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Тактика снижения уровня холестерина липопротеинов низкой плотности в крови у больных с острым коронарным синдромом: как быстро, как низко, чем и зачем?
Тактика снижения уровня холестерина липопротеинов низкой плотности в крови у больных с острым коронарным синдромом: как быстро, как низко, чем и зачем?
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Аннотация
Статья посвящена тактике применения статинов у больных с острым коронарным синдромом. Обсуждаются вопросы выбора оптимального срока начала терапии и целевые уровни холестерина липопротеинов низкой плотности в крови. Приводятся данные, полученные в ходе клинических испытаний статинов у больных с острым коронарным синдромом. Обсуждаются практические аспекты результатов недавно завершившегося исследования LUNAR по сравнительной оценке эффективности приема розувастатина по 20 и 40 мг/сут и аторвастатина по 80 мг/сут у больных с острым коронарным синдромом. Приводятся данные о безопасности использования статинов в такой клинической ситуации, а также рассматриваются доказательные основания для выбора определенного статина и его дозы.
Ключевые слова: статины, острый коронарный синдром, розувастатин, аторвастатин.
Key words: statins; acute coronary syndrome; rosuvastatin, atorvastatin.
Ключевые слова: статины, острый коронарный синдром, розувастатин, аторвастатин.
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Key words: statins; acute coronary syndrome; rosuvastatin, atorvastatin.
Полный текст
Список литературы
1. Hamm CW, Bassand JP, Agewall S et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 2999–3054.
2. Cannon CP, Braunwald E, McCabe CH et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350: 1495–504.
3. Schwartz GG, Olsson AG, Ezekowitz MD et al. Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study Investigators. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA 2001; 285: 1711–8.
4. Hulten E, Jackson JL, Douglas K et al. The effect of early, intensive statin therapy on acute coronary syndrome: a metaanalysis of randomized controlled trials. Arch Intern Med 2006; 166: 1814–21.
5. Jones PH, Davidson MH, Stein EA et al. STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial). Am J Cardiol 2003; 92: 152–60.
6. Faergeman O, Hill L, Windler E et al. On behalf of the ECLIPSE Study Investigators. Efficacy and tolerability of rosuvastatin and atorvastatin when force-titrated in patients with primary hypercholesterolemia: results from the ECLIPSE study. Cardiology 2008; 111: 219–28.
7. Nicholls SJ, Brandrup-Wognsen G, Palmer M, Barter PJ. Meta-analysis of comparative efficacy of increasing dose of atorvastatin versus rosuvastatin versus simvastatin on lowering levels of atherogenic lipids (from VOYAGER). Am J Cardiol 2010; 105: 69–76.
8. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499–502.
9. Liao JK. Effects of statins on 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibition beyond low-density lipoprotein cholesterol. Am J Cardiol 2005; 96 (5A): 24F–33F.
10. Sposito AC, Chapman MJ. Statin therapy in acute coronary syndromes: mechanistic insight into clinical benefit. Arterioscler Thromb Vasc Biol 2002; 22: 1524–34.
11. Pitt B, Loscalzo J, Monyak J et al. Comparison of Lipid-Modifying Efficacy of Rosuvastatin Versus Atorvastatin in Patients With Acute Coronary Syndrome (from the LUNAR Study). Am J Cardiol 2012; 109: 1239–46.
12. Pedersen TR, Faergeman O, Kastelein JJ et al. Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) Study Group. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA 2005; 294: 2437–45.
13. Ridker PM, Morrow DA, Rose LM et al. Relative efficacy of atorvastatin 80 mg and pravastatin 40 mg in achieving the dual goals of low-density lipoprotein cholesterol 70 mg/dl and C-reactive protein 2 mg/l: an analysis of the PROVE-IT TIMI-22 trial. J Am Coll Cardiol 2005; 45: 1644–8.
14. Murphy SA, Cannon CP, Wiviott SD et al. Reduction in recurrent cardiovascular events with intensive lipid-lowering statin therapy compared with moderate lipid-lowering statin therapy after acute coronary syndromes from the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy – Thrombolysis In Myocardial Infarction 22) trial. J Am Coll Cardiol 2009; 54: 2358–62.
