Systematic review: Evaluating the effect of lipid-lowering therapy on lipoprotein and lipid values.
Systematic review: Evaluating the effect of lipid-lowering therapy on lipoprotein and lipid values.
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DOI：
10.1007/s10557-013-6477-6
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发表时间：
2013-10
影响因子：
3.4
通讯作者：
Underberg, James A.
中科院分区：
文献类型：
--
作者：
Rosenson, Robert S.;Underberg, James A.
关键词：
这篇系统性综述是为了总结已发表的使用低密度脂蛋白颗粒数(LDL-P)监测降脂药物治疗效果的经验。研究是通过MEDLINE的文献检索(2000年1月1日-2012年6月30日)和对选定会议的摘要检索确定的。所有被接受的研究都报告了至少10名接受降脂药物治疗的受试者的平均(或中位数)基于核磁共振的低密度脂蛋白水平。搜索发现了36项研究(61个治疗组)，其中报告了治疗前和治疗后的低密度脂蛋白测定。大多数研究也报告了低密度脂蛋白胆固醇的变化，但很少有研究报告载脂蛋白B( = 20)和非高密度脂蛋白-C(n = 28)的变化。治疗包括他汀类药物(22个ARM/15个研究)、贝特类药物(7个ARM/7个研究)、烟酸(7个ARM/6个研究)、胆汁酸隔离剂(5个ARM/2个研究)、抗载脂蛋白B寡核苷酸(2个ARM/2个研究)、联合治疗(8个ARM/6个研究)、抗糖尿病(5个ARM/4个研究)和其他治疗(5个ARM/2个研究)。除两项研究外，所有研究中降脂药物治疗均导致平均低密度脂蛋白水平降低。在几项他汀类研究中，低密度脂蛋白降低的百分比小于低密度脂蛋白降低的百分比，当报告低密度脂蛋白和载脂蛋白B时，报告了类似的变化。这项系统性综述的研究水平数据表明，不同的降脂剂会导致低密度脂蛋白和低密度脂蛋白之间的不一致，因此，将降脂治疗仅仅建立在实现胆固醇目标的基础上可能会导致治疗差距。因此，使用低密度脂蛋白-P监测降脂治疗，特别是他汀类药物，可以提供更准确的残余心血管风险评估。
This systematic review was performed to summarize published experience using low density lipoprotein particle number (LDL-P) to monitor the efficacy of lipid-lowering pharmacotherapies. Studies were identified from a literature search of MEDLINE (January 1, 2000 – June 30, 2012); and abstract searches of select conferences. All accepted studies reported mean (or median) nuclear magnetic resonance (NMR)-based LDL-P values for at least 10 subjects receiving lipid lowering pharmacotherapy. Searches revealed 36 studies (with 61 treatment arms) in which LDL-P measurements were reported pre- and post-treatment. Most studies also reported changes in low-density lipoprotein cholesterol (LDL-C), but fewer studies reported changes in apolipoprotein B (apoB)(n = 20) and non-HDL-C (n = 28). Treatments included statins (22 arms/15 studies), fibrates (7 arms/7studies), niacin (7 arms/6 studies), bile acid sequestrants (5 arms/2 studies), an anti-apoB oligonucleotide (2 arms/2 studies), combination therapies (8 arms/6 studies), anti-diabetics (5 arms/4 studies), and, other treatments (5 arms/2 studies). Lipid-lowering pharmacotherapy resulted in reductions in mean LDL-P in all but two studies. In several statin studies, the percent reductions in LDL-P were smaller than reductions in LDL-C, comparable changes were reported when LDL-P and apoB, were reported. Study-level data from this systemic review establish that different lipid lowering agents can lead to discordance between LDL-P and LDL-C, therefore, basing LDL-lowering therapy only on the achievement of cholesterol goals may result in a treatment gap. Therefore, the use of LDL-P for monitoring lipid-lowering therapy, particularly for statins, can provide a more accurate assessment of residual cardiovascular risk.
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