升高HDL-C治疗的现状与展望严晓伟PPT.ppt

该双盲、安慰剂对照临床试验结果显示，微粒化非诺贝特200mg/日可显著改善致动脉粥样硬化性血脂异常，无论是常规性血脂参数或非常规性血脂参数，例如小而密LDL。在非糖尿病患者，非诺贝特可减少小而密LDL组分，使其向大而轻颗粒转换，而安慰剂不能改变小而密LDL为主的LDL组成。 DAIS研究结果表明，通过对主要冠脉造影结果（最小腔径，狭窄百分比及平均节段直径）的分析证实，为期3年的非诺贝特治疗延缓了冠状动脉粥样硬化的进程。 研究结果显示HDL-C是CHD事件的独立预测因子，治疗后HDL-C越高，CHD 事件率越低。 Slide 22. ARBITER 2: ? CIMT at 12 months versus baseline Significant CIMT progression occurred in the placebo group (.044 mm/year; P .001). In comparison, CIMT progression was 68% lower, and was statistically unchanged from baseline (.014 mm/year), in the niacin group. No significant side effects occurred, and the compliance rates (measured using pill counts) were 90%. Reference: Taylor AJ, Sullenberger LE, Lee HJ, Lee JK, Grace KA. Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: a double-blind, placebo-controlled study of extended-release niacin on atherosclerosis progression in secondary prevention patients treated with statins. Circulation 2004;110:3512-3517. Slide 23. ARBITER 2: secondary efficacy endpoint—clinical events In addition to the beneficial effects on CIMT progression, a nonsignificant reduction in recurrent CHD events was noted. The study was not powered to detect a difference in clinical events, so further study on this question is needed; however, this is an expected clinical correlate of reduced CIMT progression. Additional abbreviation on slide: CABG = coronary artery bypass grafting. Reference: Taylor AJ, Sullenberger LE, Lee HJ, Lee JK, Grace KA. Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: a double-blind, placebo-controlled study of extended-release niacin on atherosclerosis progression in secondary prevention patients treated with statins. Circulation 2004;110:3512-3517. 升高HDL-C一直是人们探索除降LDL-C外的抗动脉粥样硬化新途径的兴奋点。 辉瑞公司斥资8亿美元研发的升高HDL-C的药物——Torcetrapib，是一种胆固醇酯转运蛋白(CETP)抑制剂，它能在载脂蛋白-B中抑制HDL-C同甘油三酯的交换，从而使血循环中HDL-C升高。其系列研究包括3项替代终点研究和1项临床终点研究。人们对Torcetrapib药物的研究寄予厚望。 ILLUMINATE是Tor