Effects of obesity on lipid-lowering, anti-inflammatory, and antiatherosclerotic benefits of Atorvastatin or Pravastatin in patients with coronary artery disease (from the REVERSAL study)
Effects of obesity on lipid-lowering, anti-inflammatory, and antiatherosclerotic benefits of Atorvastatin or Pravastatin in patients with coronary artery disease (from the REVERSAL study)
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DOI：
10.1016/j.amjcard.2005.12.042
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发表时间：
2006-06-01
影响因子：
2.8
通讯作者：
Nissen, Steven E.
中科院分区：
文献类型：
--
作者：
Nicholls, Stephen J.;Tuzcu, E. Murat;Nissen, Steven E.
肥胖对动脉粥样硬化负荷的影响及其通过降脂治疗的调节尚不清楚。分析积极降脂治疗抵抗动脉粥样硬化（REVERSAL）研究，以确定体重指数（BMI）增加对血脂、C反应蛋白、血管内超声测定的斑块负荷的影响，以及中度或强化降脂策略下这些参数的连续变化。BMI较高的患者更年轻，更可能是女性，并且高血压、糖尿病和代谢综合征的患病率更高。尽管BMI越高，高密度脂蛋白水平越低，甘油三酯和C反应蛋白水平越高，但BMI对斑块负荷没有明显影响。然而，在强化降脂策略中，BMI越大，低密度脂蛋白降低比例越低（49.1 +/- 21.4% vs 43.0 +/-22.4%，p = 0.008），C反应蛋白降低比例越大（39.7% vs 33.3%，p < 0.04）。此外，尽管中度和强化降脂策略阻止了低BMI受试者的斑块进展，（中位进展率分别为+1.5%和+1.2%），只有在最肥胖的受试者中采用强化降脂策略才对斑块进展率有显著影响（中位进展率-1.88% vs中度降脂策略+ 6.5%，p = 0.01）。总之，肥胖患者的斑块进展使用强化而非中度降脂策略可减弱。这些结果强调了对肥胖患者进行积极的风险因素调整和减少血管炎症的必要性。(c)2006年爱思唯尔公司All rights reserved.
The effect of obesity on atherosclerotic burden and its modulation by lipid-lowering therapy is unknown. The Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) study was analyzed to determine the influence of increasing body mass index (BMI) on plasma lipids, C-reactive protein, plaque burden as determined by intravascular ultrasound, and the serial change in these parameters with a moderate or intensive lipid-lowering strategy. Patients with a higher BMI were younger, more likely to be women, and had a greater prevalence of hypertension, diabetes, and the metabolic syndrome. Although a higher BMI was associated with a lower high-density lipoprotein level and higher triglyceride and C-reactive protein levels, there was no apparent influence of BMI on plaque burden. However, with the intensive lipid-lowering strategy, a greater BMI was associated with a lower proportionate decrease in low-density lipoprotein (49.1 +/- 21.4% vs 43.0 +/- 22.4%, p = 0.008) and a greater proportionate decrease in C-reactive protein (39.7% vs 33.3%, p < 0.04). Further, although moderate and intensive lipid-lowering strategies halted plaque progression in subjects with a lower BMI (median progression rates +1.5% and +1.2%, respectively), a significant effect on plaque progression rates was seen only with adoption of an intensive lipid-lowering strategy in the most obese subjects (median progression rate - 1.88% vs + 6.5% with the moderate lipid-lowering strategy, p = 0.01). In conclusion, plaque progression in obese patients is attenuated using an intensive, but not moderate, lipid-lowering strategy. These results highlight the need for aggressive risk factor modification and a decrease in vascular inflammation in obese patients. (c) 2006 Elsevier Inc. All rights reserved.