膽固醇治療悖論的新例子——既降低LDL又升高HDL，但不減少心血管事件。

Cleveland Clinic researchers studying evacetrapib have shown that despite reducing levels of low-density lipoprotein (LDL, or "bad" cholesterol) by 37 percent and raising levels of high-density lipoprotein (HDL, or "good" cholesterol) by 130 percent, the drug failed to reduce rates of major cardiovascular events, including heart attack, stroke, angina or cardiovascular death.

"Here we have a paradox. The drug more than doubled HDL and lowered LDL levels by as much as many statins, but had no effect on cardiac events," said Steve Nissen, M.D., chairman of Cardiovascular Medicine at Cleveland Clinic. "These findings illustrate the importance of performing large, high-quality outcome trials. Just looking at the effects a therapy has on cholesterol levels doesn't always translate into clinical benefits."

http://medicalxpress.com/news/2016-04-evacetrapib-impacts-cholesterol-doesnt-cardiovascular.html

 

Participants taking the drug saw their LDL levels fall to an average of 55 milligrams per deciliter from 84. Their HDL levels rose to an average of 104 milligram per deciliter from 46. Yet 256 participants had heart attacks, compared with 255 patients in the group who were taking a placebo. Ninety-two patients taking the drug had a stroke, compared with 95 in the placebo group. And 434 people taking the drug died from cardiovascular disease, such as a heart attack or a stroke, compared with 444 participants who were taking a placebo.

“We had an agent that seemed to do all the right things,” said Dr. Stephen J. Nicholls, the study’s principal investigator and the deputy director of the South Australian Health and Medical Research Institute in Adelaide. “It’s the most mind-boggling question. How can a drug that lowers something that is associated with benefit not show any benefit?” he said, referring to the 37 percent drop in LDL levels with the drug.

http://www.nytimes.com/2016/04/04/health/dashing-hopes-study-shows-cholesterol-drug-has-no-benefits.html

所有跟帖： 

• 我也是覺得現在主流方向有問題，膽固醇是個指標，隻治指標不治根源就像靠作弊提高考試分數 -羽衣甘藍- ♂ (155 bytes) () 04/03/2016 postreply 22:20:25

• 藥物很可能改變了膽固醇脂蛋白中脂蛋白的組成，而HDL脂蛋白的功能沒提高，起不到該起的作用。 -吃與活- ♂ (0 bytes) () 04/04/2016 postreply 05:08:56

• 看過一本書認為起因是血管有破裂，所以身體合成膽固醇來修補血管 -羽衣甘藍- ♂ (682 bytes) () 04/04/2016 postreply 05:37:59

• 這個說法有一定道理。 -吃與活- ♂ (0 bytes) () 04/04/2016 postreply 06:37:37

• 膽固醇的功能(LDL,不論顆粒大小）遠遠不止是來修補血管壁。更重要的，血管壁是一個膽固醇的再加工場所。 -益生菌- ♂ (368 bytes) () 04/04/2016 postreply 06:58:41

• 換句話說，動脈粥樣硬化及斑塊的形成原因是“膽固醇缺乏”所導致的，不是現在人與亦雲的膽固醇過多。 -益生菌- ♂ (0 bytes) () 04/04/2016 postreply 07:01:50

• 能不能給一個支持這種說法的文獻供學習？ -吃與活- ♂ (0 bytes) () 04/04/2016 postreply 07:06:02

• 剛查了一下，已經有專門的文章：A novel hypothesis for atherosclerosis as a chole -益生菌- ♂ (132 bytes) () 04/04/2016 postreply 07:16:08

• 誰能夠設計一個實驗來證明這個hypothesis，必定是諾貝爾大獎。 -益生菌- ♂ (0 bytes) () 04/04/2016 postreply 07:18:37

• 請問, Seneff的這個假設,如果相信它,它對於一般人的意義,是不是就是該多攝取膳食膽固醇（動物食品),多吃含硫的食物, -虎嗅薔薇- ♀ (71 bytes) () 04/04/2016 postreply 08:03:31

• 另外我一直想理解你說的“HDL－c為不新鮮的膽固醇”這個說法的來源，能否展開說說你的思路? -虎嗅薔薇- ♀ (0 bytes) () 04/04/2016 postreply 08:14:34

• HDL－c被回收至肝髒供重複利用，減輕肝髒合成新膽固醇的負擔（因為要二十幾步反應）。 -益生菌- ♂ (0 bytes) () 04/04/2016 postreply 08:28:47

