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首页> 外文期刊>Clinical drug investigation >Regression or Reduction in Progression of Atherosclerosis, and Avoidance of Coronary Events, With Lovastatin in Patients With or at High Risk of Cardiovascular Disease A Review
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Regression or Reduction in Progression of Atherosclerosis, and Avoidance of Coronary Events, With Lovastatin in Patients With or at High Risk of Cardiovascular Disease A Review

机译：洛伐他汀在患有心血管疾病或处于心血管疾病高风险的患者中的进展或减少，以及避免冠状动脉事件的进展

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HMG-CoA reductase inhibitors (statins) are the drugs of first choice for treating hypercholesterolaemia in order to prevent or slow the progression of coronary heart disease (CHD). Statins generally reduce the risk of CHD morbidity or mortality by about 30%. Lovastatin is effective in lowering plasma total cholesterol and low-density lipoprotein cholesterol levels, and is widely pre-scribed for both the primary and secondary prevention of CHD. In the major AFCAPS/TexCAPS primary prevention study of 6605 middle-aged or elderly men and women without symptomatic cardiovascular disease and with only moderately elevated serum lipids, treatment with lovastatin 20-40mg once daily for a mean of 5.2 years significantly (p < 0.001) reduced the incidence of a first acute major cardiac event by 37% compared with placebo. In the smaller ACAPS study of 919 men and women who were asymptomatic for cardiovascular disease, but with evidence of early atherosclerosis, treatment with lovastatin for 3 years significantly (p= 0.001) slowed or reversed atherosclerosis compared with placebo, as measured by changes in the intimal-medial thickness of carotid arteries on B-mode ultrasound. Three randomised, controlled, secondary preven-tion trials have demonstrated that in patients with coronary artery disease, treat-ment with lovastatin 20-80 mg/day alone or in combination with colestipol for 2-2.5 years reduced the severity of stenosis and/or slowed or reversed the progression of atherosclerosis, as assessed by angiography. In the FATS study, the severity of stenosis after 2.5 years in recipients of lovastatin plus colestipol was reduced by 2.8% compared with placebo, while the frequency of lesion progres-sion was halved and the frequency of lesion regression was tripled. Treatment with lovastatin for 2.2 years in the MARS study significantly reduced the mean percent diameter stenosis compared with placebo (p = 0.005) in patients with more severe stenosis, and also significantly (p = 0.002) reduced the mean global change score (indicating less progression). In the CCATT study, lovastatin therapy for 2 years significantly improved coronary change scores (p < 0.01) and signifi-cantly reduced the incidence of new lesions (p = 0.001) compared with placebo. Across the primary and secondary prevention studies, lovastatin was shown to be similarly effective in women, the elderly, smokers and in subjects with hyperten-sion, hypercholesterolaemia or type 2 diabetes mellitus. Therefore, the available data demonstrate that lovastatin provides significant lipid-modifying efficacy, slows progression or causes regression of atherosclerosis, and protects against acute cardiac events, in both those with and those without symptomatic CHD.
机译：HMG-CoA还原酶抑制剂（他汀类药物）是治疗高胆固醇血症以预防或减慢冠心病（CHD）进展的首选药物。他汀类药物通常可将冠心病发病或死亡的风险降低约30％。洛伐他汀可有效降低血浆总胆固醇和低密度脂蛋白胆固醇水平，并且广泛用于CHD的一级和二级预防。在主要的AFCAPS / TexCAPS一级预防研究中，对6605名无症状心血管疾病且血清脂质仅中等升高的中老年男女，洛伐他汀20-40mg每天一次，平均5.2年（p <0.001）。 ）与安慰剂相比，首次急性重大心脏事件的发生率降低了37％。在较小的ACAPS研究中，对919例无心血管疾病但有早期动脉粥样硬化症状的男性和女性进行研究，与安慰剂相比，洛伐他汀治疗3年显着（p = 0.001）减慢或逆转了动脉粥样硬化，这通过安慰剂的变化来衡量。 B型超声检查颈动脉内膜中层厚度。三项随机，对照，二级预防试验表明，在冠心病患者中，单独使用洛伐他汀20-80 mg /天或与Colestipol联合治疗2-2.5年，可降低狭窄和/或严重程度通过血管造影评估，可以减缓或逆转动脉粥样硬化的进展。在FATS研究中，与安慰剂相比，洛伐他汀加初立哌唑的接受者2.5年后狭窄的严重程度降低了2.8％，病变进展的频率减半，病变消退的频率增加了三倍。 MARS研究中洛伐他汀治疗2.2年显着降低了狭窄程度较重的患者的平均直径狭窄百分比（p = 0.005），同时显着（p = 0.002）降低了平均总体变化评分（表明进展较少） ）。在CCATT研究中，与安慰剂相比，洛伐他汀治疗2年显着改善了冠状动脉变化评分（p <0.01），并显着降低了新病变的发生率（p = 0.001）。在一级和二级预防研究中，洛伐他汀在女性，老年人，吸烟者和高血压，高胆固醇血症或2型糖尿病患者中同样有效。因此，现有数据表明，在有症状和无症状冠心病的患者中，洛伐他汀可提供显着的脂质修饰功效，减缓进展或引起动脉粥样硬化的消退，并预防急性心脏事件。

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