HMG-CoA reductase inhibitors for lowering elevated levels of C-reactive protein
HMG-CoA reductase inhibitors for lowering elevated levels of C-reactive protein
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DOI：
10.1093/ajhp/61.16.1676
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发表时间：
2004-08-15
影响因子：
2.7
通讯作者：
Silva, MA
中科院分区：
文献类型：
--
作者：
Chan, KY;Boucher, ES;Silva, MA
目的.本文综述了羟甲基戊二酰辅酶A（HMG-CoA）还原酶抑制剂治疗降低C反应蛋白（CRP）水平升高和相关冠状动脉事件的临床试验。动脉粥样硬化斑块的生长可以通过旨在最小化炎症的治疗来减弱。由于CRP水平的升高与动脉壁炎症有关，他汀类药物可以通过抑制脂质沉积和减少炎症来预防缺血。最近的临床试验（包括WOSCOPS、PRINCE、AFCAPS/TexCAPS、MIRACL、CURVES、REVERSAL和JUPITER）的评价表明，他汀类药物治疗与CRP水平降低相关。WOSCOPS发现，基线时CRP值>4.59 mg/L的患者发生冠状动脉事件的风险最高。PRINCE试验评估了普伐他汀的抗抑郁作用，发现治疗24周后CRP水平平均降低16.9%。AFCAPS/TexCAPS研究人员发现，洛伐他汀使CRP的中位数水平降低了14.8%（p < 0.001）。MIRACL研究显示，阿托伐他汀使CRP水平降低了83%（p < 0.001）。CURVES研究中的研究人员发现，与基线相比，普伐他汀、辛伐他汀和阿托伐他汀显著降低了CRP水平（p < 0.025）。REVERSAL研究的结果表明，阿托伐他汀与CRP水平下降36.4%相关，而普伐他汀与CRP水平下降5.2%相关（p < 0.0001）。JUPITER研究正在进行中，将确定长期使用瑞舒伐他汀是否可以降低冠状动脉事件的发生率。他汀类药物降低升高的CRP水平可能降低冠状动脉事件的风险，与他汀类药物对血脂水平的影响无关。
Purpose. Clinical trials evaluating the effectiveness of therapy with hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors for reducing elevated C-reactive protein (CRP) levels and associated coronary events are reviewed.Summary. Atherosclerotic plaque growth may be attenuated with therapy aimed at minimizing inflammation. Because increased levels of CRP have been associated with arterial-wall inflammation, statins can prevent ischemia by both inhibiting deposition of lipids and decreasing inflammation. Evaluation of recent clinical trials, including WOSCOPS, PRINCE, AFCAPS/TexCAPS, MIRACL, CURVES, REVERSAL, and JUPITER, demonstrated the correlation of statin therapy with decreased levels of CRP. WOSCOPS found that patients with CRP values of >4.59 mg/L at baseline were at the highest risk of coronary events. The PRINCE trial evaluated the antiinflammatory effects of pravastatin and found a mean 16.9% reduction in CRP levels after 24 weeks of therapy. AFCAPS/TexCAPS researchers found that lovastatin provided a 14.8% reduction in the median levels of CRP (p < 0.001). The MIRACL study showed that atorvastatin reduced CRP levels by 83% (p < 0.001). Researchers in the CURVES study found a significant reduction in CRP levels with pravastatin, simvastatin, and atorvastatin compared with baseline (p < 0.025). Results of the REVERSAL study linked atorvastatin with a 36.4% decrease in CRP levels, while pravastatin was associated with a 5.2% decrease (p < 0.0001). JUPITER is ongoing and will determine whether long-term use of rosuvastatin can reduce the rate of coronary events.Conclusion. The lowering of elevated CRP levels by statins may reduce the risk of coronary events independently of the effect of statins on lipid levels.