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首页> 外文期刊>Circulation journal >Statins and Renin-Angiotensin System Inhibitor Combination Treatment to Prevent Cardiovascular Disease
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Statins and Renin-Angiotensin System Inhibitor Combination Treatment to Prevent Cardiovascular Disease

机译：他汀类药物和肾素-血管紧张素系统抑制剂联合治疗可预防心血管疾病

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Hypercholesterolemia and hypertension are common risk factors for cardiovascular disease (CVD). Updated guidelines emphasize target reductions of overall cardiovascular risks. Experimental studies have shown reciprocal relationships between insulin resistance (IR) and endothelial dysfunction. Hypercholesterolemia and hypertension have a synergistic deleterious effect on IR and endothelial dysfunction. Unregulated renin-angiotensin system (RAS) is important in the pathogenesis of atherosclerosis and hypertension. Various strategies with different classes of antihypertensive medications to reach target goals have failed to reduce residual CVD risk further. Of interest, treating moderate cholesterol elevations with low-dose statins in hypertensive patients reduced CVD risk by 35–40% further. Therefore, statins are important in reducing CVD risk. Unfortunately, statin therapy causes IR and increases the risk of type 2 diabetes mellitus. RAS inhibitors improve both endothelial dysfunction and IR. Further, cross-talk between hypercholesterolemia and RAS exists at multiple steps of IR and endothelial dysfunction. In this regard, combined therapy with statins and RAS inhibitors demonstrates additive/synergistic effects on endothelial dysfunction and IR in addition to lowering cholesterol levels and blood pressure when compared with either monotherapy in patients. This is mediated by both distinct and interrelated mechanisms. Therefore, combined therapy with statins and RAS inhibitors may be important in developing optimal management strategies in patients with hypertension, hypercholesterolemia, diabetes, metabolic syndrome, or obesity to prevent CVD.??( Circ J ?2014; 78: 281–287)
机译：高胆固醇血症和高血压是心血管疾病（CVD）的常见危险因素。更新的指南强调降低总体心血管风险的目标。实验研究表明，胰岛素抵抗（IR）与内皮功能障碍之间存在相互关系。高胆固醇血症和高血压对IR和内皮功能障碍具有协同的有害作用。肾素-血管紧张素系统（RAS）的失控在动脉粥样硬化和高血压的发病机理中很重要。使用不同类别的降压药物达到目标目标的各种策略未能进一步降低残留的CVD风险。有趣的是，在高血压患者中用低剂量他汀类药物治疗中度胆固醇升高可将CVD风险进一步降低35-40％。因此，他汀类药物对于降低CVD风险很重要。不幸的是，他汀类药物疗法可引起IR，并增加2型糖尿病的风险。 RAS抑制剂可改善内皮功能障碍和IR。此外，高胆固醇血症和RAS之间的串扰存在于IR和内皮功能障碍的多个步骤。在这方面，与任何一种单一疗法相比，他汀类药物和RAS抑制剂的联合疗法在降低胆固醇水平和血压的同时，还显示出对内皮功能障碍和IR的累加/协同效应。这是由不同的和相互关联的机制介导的。因此，在高血压，高胆固醇血症，糖尿病，代谢综合征或肥胖的患者中，联合他汀类药物和RAS抑制剂联合治疗对于预防CVD的最佳治疗策略可能很重要。（Circ J？2014; 78：281-287）

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