頁籤選單縮合
題名 | 在高心血管風險人群statin之外的降血脂新希望--深入檢視IMPROVE-IT試驗=New Hope for Lipid-Lowering Beyond Statins in High Cardiovascular Risk Population--An In-depth Look through the IMPROVE-IT Trial |
---|---|
作者 | 陳朝欽; 雷孟桓; 陳文鍾; | 書刊名 | 內科學誌 |
卷期 | 27:1 2016.02[民105.02] |
頁次 | 頁1-12 |
分類號 | 418.227 |
關鍵詞 | IMPROVE-IT研究; 低密度脂蛋白膽固醇; 急性冠心症; IMPROVE-IT trial; Low density lipoprotein-cholesterol; Acute coronary syndrome; Statin; Ezetimibe; |
語文 | 中文(Chinese) |
中文摘要 | 最近完成的IMPROVE-IT研究指出近期發生急性冠心症的高風險人群中,將ezetimibe加入simvastatin與單用simvastatin比較,還能進一步減少心血管事件。這是第一次有臨床研究表明在statin的基礎下加入另一非statin藥物能有顯著臨床效益。特別是IMPROVE-IT研究顯示低密度脂蛋白膽固醇(LDL-C)降幅與心血管事件減少之間的量效呈正比關係,符合膽固醇治療試驗統合分析的結果所預期。然而卻不能解讀在本研究中的ezetimibe有獨到之處,實際上,其真正含義是提示我們如能有效降低LDL-C,無論何種機制都有相同效益。這些資料也充分地強化了膽固醇學說,並證明LDL-C是預估心血管預後最重要的替代性指標。此外該研究表明將現行準則所建議的LDL-C目標值額外再降低,還能進一步減少心血管事件而且具安全性。總合這些結果在臨床實務中對降低LDL-C與心血管風險間關係的進一步了解至關重要。IMPROVE-IT研究代表著降血脂策略下一步驟的里程碑,而非最後的進展,需要後續的不斷努力,才能使降血脂治療達到減少心血管風險的最理想效果。 |
英文摘要 | In the recently completed IMPROVE-IT trial, adding ezetimibe to simvastatin in a high-risk population with a recent acute coronary syndrome significantly reduced the risk of cardiovascular (CV) events relative to simvastatin alone. It is the first clinical trial to show a benefit of adding a non-statin lipid-modifying agent to statin therapy. Specifically, IMPROVE-IT trial demonstrates that ezetimibe added to a statin provides an incremental reduction in CV risk proportional to its ability to lower low density lipoprotein- cholesterol (LDL-C), as that predicted by the Cholesterol Treatment Trialists metaanalysis of statin trials. However, IMPROVE-IT trial should not be interpreted as showing anything uniquely beneficial about the use of ezetimibe. Indeed, the real implication of this trial is to suggest that all reductions in LDL-C levels, regardless of mechanism, are of equivalent benefit. These data also substantially reinforces the cholesterol theory, and proves that LDL-C is the most important surrogate marker for predicting CV outcomes. In addition, they demonstrate that even greater CV risk reductions can be safely achieved with additional reductions in LDL-C below the currently recommended goal. Taken together, the results are relevant to a better understanding of the relationship between LDL-C and CV risk and to clinical practice. IMPROVE-IT trial represents a milestone to establish the next step of lipid lowering strategy, but likely not the last advance in the on-going effort to achieve optimal CV risk reductions through lipid lowering therapy. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。