15. Tikkanen MJ, Szarek M, Fayyad R et al. IDEAL Investigators. Total cardiovascular disease burden: comparing intensive with moderate statin therapy insights from the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) trial. J Am Coll Cardiol 2009; 54: 2353–7.
16. Morrissey RP, Diamond GA, Kaul S. Statins in acute coronary syndromes. Do the guideline recommendations match the evidence? J Am Coll Cardiol 2009; 54: 425–33.
17. de Lemos JA, Blazing MA, Wiviott SD et al. A to Z Investigators. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial. JAMA 2004; 292: 1307–16.
18. Armitage J, Bowman L, Wallendszus K et al. Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) Collaborative Group. Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12,064 survivors of myocardial infarction: a double-blind randomised trial. Lancet 2010; 376: 1658–69.
19. Cannon CP, Braunwald E, McCabe CH et al. Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350: 1495–504.
2. Cannon CP, Braunwald E, McCabe CH et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350: 1495–504.
3. Schwartz GG, Olsson AG, Ezekowitz MD et al. Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study Investigators. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA 2001; 285: 1711–8.
4. Hulten E, Jackson JL, Douglas K et al. The effect of early, intensive statin therapy on acute coronary syndrome: a metaanalysis of randomized controlled trials. Arch Intern Med 2006; 166: 1814–21.
5. Jones PH, Davidson MH, Stein EA et al. STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial). Am J Cardiol 2003; 92: 152–60.
6. Faergeman O, Hill L, Windler E et al. On behalf of the ECLIPSE Study Investigators. Efficacy and tolerability of rosuvastatin and atorvastatin when force-titrated in patients with primary hypercholesterolemia: results from the ECLIPSE study. Cardiology 2008; 111: 219–28.
7. Nicholls SJ, Brandrup-Wognsen G, Palmer M, Barter PJ. Meta-analysis of comparative efficacy of increasing dose of atorvastatin versus rosuvastatin versus simvastatin on lowering levels of atherogenic lipids (from VOYAGER). Am J Cardiol 2010; 105: 69–76.
8. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499–502.
9. Liao JK. Effects of statins on 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibition beyond low-density lipoprotein cholesterol. Am J Cardiol 2005; 96 (5A): 24F–33F.
10. Sposito AC, Chapman MJ. Statin therapy in acute coronary syndromes: mechanistic insight into clinical benefit. Arterioscler Thromb Vasc Biol 2002; 22: 1524–34.
11. Pitt B, Loscalzo J, Monyak J et al. Comparison of Lipid-Modifying Efficacy of Rosuvastatin Versus Atorvastatin in Patients With Acute Coronary Syndrome (from the LUNAR Study). Am J Cardiol 2012; 109: 1239–46.
12. Pedersen TR, Faergeman O, Kastelein JJ et al. Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) Study Group. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA 2005; 294: 2437–45.
13. Ridker PM, Morrow DA, Rose LM et al. Relative efficacy of atorvastatin 80 mg and pravastatin 40 mg in achieving the dual goals of low-density lipoprotein cholesterol 70 mg/dl and C-reactive protein 2 mg/l: an analysis of the PROVE-IT TIMI-22 trial. J Am Coll Cardiol 2005; 45: 1644–8.
14. Murphy SA, Cannon CP, Wiviott SD et al. Reduction in recurrent cardiovascular events with intensive lipid-lowering statin therapy compared with moderate lipid-lowering statin therapy after acute coronary syndromes from the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy – Thrombolysis In Myocardial Infarction 22) trial. J Am Coll Cardiol 2009; 54: 2358–62.
15. Tikkanen MJ, Szarek M, Fayyad R et al. IDEAL Investigators. Total cardiovascular disease burden: comparing intensive with moderate statin therapy insights from the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) trial. J Am Coll Cardiol 2009; 54: 2353–7.
16. Morrissey RP, Diamond GA, Kaul S. Statins in acute coronary syndromes. Do the guideline recommendations match the evidence? J Am Coll Cardiol 2009; 54: 425–33.
17. de Lemos JA, Blazing MA, Wiviott SD et al. A to Z Investigators. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial. JAMA 2004; 292: 1307–16.
