-I ratio and remnant-like particle cholesterol were only significantly decreased by add-on ezetimibe. Both treatments caused similar elevation of hemoglobin A1c.CONCLUSIONIn Japanese patients with type 2 diabetes or impaired glucose tolerance and coronary artery disease, adding ezetimibe (10mg/day) to atorvastatin (10mg/day) significantly improved the lipid profile compared with atorvastatin monotherapy at 20mg/day.