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首页> 外文期刊>The Lancet >Effect of aggressive versus conventional lipid lowering on atherosclerosis progression in familial hypercholesterolaemia (ASAP): a prospective, randomised, double-blind trial.
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Effect of aggressive versus conventional lipid lowering on atherosclerosis progression in familial hypercholesterolaemia (ASAP): a prospective, randomised, double-blind trial.

机译：在家族性高胆固醇血症（ASAP）中，积极降脂与常规降脂对动脉粥样硬化进展的影响：一项前瞻性，随机，双盲试验。

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BACKGROUND: High LDL-cholesterol is a risk factor for atherosclerosis. We aimed to determine whether aggressive cholesterol lowering with statins was more effective than conventional statin treatment in this disease. We investigated the effect of high-dose atorvastatin on carotid atherosclerosis progression. METHOD: We did a randomised, double-blind clinical trial in 325 patients with familial hypercholesterolaemia. Patients were given either atorvastatin 80 mg (n=160) or simvastatin 40 mg (n=165) daily, on an intent-to-treat basis. The primary endpoint was the change of carotid intima media thickness (IMT), as measured by quantitative B-mode ultrasound, over 2 years. FINDINGS: The overall baseline IMT, combining the measurements of the common and internal carotid artery and the carotid bifurcation on both sides, was 0.93 mm (SD 0.22) and 0.92 mm (0.21) in the atorvastatin and simvastatin groups, respectively. After treatment with atorvastatin for 2 years, IMT decreased (-0.031 mm [95% CI -0.007 to -0.055]; p=0.0017), whereas in the simvastatin group it increased (0.036 [0.014-0.058]; p=0.0005). The change in thickness differed significantly between the two groups (p=0.0001). Atorvastatin showed greater reductions in cholesterol concentrations than did simvastatin. HDL-cholesterol concentrations increased in both groups. Both drugs were equally well tolerated. INTERPRETATION: Our results show that aggressive LDL-cholesterol reduction by atorvastatin was accompanied by regression of carotid intima media thickness in patients with familial hypercholesterolaemia, whereas conventional LDL lowering was not.
机译：背景：高LDL胆固醇是动脉粥样硬化的危险因素。我们旨在确定他汀类药物在降低胆固醇方面是否比常规他汀类药物治疗更有效。我们调查了大剂量阿托伐他汀对颈动脉粥样硬化进展的影响。方法：我们对325例家族性高胆固醇血症患者进行了一项随机，双盲临床试验。每天给患者服用意图治疗的阿托伐他汀80 mg（n = 160）或辛伐他汀40 mg（n = 165）。主要终点是在2年中通过定量B型超声测量的颈动脉内膜中层厚度（IMT）的变化。研究结果表明，阿托伐他汀和辛伐他汀组的总基线IMT结合了两侧颈总动脉和颈内动脉以及颈动脉分叉的测量值，分别为0.93 mm（SD 0.22）和0.92 mm（0.21）。阿托伐他汀治疗2年后，IMT降低（-0.031 mm [95％CI -0.007至-0.055]; p = 0.0017），而在辛伐他汀组则增加（0.036 [0.014-0.058]; p = 0.0005）。两组之间的厚度变化差异显着（p = 0.0001）。与辛伐他汀相比，阿托伐他汀显示出更大的胆固醇浓度降低。两组的HDL-胆固醇浓度均升高。两种药物的耐受性均相同。解释：我们的结果表明，阿托伐他汀可降低LDL-胆固醇的积极性，并伴有家族性高胆固醇血症患者的颈动脉内膜中层厚度的消退，而传统的LDL降低并未。

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