18. Armitage J, Bowman L, Wallendszus K et al. Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) Collaborative Group. Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12,064 survivors of myocardial infarction: a double-blind randomised trial. Lancet 2010; 376: 1658–69.
19. Cannon CP, Braunwald E, McCabe CH et al. Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350: 1495–504.
2. Cannon CP, Braunwald E, McCabe CH et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350: 1495–504.
3. Schwartz GG, Olsson AG, Ezekowitz MD et al. Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study Investigators. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA 2001; 285: 1711–8.
4. Hulten E, Jackson JL, Douglas K et al. The effect of early, intensive statin therapy on acute coronary syndrome: a metaanalysis of randomized controlled trials. Arch Intern Med 2006; 166: 1814–21.
5. Jones PH, Davidson MH, Stein EA et al. STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial). Am J Cardiol 2003; 92: 152–60.
6. Faergeman O, Hill L, Windler E et al. On behalf of the ECLIPSE Study Investigators. Efficacy and tolerability of rosuvastatin and atorvastatin when force-titrated in patients with primary hypercholesterolemia: results from the ECLIPSE study. Cardiology 2008; 111: 219–28.
7. Nicholls SJ, Brandrup-Wognsen G, Palmer M, Barter PJ. Meta-analysis of comparative efficacy of increasing dose of atorvastatin versus rosuvastatin versus simvastatin on lowering levels of atherogenic lipids (from VOYAGER). Am J Cardiol 2010; 105: 69–76.
8. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499–502.
9. Liao JK. Effects of statins on 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibition beyond low-density lipoprotein cholesterol. Am J Cardiol 2005; 96 (5A): 24F–33F.
10. Sposito AC, Chapman MJ. Statin therapy in acute coronary syndromes: mechanistic insight into clinical benefit. Arterioscler Thromb Vasc Biol 2002; 22: 1524–34.
11. Pitt B, Loscalzo J, Monyak J et al. Comparison of Lipid-Modifying Efficacy of Rosuvastatin Versus Atorvastatin in Patients With Acute Coronary Syndrome (from the LUNAR Study). Am J Cardiol 2012; 109: 1239–46.
12. Pedersen TR, Faergeman O, Kastelein JJ et al. Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) Study Group. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA 2005; 294: 2437–45.
13. Ridker PM, Morrow DA, Rose LM et al. Relative efficacy of atorvastatin 80 mg and pravastatin 40 mg in achieving the dual goals of low-density lipoprotein cholesterol 70 mg/dl and C-reactive protein 2 mg/l: an analysis of the PROVE-IT TIMI-22 trial. J Am Coll Cardiol 2005; 45: 1644–8.
14. Murphy SA, Cannon CP, Wiviott SD et al. Reduction in recurrent cardiovascular events with intensive lipid-lowering statin therapy compared with moderate lipid-lowering statin therapy after acute coronary syndromes from the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy – Thrombolysis In Myocardial Infarction 22) trial. J Am Coll Cardiol 2009; 54: 2358–62.
15. Tikkanen MJ, Szarek M, Fayyad R et al. IDEAL Investigators. Total cardiovascular disease burden: comparing intensive with moderate statin therapy insights from the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) trial. J Am Coll Cardiol 2009; 54: 2353–7.
16. Morrissey RP, Diamond GA, Kaul S. Statins in acute coronary syndromes. Do the guideline recommendations match the evidence? J Am Coll Cardiol 2009; 54: 425–33.
17. de Lemos JA, Blazing MA, Wiviott SD et al. A to Z Investigators. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial. JAMA 2004; 292: 1307–16.
18. Armitage J, Bowman L, Wallendszus K et al. Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) Collaborative Group. Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12,064 survivors of myocardial infarction: a double-blind randomised trial. Lancet 2010; 376: 1658–69.
19. Cannon CP, Braunwald E, McCabe CH et al. Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350: 1495–504.
________________________________________________
2. Cannon CP, Braunwald E, McCabe CH et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350: 1495–504.
3. Schwartz GG, Olsson AG, Ezekowitz MD et al. Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study Investigators. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA 2001; 285: 1711–8.
4. Hulten E, Jackson JL, Douglas K et al. The effect of early, intensive statin therapy on acute coronary syndrome: a metaanalysis of randomized controlled trials. Arch Intern Med 2006; 166: 1814–21.