• 假如膽固醇有害的話，應該是被輸送到腎髒，以快速排出體外。 -益生菌- ♂ (0 bytes) () 04/04/2016 postreply 08:31:20

• 像膽紅素，尿酸等等廢物，甚至人體內過多的一些激素 -益生菌- ♂ (0 bytes) () 04/04/2016 postreply 08:32:28

• 多謝答複，我得去琢磨琢磨，消化一下。若是有不同意的地方，回來討論，先這裏謝過了。：)) -虎嗅薔薇- ♀ (0 bytes) () 04/04/2016 postreply 08:40:23

• 今天上班忙著麵試人一直沒空，下班回來後靜下心來想了一下, 想到哪說哪, -虎嗅薔薇- ♀ (1529 bytes) () 04/04/2016 postreply 21:36:04

• 有邏輯會思考的人，一下子就抓住了要點。 -益生菌- ♂ (0 bytes) () 04/04/2016 postreply 08:23:18

• 謝謝 -吃與活- ♂ (0 bytes) () 04/04/2016 postreply 07:24:26

• 四十不惑後明白一個道理是世界上不存在捷徑 -羽衣甘藍- ♂ (104 bytes) () 04/04/2016 postreply 00:05:31

• 年輕時走啥捷徑了？ -lawattaction- ♀ (0 bytes) () 04/04/2016 postreply 07:42:43

• 年輕時對營養，醫療一竅不通，覺得求助於專業醫療人員最正確 -羽衣甘藍- ♂ (158 bytes) () 04/05/2016 postreply 00:58:46

• 我家領導的膽固醇在正常範圍，什麽都正常，就是心髒不那麽正常。正在檢查。朋友的膽固醇也正常，可是搭橋了。不理解啊！ -我愛梔子花- ♀ (0 bytes) () 04/04/2016 postreply 07:12:38

• 要轉換腦筋，表麵上的膽固醇“正常”或“異常”，都不能夠說明本質——因為，膽固醇是人體的健康衛士。 -益生菌- ♂ (0 bytes) () 04/04/2016 postreply 07:33:22

• 看來血液檢查一切都在正常範圍，並不代表健康。我家那位從來檢查結果都很好，比我好很多，但是從來都是無精打采，最近心髒還七上八下的。 -我愛梔子花- ♀ (163 bytes) () 04/04/2016 postreply 07:38:19

• 同情一下。我知道的情況是，除了膽固醇，還有inflammation 也會造成有plaque，還有其他很多原因。 -蓍草為yarrow- ♀ (0 bytes) () 04/04/2016 postreply 07:45:33

• 是啊，就這麽混著吧 -我愛梔子花- ♀ (0 bytes) () 04/04/2016 postreply 07:54:40

• 隻能說明膽固醇預測健康狀況根本就是錯的 -pamperedpaws- ♀ (0 bytes) () 04/04/2016 postreply 14:25:36

• 這個吧，說明對一部分人群來說，常規血檢裏的各種膽固醇（cholesterol－c）指標，不具備預測心血管疾病的能力。 -虎嗅薔薇- ♀ (1002 bytes) () 04/04/2016 postreply 07:55:53

• 我先生沒搭橋，是一個比他年輕好幾歲的搭橋了。他最近會有一些檢查，還沒做。謝謝！ -我愛梔子花- ♀ (0 bytes) () 04/04/2016 postreply 08:10:12

• 寫得很好，讚一個！我有 -蓍草為yarrow- ♀ (390 bytes) () 04/04/2016 postreply 08:37:03

• 膽固醇的預測意義不大。相對而言，總膽固醇/HDL-c比LDL顆粒大小更有意義，因這個比值 -益生菌- ♂ (92 bytes) () 04/04/2016 postreply 08:39:05

• 關鍵是看他們選擇的受試者。如果這些受試者已經有動脈硬化了，盡管降低了LDL或提升了HDL，估計結果不會更好。 -gamlastan- ♀ (210 bytes) () 04/04/2016 postreply 10:01:24

• 有道理。在美國，小孩子到了10歲就開始出現動脈硬化了，到了20歲，就已經很普遍了。 -蓍草為yarrow- ♀ (0 bytes) () 04/04/2016 postreply 10:53:16

• 我說的是atherosclerosis. -蓍草為yarrow- ♀ (0 bytes) () 04/04/2016 postreply 10:54:21