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根据5月BritishMedicalJournal杂志上的一项报告,联合使用他汀类、阿司匹林和β阻断剂可改善缺血性心脏病患者的生存。然而,在此基础上增加ACE抑制剂却不提供进一步的益处。共同作者、英国诺丁汉大学的Dr.JuliaHippisley—Cox和Dr.CarolCoupland指出,“我们的研究是首个大规模、长期基于社区的研究,旨在报告不同药物组合对缺血性心脏病患者全因死亡率的二级预防的作用。”研究从英国综合医疗登记处遴选了11330例被首次诊断为缺血性心脏病的患者,分析比较了2266例已经死亡的患者和9064例未死亡的匹配对照的联合用药情况。联合使用他汀类、阿司匹林和β阻断剂使全因死亡率降低最明显,为83%。再加入一种ACE抑制剂对该降低没有显著影响。然而,如果用ACE抑制剂替代β阻断剂,死亡率的降低下降至71%。β阻断剂和ACE抑制剂单药治疗仅使死亡率降低20%左右。同样,联合使用他汀类和ACE抑制剂,只使死亡率降低31%。在相关评论中,苏格兰敦提大学的Dr.TomFahey及其同事提醒,虽然联合用药可能对冠心病二级预防效果极佳,但这个方案对初级预防不一定理想,还需要进一步研究联合用药对初级预防的影响。
According to a report in the May British Journal of Medicine, the combination of statins, aspirin, and beta blockers improves survival in patients with ischemic heart disease. However, adding ACE inhibitors to this does not provide any further benefit. Co-author, Dr. Julia Hippisley-Cox and Dr.CarolCoupland of the University of Nottingham, UK, said: “Our study was the first large-scale, long-term community-based study to report the effects of different combinations of drugs on all-cause death in patients with ischemic heart disease Rate of secondary prevention. ”The study selected 11330 patients diagnosed with ischemic heart disease from the British General Registry of Medicines and compared 2266 patients who had died with 9064 matched controls who did not die Combination of medication. Combined use of statins, aspirin, and beta blockers most significantly reduced all-cause mortality to 83%. The addition of an ACE inhibitor has no significant effect on this reduction. However, if beta blockers were replaced with ACE inhibitors, the reduction in mortality dropped to 71%. Monotherapy with beta blockers and ACE inhibitors reduced mortality by only about 20%. Similarly, the combination of statins and ACE inhibitors reduced mortality by 31%. In related comments, Dr. Tom Fahey and his colleagues at Dundee University in Scotland cautioned that though combination therapy may have an excellent secondary prevention effect on coronary heart disease, this regimen may not be ideal for primary prevention and further research is needed on the effects of combination therapy on primary The impact of prevention.