在强化降脂治疗下的冠状动脉钙化进展:一项随机对照试验  

Progressive coronary calcification despite intensive lipid-lowering treatment:A randomised controlled trial

作　　者：Houslay E.S. Cowell S.J. Prescott R.J. D.E. Newby 郭俊 

机构地区：[1]SU.314 Chancellor's Building, University of Edinburgh, Edinburgh EH16 4SA, United Kingdom,Prof

出　　处：《世界核心医学期刊文摘（心脏病学分册）》2007年第1期55-56,共2页

摘　　要：目的:在一项纳入钙化性主动脉瓣狭窄患者的试验的亚研究中,评价强化降脂治疗对冠状动脉钙化的影响。方法:在一项双盲、随机对照试验中,通过最小化方法将102例钙化性主动脉瓣狭窄和冠状动脉钙化患者随机分入阿托伐他汀80mg/d组或匹配安慰剂组。采用螺旋CT对冠状动脉钙化进行每年1次的评估。Objectives: To evaluate the effect of intensive lipid-lowering treatment on coronary artery calcification in a substudy of a trial recruiting patients with calcific aortic stenosis. Methods: In a double blind randomised controlled trial, 102 patients with calcific aortic stenosis and coronary artery calcification were randomly assigned by the minimisation technique to atorvastatin 80 mg daily or matched placebo. Coronary artery calcification was assessed annually by helical computed tomography. Results: 48 patients were randomly assigned to atorvastatin and 54 to placebo with a median follow up of 24 months (interquartile range 24-30). Baseline characteristics and coronary artery calcium scores were similar in both groups. Alorvastatin reduced serum low density lipoprotein cholesterol(-53%, p< 0.001) and C reactive protein (-49%, p< 0.001) concentrations whereas there was no change with placebo(-7%and 17%, p >0.95 for both). The rate of change in coronary artery calcification was 26%/year (0.234 (SE 0.037)log arbitrary units (AU)/year; n=39) in the atorvastatin group and 18%/year (0.167(SE 0.034) log AU/year; n=49) in the placebo group, with a geometric mean difference of 7%/year (95%confidence interval -3%to 18%, p=0.18). Serum low density lipoprotein concentrations were not correlated with the rate of progression of coronary calcification (r=0.05, p=0.62). Conclusion: In contrast to previous observational studies, this randomised controlled trial has shown that, despite reducing systemic inflammation and halving serum low density lipoprotein cholesterol concentrations, statin treatment does not have a major effect on the rate of progression of coronary artery calcification.

关 键 词：冠状动脉钙化 降脂治疗 随机对照试验 安慰剂 低密度脂蛋白 他汀类药物 进展率 全身炎症反应 几何平 

分 类 号：R543[医药卫生—心血管疾病]