[在日常临床实践中增加他汀类药物剂量的理由]。

IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Kardiologiya Pub Date : 2024-08-31 DOI:10.18087/cardio.2024.8.n2709
A V Susekov
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引用次数: 0

摘要

HMG-CoA 还原酶抑制剂(他汀类药物)于 20 世纪 70 年代初在日本发现,最初用于治疗遗传性高脂血症患者。20 世纪 90 年代末和 21 世纪初,使用他汀类药物进行一级和二级预防的临床试验显示,该药物可降低心血管疾病(CV)死亡率,在某些情况下还可降低全因死亡率。与初始剂量相比,他汀类药物的强化治疗(阿托伐他汀 80 毫克/天和罗苏伐他汀 40 毫克/天)可将心血管并发症的发生率额外降低 16%。利用冠状动脉内超声波和其他现代方法对最初的罗伐他汀进行的回归研究表明,颈动脉和冠状动脉的动脉粥样硬化有可能稳定和回归。大剂量他汀类药物治疗的耐受性普遍良好;临床上显著的肝脏不良反应发生率不超过每 10 万人中 2-3 例,肌酸激酶升高超过正常值上限 10 的肌病发生率不高于每年每 1 万人中 1 例。长期他汀类药物治疗不会增加痴呆症的风险,在一些研究中还降低了阿尔茨海默病的风险。在常规治疗中,低密度脂蛋白胆固醇(LDL-C)达到目标水平的比例不超过 5-11%;其中一个主要原因是很少(2-3%)使用大剂量他汀类药物。在常规临床实践中增加他汀类药物的剂量将优化对高心血管风险患者的治疗,并有助于进一步降低我国的死亡率。
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[Rationale for Increasing Doses of Statins in Everyday Clinical Practice].

HMG-CoA reductase inhibitors (statins) were discovered in the early 1970s in Japan and were originally used to treat patients with hereditary hyperlipidemia. In the late 1990s and early 2000s, clinical trials using statins for primary and secondary prevention showed the possibility of reducing cardiovascular (CV) and, in some cases, all-cause mortality. Intensive statin therapy (atorvastatin 80 mg/day and rosuvastatin 40 mg/day) compared to initial doses provides an additional 16% reduction in CV complications. Regression studies with the original rosuvastatin using intracoronary ultrasound and other modern methods have shown the possibility of stabilization and regression of atherosclerosis in the carotid and coronary arteries. High-dose statin therapy is generally well tolerated; the incidence of clinically significant adverse liver reactions does not exceed 2-3 per 100,000 people, and the incidence of myopathies with increased creatine kinase over 10 upper limits of normal is not higher than 1 per 10,000 people per year. Long-term statin treatment does not increase the risk of dementia and, in some studies, reduced the risk of Alzheimer's disease. Achieving target levels of low-density lipoprotein cholesterol (LDL-C) in routine practice does not exceed 5-11%; one of the main reasons for that is the rare (2-3%) prescription of high doses of statins. Increasing statin doses in routine clinical practice will optimize the treatment of patients with high CV risk and will contribute to further reduction of mortality in our country.

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来源期刊
Kardiologiya
Kardiologiya 医学-心血管系统
CiteScore
1.70
自引率
20.00%
发文量
94
审稿时长
3-8 weeks
期刊介绍: “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.
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