스타틴 치료 후에도 남아있는 심혈관계 질환의 위험성: HDL-C의 중요성
Residual Cardiovascular Risk Remains Despite of Statin Treatment: Importance of High-Density Lipoprotein Cholesterol
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대단위 임상연구 결과 HDL 콜레스테롤이 1 mg/dL 증가할 때마다 관상동맥 질환을 3% 감소시킬 수 있음이 증명되었다[19]. 따라서 HDL 콜레스테롤을 올리는 치료는 HDL 콜레스테롤이 낮은 환자뿐만 아니라 심혈관계 질환 위험성이 있는 환자에서도 유망한, 획기적인 치료 방법이 되겠다. HDL 콜레스테롤의 목표 수치는 남자 40 mg/dL, 여자 50 mg/dL 이상이다. HDL 콜레스테롤을 상승시키기 위해 1차적으로 체중감소, 운동, 금연, 적절한 양의 알코올 등을 적극 권해야 한다. 이러한 생활 습관 개선으로 HDL 콜레스테롤을 10% 이상 상승시킬 수 있다. 중성지방이 같이 높은 경우에는 중성지방 치료지침과 같이 비HDL 콜레스테롤 농도를 목표치 이하로 하강시키는 데 역점을 둬야 한다. 그리고 중성지방이 200 mg/dL 미만이면서 HDL 콜레스테롤 농도가 낮은 환자들 중에서 관상동맥 질환을 가지고 있거나 관상동맥 질환에 상당하는 위험을 가진 경우에는 적극적으로 화이브리트산이나 니코틴산과 같이 HDL 콜레스테롤을 상승시키는 약제의 사용을 고려해야 한다.
Abstract
Lowering low-density lipoprotein-cholesterol (LDL-C) is the primary target to prevent cardiovascular events in patients with dyslipidemia at high risk for cardiovascular disease. Many patients on statin therapy have initial or recurrent coronary heart disease events despite reductions in LDL-C. Indeed, 2/3 of patients on statin therapy suffer from residual risk. Low high-density lipoprotein-cholesterol (HDL-C) and high triglycerides levels are modifiable and important factors to resolve a residual risk. Especially, low serum levels of HDL-C (< 40 mg/dL for men, < 50 mg/dL for women) are highly prevalent and are recognized as an independent risk factor for cardiovascular morbidity (myocardial infarction, stroke, peripheral arterial disease, and restenosis after coronary stenting) and mortality. Thus, therapy focusing on raising HDL-C may be an important paradigm for treating and slowing progression of atherosclerosis, coronary heart disease, and co-morbid metabolic disorders. In this review, we discuss the importance of HDL-C based on experimental and large scaled clinical trials. (Korean J Med 2011;80:397-401)
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