Long-Term Effects of Cholesterol Lowering and Angiotensin-Converting Enzyme Inhibition on Coronary Atherosclerosis: The Simvastatin/Enalapril Coronary Atherosclerosis Trial (SCAT)
Long-Term Effects of Cholesterol Lowering and Angiotensin-Converting Enzyme Inhibition on Coronary Atherosclerosis: The Simvastatin/Enalapril Coronary Atherosclerosis Trial (SCAT)
复制标题
降低胆固醇和抑制血管紧张素转换酶对冠状动脉粥样硬化的长期影响：辛伐他汀/依那普利冠状动脉粥样硬化试验 (SCAT)
作者：
K. Teo;J. Burton;C. Buller;S. Plante;D. Catellier;W. Tymchak;V. Džavík;Dylan A. Taylor;S. Yokoyama;T. Montague
本研究采用长期、多中心、随机、双盲、安慰剂对照、2×2析因的血管造影试验，评价了降胆固醇和血管紧张素转换酶抑制剂对正常胆固醇血症患者冠状动脉粥样硬化的影响。方法和结果共有460例患者：230例接受辛伐他汀治疗，230例接受辛伐他汀安慰剂治疗，229例接受依那普利治疗，231例接受依那普利安慰剂治疗（一些受试者接受两种药物治疗，一些受试者接受双重安慰剂治疗）。平均基线测量值如下：胆固醇水平，5.20 mmol/L;甘油三酯水平，1.82 mmol/L; HDL，0.99 mmol/L; LDL，3.36 mmol/L。平均随访47.8个月。辛伐他汀组和安慰剂组的定量冠状动脉造影指标变化分别如下：平均直径，−0.07与−0.14 mm（P =0.004）;最小直径，−0.09与−0.16 mm（P =0.0001）;直径狭窄百分比，1.67%与3.83%（P =0.0003）。与安慰剂相比，依那普利组患者未观察到这些益处。在接受两种药物的组中没有观察到额外的益处。辛伐他汀组患者较少需要经皮冠状动脉腔内成形术（8对21起事件;P =0.020），依那普利组患者较少发生死亡/心肌梗死/卒中联合终点（16对30;P =0.043）。结论：本试验将降脂治疗的有益血管造影效果的观察扩展到胆固醇正常的患者。血管紧张素转换酶抑制剂的中性血管造影作用的影响尚不确定，但根据本文和其他文献中提出的积极临床获益，值得进一步研究。
BackgroundThis long-term, multicenter, randomized, double-blind, placebo-controlled, 2×2 factorial, angiographic trial evaluated the effects of cholesterol lowering and angiotensin-converting enzyme inhibition on coronary atherosclerosis in normocholesterolemic patients. Methods and ResultsThere were a total of 460 patients: 230 received simvastatin and 230, a simvastatin placebo, and 229 received enalapril and 231, an enalapril placebo (some subjects received both drugs and some received a double placebo). Mean baseline measurements were as follows: cholesterol level, 5.20 mmol/L; triglyceride level, 1.82 mmol/L; HDL, 0.99 mmol/L; and LDL, 3.36 mmol/L. Average follow-up was 47.8 months. Changes in quantitative coronary angiographic measures between simvastatin and placebo, respectively, were as follows: mean diameters, −0.07 versus −0.14 mm (P =0.004); minimum diameters, −0.09 versus −0.16 mm (P =0.0001); and percent diameter stenosis, 1.67% versus 3.83% (P =0.0003). These benefits were not observed in patients on enalapril when compared with placebo. No additional benefits were seen in the group receiving both drugs. Simvastatin patients had less need for percutaneous transluminal coronary angioplasty (8 versus 21 events;P =0.020), and fewer enalapril patients experienced the combined end point of death/myocardial infarction/stroke (16 versus 30;P =0.043) than their respective placebo patients. ConclusionsThis trial extends the observation of the beneficial angiographic effects of lipid-lowering therapy to normocholesterolemic patients. The implications of the neutral angiographic effects of angiotensin-converting enzyme inhibition are uncertain, but they deserve further investigation in light of the positive clinical benefits suggested here and seen elsewhere.
影响因子：
2.8
作者：
Herd, JA;Ballantyne, CM;Gotto, AM
通讯作者：
Gotto, AM
DOI：
10.1001/jama.1990.03450230043027
发表时间：
1990-12
期刊：
JAMA
影响因子：
--
作者：
J. Kane;M. Malloy;T. Ports;N. Phillips;James C. Diehl;R. Havel
通讯作者：
J. Kane;M. Malloy;T. Ports;N. Phillips;James C. Diehl;R. Havel
ACE抑制对冠状动脉疾病的保护作用机制。
DOI：
--
发表时间：
1998
期刊：
European heart journal.
影响因子：
--
作者：
Dzau,VJ
通讯作者：
Dzau,VJ