Safety and Effect of Very Low Levels of Low-Density Lipoprotein Cholesterol on Cardiovascular Events
Safety and Effect of Very Low Levels of Low-Density Lipoprotein Cholesterol on Cardiovascular Events
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DOI：
10.1016/j.amjcard.2012.12.052
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发表时间：
2013-04-15
影响因子：
2.8
通讯作者：
Wasserman, Scott M.
中科院分区：
文献类型：
--
作者：
LaRosa, John C.;Pedersen, Terje R.;Wasserman, Scott M.
基于主要来自3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（他汀类）试验的心血管（CV）结局数据，指南将低密度脂蛋白（LDL）胆固醇目标设定为随时间不断降低的水平。最近的数据表明，与低强度的他汀类药物治疗相比，高强度的他汀类药物治疗（从而降低LDL胆固醇水平）在减少心血管事件方面更有效。尽管美国成年人的平均低密度脂蛋白胆固醇水平为119毫克/分升，在美国国家胆固醇教育计划-成人治疗小组III指南的“正常”范围内（90至130毫克/分升），但来自胎儿研究、饮食研究、当代狩猎采集人群和其他哺乳动物的数据表明，人类低密度脂蛋白胆固醇的“正常”生理范围可能是50至70毫克/分升。在人口研究和临床试验中，低LDL胆固醇水平与癌症、出血性中风和其他并发症的风险增加偶尔相关。然而，他汀类药物临床试验通常没有证明治疗期间LDL胆固醇水平与安全性之间的相关性。临床数据表明，降低LDL胆固醇与降低CV风险之间存在线性关系，这支持了达到极低水平LDL胆固醇以最小化CV事件风险的有利风险/获益比。总之，临床试验证据表明LDL胆固醇降至极低水平的有效性和安全性对于确定降低血管疾病残留风险的益处和风险至关重要。(C) 2013爱思唯尔公司版权所有。[J] .中华心血管病杂志，2013;11:1221-1229。
Based on the cardiovascular (CV) outcomes data derived predominantly from 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor (statin) trials, guidelines have set low-density lipoprotein (LDL) cholesterol targets at successively lower levels over time. Recent data have demonstrated that more-intensive statin therapy (and, consequently, lower LDL cholesterol level) is more effective at reducing CV events than less-intensive statin therapy. Although the average LDL cholesterol level for a United States adult is 119 mg/dl, within the "normal" range (90 to 130 mg/dl) per the United States National Cholesterol Education Program-Adult Treatment Panel III guidelines, data from fetal studies, diet studies, contemporary hunter-gatherer populations, and other mammals have suggested that the "normal" physiologic range for LDL cholesterol in humans is likely 50 to 70 mg/dl. Low LDL cholesterol levels have been sporadically associated with an increased risk of cancer, hemorrhagic stroke, and other complications in population studies and clinical trials. However, statin clinical trials have generally not demonstrated correlations between on-treatment LDL cholesterol levels and safety. Clinical data have suggested a linear relation between LDL cholesterol lowering and CV risk reduction, supporting a favorable risk/benefit ratio for attaining very low levels of LDL cholesterol to minimize the risk of CV events. In conclusion, clinical trial evidence demonstrating the efficacy and safety of LDL cholesterol lowering to a very low level is essential to ascertain the benefits and risks in reducing the residual risk of vascular disease. (C) 2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;111:1221-1229)