5. Jones PH, Davidson MH, Stein EA et al. STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial). Am J Cardiol 2003; 92: 152–60.
6. Faergeman O, Hill L, Windler E et al. On behalf of the ECLIPSE Study Investigators. Efficacy and tolerability of rosuvastatin and atorvastatin when force-titrated in patients with primary hypercholesterolemia: results from the ECLIPSE study. Cardiology 2008; 111: 219–28.
7. Nicholls SJ, Brandrup-Wognsen G, Palmer M, Barter PJ. Meta-analysis of comparative efficacy of increasing dose of atorvastatin versus rosuvastatin versus simvastatin on lowering levels of atherogenic lipids (from VOYAGER). Am J Cardiol 2010; 105: 69–76.
8. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499–502.
9. Liao JK. Effects of statins on 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibition beyond low-density lipoprotein cholesterol. Am J Cardiol 2005; 96 (5A): 24F–33F.
10. Sposito AC, Chapman MJ. Statin therapy in acute coronary syndromes: mechanistic insight into clinical benefit. Arterioscler Thromb Vasc Biol 2002; 22: 1524–34.
11. Pitt B, Loscalzo J, Monyak J et al. Comparison of Lipid-Modifying Efficacy of Rosuvastatin Versus Atorvastatin in Patients With Acute Coronary Syndrome (from the LUNAR Study). Am J Cardiol 2012; 109: 1239–46.
12. Pedersen TR, Faergeman O, Kastelein JJ et al. Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) Study Group. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA 2005; 294: 2437–45.
13. Ridker PM, Morrow DA, Rose LM et al. Relative efficacy of atorvastatin 80 mg and pravastatin 40 mg in achieving the dual goals of low-density lipoprotein cholesterol 70 mg/dl and C-reactive protein 2 mg/l: an analysis of the PROVE-IT TIMI-22 trial. J Am Coll Cardiol 2005; 45: 1644–8.
14. Murphy SA, Cannon CP, Wiviott SD et al. Reduction in recurrent cardiovascular events with intensive lipid-lowering statin therapy compared with moderate lipid-lowering statin therapy after acute coronary syndromes from the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy – Thrombolysis In Myocardial Infarction 22) trial. J Am Coll Cardiol 2009; 54: 2358–62.
15. Tikkanen MJ, Szarek M, Fayyad R et al. IDEAL Investigators. Total cardiovascular disease burden: comparing intensive with moderate statin therapy insights from the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) trial. J Am Coll Cardiol 2009; 54: 2353–7.
16. Morrissey RP, Diamond GA, Kaul S. Statins in acute coronary syndromes. Do the guideline recommendations match the evidence? J Am Coll Cardiol 2009; 54: 425–33.
17. de Lemos JA, Blazing MA, Wiviott SD et al. A to Z Investigators. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial. JAMA 2004; 292: 1307–16.
18. Armitage J, Bowman L, Wallendszus K et al. Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) Collaborative Group. Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12,064 survivors of myocardial infarction: a double-blind randomised trial. Lancet 2010; 376: 1658–69.
19. Cannon CP, Braunwald E, McCabe CH et al. Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350: 1495–504.
Авторы
С.Р.Гиляревский*1, В.А.Орлов2, И.М.Кузьмина2
1 Научно-исследовательский институт скорой помощи им. Н.В.Склифосовского
2 Кафедра клинической фармакологии и терапии Российской медицинской академии последипломного образования Минздрава РФ
*sgilarevsky@rambler.ru
1 N.V.Sklifosovsky Research Institute of Emergency Care
2 Department of Clinical Pharmacology and Therapy, Russian Medical Academy of Postgraduate Education
*sgilarevsky@rambler.ru
1 Научно-исследовательский институт скорой помощи им. Н.В.Склифосовского
2 Кафедра клинической фармакологии и терапии Российской медицинской академии последипломного образования Минздрава РФ
*sgilarevsky@rambler.ru
________________________________________________
1 N.V.Sklifosovsky Research Institute of Emergency Care
2 Department of Clinical Pharmacology and Therapy, Russian Medical Academy of Postgraduate Education
*sgilarevsky@rambler.ru
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