Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease
Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease
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DOI：
10.1056/nejmoa011090
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发表时间：
2001-11-29
影响因子：
158.5
通讯作者：
Dodek, A
中科院分区：
文献类型：
--
作者：
Brown, BG;Zhao, XQ;Dodek, A
背景：调脂治疗和抗氧化维生素被认为对冠心病患者有益。我们研究了辛伐他汀-烟酸和抗氧化剂-维生素治疗，单独和联合，对冠心病和低血浆高密度脂蛋白（HDL）胆固醇水平患者的心血管保护作用。方法：在一项为期三年的双盲试验中，160例冠心病患者，低HDL胆固醇水平，和正常低密度脂蛋白（LDL）胆固醇水平被随机分配接受四种方案之一：辛伐他汀加烟酸、抗氧化剂、辛伐他汀-烟酸加抗氧化剂或安慰剂。研究终点为冠状动脉狭窄改变和首次心血管事件（死亡、心肌梗死、中风或血运重建）发生的动脉造影证据。结果：抗氧化剂组和安慰剂组的LDL和HDL胆固醇平均水平没有改变;辛伐他汀-烟酸组的这些水平发生了显著变化（分别为-42%和+26%）。辛伐他汀加烟酸对HDL 2的保护性增加被抗氧化剂同时治疗减弱。安慰剂组平均狭窄进展为3.9%，抗氧化剂组为1.8%（与安慰剂组相比，P=0.16），辛伐他汀-烟酸加抗氧化剂组为0.7%（P=0.004），辛伐他汀-烟酸单药组为0.4%（P
Background: Both lipid-modifying therapy and antioxidant vitamins are thought to have benefit in patients with coronary disease. We studied simvastatin-niacin and antioxidant-vitamin therapy, alone and together, for cardiovascular protection in patients with coronary disease and low plasma levels of high-density lipoprotein (HDL) cholesterol.Methods: In a three-year, double-blind trial, 160 patients with coronary disease, low HDL cholesterol levels, and normal low-density lipoprotein (LDL) cholesterol levels were randomly assigned to receive one of four regimens: simvastatin plus niacin, antioxidants, simvastatin-niacin plus antioxidants, or placebos. The end points were arteriographic evidence of a change in coronary stenosis and the occurrence of a first cardiovascular event (death, myocardial infarction, stroke, or revascularization).Results: The mean levels of LDL and HDL cholesterol were unaltered in the antioxidant group and the placebo group; these levels changed substantially (by -42 percent and +26 percent, respectively) in the simvastatin-niacin group. The protective increase in HDL2 with simvastatin plus niacin was attenuated by concurrent therapy with antioxidants. The average stenosis progressed by 3.9 percent with placebos, 1.8 percent with antioxidants (P=0.16 for the comparison with the placebo group), and 0.7 percent with simvastatin-niacin plus antioxidants (P=0.004) and regressed by 0.4 percent with simvastatin-niacin alone (P