Effects of lovastatin and warfarin on early carotid atherosclerosis: sex-specific analyses. Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group.
Effects of lovastatin and warfarin on early carotid atherosclerosis: sex-specific analyses. Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group.
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洛伐他汀和华法林对早期颈动脉粥样硬化的影响：性别特异性分析。
DOI：
10.1161/01.cir.100.3.e14
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发表时间：
1999
期刊：
影响因子：
37.8
通讯作者：
Furberg,CD
中科院分区：
文献类型：
--
作者：
Byington,RP;Evans,GW;Espeland,MA;Applegate,WB;Hunninghake,DB;Probstfield,J;Furberg,CD
背景--很少有临床试验记录了无症状women.Methods和Results-Lovastatin和小剂量华法林的预防性治疗的有效性，在一项因子设计的、安慰剂对照的随机试验中进行了评价。主要结果是通过B型超声测量的颈动脉平均最大内膜-中膜厚度的3年变化。参与者（n=919）被随机分配到4个治疗组中的一个：单独使用洛伐他汀，单独使用华法林，洛伐他汀+华法林联合治疗或双安慰剂组。符合条件的参与者无心血管疾病症状，有早期颈动脉粥样硬化和LDL胆固醇水平中度升高的证据。几乎一半（n=445）的参与者是女性。为了避免混淆，117名服用雌激素的妇女被排除在分析之外。两种性别的患者在接受洛伐他汀治疗后均出现疾病进展减缓;没有证据表明总体性别×治疗相互作用（P=0.72）。当事后检查性别特异性结果的估计值时，洛伐他汀+华法林联合治疗的女性患者的疾病消退程度最大（P=0.02），尽管单独使用洛伐他汀的女性患者的疾病进展也有所减少（P=0.09）。男性经历了最大的减少与单独的洛伐他汀（P=0.02），虽然有一个建议，华法林也可以减少进展到一定程度上。结论-洛伐他汀是有益的，在减少疾病进展的妇女和男子。Warfarin对女性没有影响，尽管它可能会减少男性的进展。在男性中，华法林不能增加洛伐他汀的获益，与单独使用洛伐他汀相比没有优势。
Background—Few clinical trials have documented the efficacy of preventive treatment in asymptomatic women.Methods and Results—Lovastatin and minidose warfarin were evaluated in a factorially designed, placebo-controlled, randomized trial. The primary outcome was 3-year change in the mean maximum intimal-medial thickness of the carotid arteries as measured by B-mode ultrasonography. Participants (n=919) were randomized to 1 of 4 treatment groups: lovastatin alone, warfarin alone, lovastatin+warfarin combination, or a double-placebo group. Eligible participants were asymptomatic for cardiovascular disease, with evidence of early carotid atherosclerosis and moderately elevated LDL cholesterol level. Almost half (n=445) of the participants were women. To avoid confounding, 117 women taking estrogen were excluded from analysis. Both sexes experienced reductions in disease progression with lovastatin; there was no evidence of an overall sex×treatment interaction (P=0.72). When estimates of the sex-specific results were examined post hoc, women experienced disease regression to the greatest extent with the lovastatin+warfarin combination (P=0.02), although the women on lovastatin alone also had a reduction in progression (P=0.09). Men experienced the greatest reduction with lovastatin alone (P=0.02), although there is a suggestion that warfarin may also reduce progression to some extent.Conclusions—Lovastatin is beneficial in reducing disease progression in women and men. Warfarin has no effect in women, although it may reduce progression in men. In men, warfarin does not add to the benefit of lovastatin and has no advantage over lovastatin alone.