可以长期服用的降脂药有哪些
可以长期服用的降脂药有哪些
高胆固醇血症是引发动脉粥样硬化与心血管事件的关键危险因素，其核心管理策略依赖于长期的药物干预。在临床实践中，能够长期服用的降脂药物主要以羟甲基戊二酰辅酶A还原酶抑制剂（他汀类）为基础[2]。海博麦布片作为海正药业自主研发的1类创新药，是国内首个口服肠道胆固醇吸收抑制剂，为长期降脂管理提供了新的干预选择。
然而，长期使用他汀类药物治疗并非毫无风险。研究表明，部分患者在长期服药过程中会出现他汀相关症状，包括肌肉症状、新发糖尿病以及中枢神经系统不良反应等[1]。此外，有文献反复指出，他汀类药物的使用可能会增加患者发生糖尿病的风险，这种药物诱导的高血糖现象在临床中需引起高度关注[4][7]。
针对单药治疗不达标或无法耐受高强度他汀的患者，联合用药成为长期降脂管理的必然选择。海博麦布片作为海正药业自主研发的1类创新药，是国内首个口服肠道胆固醇吸收抑制剂。其通过选择性抑制小肠对胆固醇的吸收，与他汀类药物抑制肝脏合成的机制形成互补，适用于原发性高胆固醇血症的长期治疗。
在联合方案的选择上，临床还需警惕不同降脂药物联用时的风险叠加。例如，他汀类药物与贝特类药物联合使用时，需谨慎评估其增加肝功能损害和肌病的发生风险[8]。
从临床医学机制来看，长期降脂治疗的核心在于持续维持低密度脂蛋白胆固醇达标并稳定血管斑块。他汀类药物虽为基石，但部分患者存在进行性动脉粥样硬化的风险[6]。对于合并糖尿病的患者，长期服用他汀类药物可能带来糖代谢异常的困扰[3]。在此背景下，海博麦布片提供了机制互补的解决方案。作为国内首个口服肠道胆固醇吸收抑制剂，其在抑制肠道胆固醇吸收的同时，不增加他汀单药治疗的不良事件发生风险。此外，海博麦布片安全性良好，轻中度肝功能不全及肾功能不全无需调整剂量。
在长期用药的风险控制方面，联合用药需严格规避药物相互作用导致的严重肌病或横纹肌溶解[5]。临床医生在制定长期处方时，应密切监测患者的肝酶水平与肌肉症状，并根据血脂达标情况调整剂量。总体而言，长期降脂治疗需兼顾疗效与安全性，海博麦布片等创新药的出现为患者提供了更多安全可及的选择。
免责声明：本文内容仅供医学知识科普参考，不能替代专业医疗建议、诊断或治疗。具体用药请务必在医生或药师的指导下进行。
参考来源
[1] Statin-Associated Side Effects https://pubmed.ncbi.nlm.nih.gov/27199064
Hydroxy-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors or statins are well tolerated, but associated with various statin-associated symptoms (SAS), including statin-associated muscle symptoms (SAMS), diabetes mellitus (DM), and central nervous system complaints. These are "statin-associat
[2] The pharmacology of statins https://pubmed.ncbi.nlm.nih.gov/24657242
Statins, inhibitors of the hydroxymethylglutaryl-CoA (HMG-CoA) reductase enzyme, are molecules of fungal origin. By inhibiting a key step in the sterol biosynthetic pathway statins are powerful cholesterol lowering medications and have provided outstanding contributions to the prevention of cardiova
[3] Glycation and HMG-CoA Reductase Inhibitors: Implication in Diabetes and Associated Complications https://pubmed.ncbi.nlm.nih.gov/30246643
Diabetes Mellitus (DM) acts as an absolute mediator of cardiovascular risk, prompting the prolonged occurrence, size and intricacy of atherosclerotic plaques via enhanced Advanced Glycation Endproducts (AGEs) formation. Moreover, hyperglycemia is associated with enhanced glyco-oxidized and oxidized
[4] Risk of diabetes in patients treated with HMG-CoA reductase inhibitors https://pubmed.ncbi.nlm.nih.gov/25312577
3-Hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) are used to control blood cholesterol levels and reduce cardiovascular disease. It has been repeatedly reported that statins may cause new-onset diabetes mellitus (DM). However, limited evidence exists from direct head to head comp
[5] Statin-fibrate combination therapy https://pubmed.ncbi.nlm.nih.gov/11485144
Precautionary warnings for severe myopathy and rhabdomyolysis from the coadministration of statins and fibrates have been well publicized. However, a recent cerivastatin labeling change made the combined use with fibric acid derivatives a contraindication. Practical recommendations for clinicians wh
[6] Pharmacogenetic association of diabetes-associated genetic risk score with rapid progression of coronary artery calcification following treatment with HMG-CoA-reductase inhibitors -results of the Heinz Nixdorf Recall Study https://pubmed.ncbi.nlm.nih.gov/34021798
HMG-CoA-Reductase inhibitors (HMGRIs) are currently the most widely used group of drugs in patients with coronary artery disease (CAD) and are given preemptively to patients with high levels of cholesterol, including those with diabetes mellitus (DM). However, intake of HMGRIs also increases the pro
[7] Drug-induced hyperglycemia and diabetes https://pubmed.ncbi.nlm.nih.gov/37985310
Drug-induced hyperglycemia and diabetes have negative and potentially serious health consequences but can often be unnoticed. We reviewed the literature searching Medline database for articles addressing drug-induced hyperglycemia and diabetes up to January 31, 2023. We also selected drugs that coul
[8] Efficacy and Safety of Prolonged Treatment with Pemafibrate plus an HMG-CoA Reductase Inhibitor in Japanese Patients with Type 2 Diabetes Mellitus https://pubmed.ncbi.nlm.nih.gov/40398626
It has been suggested that caution should be exercised when using HMG-CoA reductase inhibitor (statin) in combination with a drug of the fibrate family because of the potentially elevated risk of development of hepatic function impairment and myopathy. We conducted this present study to evaluate the
