2006-12-20 00:00 来源:丁香园 作者:蓝色幻想 译
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英国伦敦大学帝国理工学院的Peter Sever 和他的合作者解释说,以前ASCOT降压部分(ASCOT-BPLA)的分析表明,除血压外,高密度脂蛋白(HDL)胆固醇可能减少冠心病(CHD)和中风事件。

共有19,257名高血压患者参加了ASCOT研究,随机分配到氨氯地平组或阿替洛尔组。10,305名空腹总胆固醇≤6.5 mmol (250 mg/dl)及当时未接受他汀或fibrate治疗的患者被随机分到阿托伐他汀10mg/日组或安慰剂组。平均随访3.3年以上,ASCOT-LLA的结果是阿托伐他汀可将主要终点事件(非致死性心肌梗死和致死性冠心病)的相对危险度降低36%(p<0.0001)。该结果发表在《欧洲心脏杂志》。



study suggests synergistic lipid- and BP-lowering effects

19 December 2006

Analysis of the Anglo-Scandinavian Cardiac Outcomes Trial Lipid-Lowering Arm (ASCOT-LLA) suggests that lipid-lowering and blood pressure (BP)-lowering regimens have synergistic effects in preventing cardiovascular events.

Previous analyses of the ASCOT BP Lowering Arm (ASCOT-BPLA) suggested that factors other than BP, particularly high-density lipoprotein (HDL) cholesterol, may have contributed to the reductions in coronary heart disease (CHD) and stroke events observed in the trial, explain Peter Sever (Imperial College London, UK) and co-investigators.

Noting that additional mechanisms could also be involved, the researchers investigated whether potential interactions between the antihypertensive and lipid-lowering regimens could have affected the ASCOT-BPLA findings, in a prespecified analysis of ASCOT-LLA.

Of the total 19,257 hypertensive patients participating in ASCOT who were randomly assigned to receive an amlodipine-based regimen or an atenolol-based regimen, 10,305 patients who had a fasting total cholesterol level ≤6.5 mmol (250 mg/dl) and were currently untreated with a statin or fibrate were also randomly assigned to receive either atorvastin 10 mg daily or placebo in ASCOT-LLA.

Over a median follow-up of 3.3 years, the main result of ASCOT-LLA was that atorvastatin reduced the relative risk of the primary endpoint of nonfatal myocardial infarction and fatal CHD events by 36% (p<0.0001), the authors note in the European Heart Journal.

The current analysis, taking each antihypertensive group separately, revealed that atorvastatin reduced the relative risk of the primary endpoint by 53% (p<0.0001) in the amlodipine group, whereas the risk of this outcome was reduced nonsignificantly, by just 16%, among those on atenolol.

Testing for heterogeneity indicated that the difference between these risk reductions was of borderline significance (p=0.025).

Differences between antihypertensive groups in the risk reductions for total cardiovascular events and procedures and stroke were not significant, however.

The authors say that their findings warrant further study, noting that there are "plausible" molecular explanations for an interaction between calcium channel blockers and statins, which could lead to atherosclerotic plaque stabilization and thereby account for the differential effect specifically on CHD events.

Eur Heart J 2006; 27: 2982-2988


编辑: 张靖