Eur Heart J：他汀可延缓高危冠脉疾病患者疾病进展

　　美国一项研究表明，在有效他汀类治疗情况下，高危患者更有可能出现疾病进展延缓，尤其是基线冠脉粥样斑块体积较大的患者。论文于5月3日在线发表于《欧洲心脏杂志》（Eur Heart J）。

　　SATURN共纳入1039例每日接受24个月瑞舒伐他汀（40 mg）或阿托伐他汀（80 mg）治疗的冠脉疾病患者，并利用系列血管腔内超声对冠脉粥样斑块负荷[动脉粥样斑块体积百分比（PAV）和总斑块体积（TAV）]进行监测。

　　结果显示，瑞舒伐他汀组患者的低密度脂蛋白胆固醇（LDL-C）降低幅度更大，高密度脂蛋白（HDL-C）则升高幅度更大。上述脂质特征变化与TAV更大消退相关（P= 0.01），但与PAV无关（P = 0.17）。瑞舒伐他汀引发的更大程度TAV消退出现于糖尿病患者中。在女性以及LDL-C或HDL-C≥中位基线水平的患者中，瑞舒伐他汀可引发更为显著的PAV降低。多变量分析显示，基线TAV和PAV较高均与TAV和PAV消退呈独立相关。

与他汀相关的拓展阅读：

• Neurology：卒中前使用他汀类药物减轻缺血性卒中的临床症状
• AACR2013：他汀类药物可显著降低乳腺癌死亡率
• MedPage：加拿大新指南称糖尿病患者40岁时应该使用他汀类药物
• JACC：高剂量他汀治疗存在两难抉择 更多信息请点击：有关他汀更多资讯

Factors underlying regression of coronary atheroma with potent statin therapy
AIMS
Statins can inhibit the progression of coronary atherosclerosis. We aimed to characterize clinical factors that associate with differing measures of coronary atheroma volume following potent statin therapy.
METHODS AND RESULTS
SATURN employed serial intravascular ultrasound (IVUS) to monitor changes in measures of coronary atheroma burden [total atheroma volume (TAV) and per cent atheroma volume (PAV)] in 1039 patients with coronary artery disease, treated with rosuvastatin (40 mg) or atorvastatin (80 mg) daily for 24 months. Rosuvastatin-treated patients demonstrated greater reductions in low-density lipoprotein cholesterol (LDL-C, 47 vs. 40%, P < 0.001) and greater increases in high-density lipoprotein cholesterol (HDL-C, 13 vs. 10%, P = 0.02). These alterations in the lipid profile associated with greater TAV (-6.4 vs. -4.4 mm3, P = 0.01), but not PAV (-1.22 vs. -0.99%, P = 0.17) regression. Greater TAV reductions with rosuvastatin vs. atorvastatin occurred in patients with diabetes (P = 0.01, treatment by diabetic status interaction P-value 0.05). Greater PAV reductions with rosuvastatin were evident in females (P = 0.01, treatment by sex interaction P-value 0.03) and in those with greater than or equal to median baseline LDL-C (P = 0.02, treatment by LDL-C group interaction P-value 0.03) or HDL-C levels (P = 0.02, treatment by HDL-C group interaction P-value 0.04). On multivariable analysis assessing change in TAV and PAV, both higher baseline TAV and PAV independently associated with TAV and PAV regression, respectively (standardized estimates: TAV -0.25, P < 0.001; PAV -0.23, P < 0.001).
CONCLUSION
Higher-risk patients, particularly those with greater baseline coronary atheroma volume, are more likely to experience less disease progression with potent statin therapy.