Beyond lipid lowering: What have we learned about the benefits of statins from the acute coronary syndromes trials?
Beyond lipid lowering: What have we learned about the benefits of statins from the acute coronary syndromes trials?
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DOI：
10.1016/j.amjcard.2006.09.016
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发表时间：
2006-12-04
影响因子：
2.8
通讯作者：
Ganz, Peter
中科院分区：
文献类型：
--
作者：
Ray, Kausik K.;Cannon, Christopher P.;Ganz, Peter
他汀类药物通过降低血清胆固醇水平预防原发性和继发性心血管事件的长期益处是无可争议的。然而，早期临床试验和临床前研究的结果表明，3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）治疗的益处可能不完全是由于其对低密度脂蛋白（LDL）胆固醇的影响。从那时起，他汀类药物治疗急性冠状动脉综合征（ACS）的大规模临床试验已经证明了与积极启动他汀类药物治疗相关的早期益处。在这些试验中，他汀类药物的多效性不仅得到了这些急性效应的支持，而且还得到了各种他汀类药物治疗方案之间疗效的明显差异的支持，这些差异似乎与其对血清胆固醇水平的影响无关。在这些研究中，对患者样本中炎症、氧化和血栓形成生物标志物的分析也表明了他汀类药物在ACS中获益的可能机制。本文回顾了ACS中一些关键的他汀类药物试验，并评估了这些药物的益处与其对LDL胆固醇的影响无关的证据。(c)2006爱思唯尔公司All rights reserved.
The long-term benefits for prevention of primary and secondary cardiovascular events achieved by lowering serum cholesterol levels with statins are undisputed. However, results of early clinical trials and preclinical studies suggested the possibility that benefits of treatment with the, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) may not be entirely due to their effects on low-density lipoprotein (LDL) cholesterol. Since then, large-scale clinical trials of statin treatment for acute coronary syndromes (ACS) have demonstrated early benefits that are associated with aggressive initiation of statin therapy. Support for pleiotropic effects of statins in these trials has been provided not only by these acute effects but also by apparent differences in efficacy between various statin regimens that seem unrelated to their effects on serum cholesterol levels. Analyses of biomarkers of inflammation, oxidation, and thrombosis in samples from patients in these studies have also suggested possible mechanisms underlying the benefits of statins in ACS. This article reviews some of the key statin trials in ACS and assesses the evidence for benefits of these drugs independent of their effects on LDL cholesterol. (c) 2006 Elsevier Inc. All rights reserved.