스타틴 투여 중단 후 기간에 따른 혈청 콜레스테롤의 변화에 대한 연구 = Changes of the Lipoprotein Profiles with Time after Discontinuation of Statin Therapy

다국어 초록 (Multilingual Abstract)

Background and Objectives: Some patients stop statin therapy in spite of their doctors' advice. This study was designed to assess the pattern of lipoprotein profile changes and clinical characteristics of the patients who discontinued statin therapy. Subjects and Methods: 69 patients (male 42.0%) were enrolled. The clinical characteristics and laboratory data on the lipoprotein levels were obtained from the medical records. Results: The coexistence of diabetes mellitus (DM) was seen in 28% of the patients, hypertension was noted in 72% and coronary artery disease (CAD) was noted in 42%. The average lipoprotein levels during statin therapy were total cholesterol (TC)=163.8 mg/dL, triglycerides (TG)=174.3 mg/dL, high-density lipoprotein cholesterol (HDL-C)=34.8 mg/dL and low-density lipoprotein cholesterol (LDL-C)=94.2 mg/dL. LDL-C level increased by 44.9% at 2-3 months after ceasing statin therapy and by 54.6% at 4-6 months after ceasing statin therapy (p<0.01). The changes of the lipoprotein levels from baseline to 2-3 months and 4-6 months after discontinuation were +22.6% and +30.0% for the TC level, +20.8% and +24.0% for the TG level, and 0.06% and -0.65% for the HDL-C level respectively (p<0.01 for TC and TG, p=not significant (NS) for HDL-C). The achievement rate of target LDL-C level as suggested by the Adult Treatment Panel III (ATP III) of National Cholesterol Education Program (NCEP) was decreased 62.7% at 2-3 months and then it was decreased to 61.8% at 4-6 months after statin discontinuation. DM and CAD were more frequent in the patients who did not achieve the target LDL-C level even with life style modification. Conclusion: After statin discontinuation, TC and LDL-C were increased within 3 months. DM and CAD were highly prevalent in patients who didn't achieve their treatment goal. (Korean Circ J 2008;38:36-42)

국문 초록 (Abstract)

배경 및 목적스타틴은 심혈관계 질환의 일차적, 이차적 예방 효과가 증명된 약물이며, 고지혈증의 약물 치료로 많이 처방되고 있다. 본 연구에서는 치료 현실에서 여러 가지 이유로 스타틴 치료가 중단되었을 때 환자의 혈중 지질 수치가 시간이 지남에 따라 변화하는 양상에 대해 조사하였다.방 법서울시립 보라매병원 순환기내과에서 추적 관찰 중인 환자들 중에서 스타틴 처방이 중단되었던 총 69명 (남자 42%)의 환자들의 혈중 지질 수치를 분석하였다. 의무기록을 검토하여 환자의 당뇨병, 고혈압, 심혈관질환 여부 및 체질량 지수 등을 조사하였다.
결 과
환자들의 임상 병력을 보면, 28%에서 당뇨병을 동반하고 있었고, 72%가 고혈압을, 42%가 관상동맥질환을 동반하고 있었다. 스타틴 치료가 되고 있던 시점에서의 혈중 총 콜레스테롤 치는 163.8 mg/dL, LDL-C은 94.2±33.5 mg/dL 이었으며, 중성지방은 174.3 mg/dL, 고밀도지단백 콜레스테롤 치는 34.8 mg/dL였다. 혈중 LDL-C 수치의 평균 증가율은 중단 시점에서 2 내지 3개월 사이에는 44.9±47.8%, 중단 시점에서 4 내지 6개월 사이에 54.6±63.0%로서, 스타틴 치료 중단 후 유의하게 증가하였다 (p<0.01). TC, TG, HDL-C의 평균 변화율은 스타틴 중단 후 2개월에서 3개월 후에 각각 22.6±23.1%, 20.8±70.7%, 0.06±16.5%였으며, 중단 후 4개월에서 6개월 후에는 각각 30.0±35.0%, 24.0±69.1%, -0.65±17.7%로 증가하여, 스타틴 치료 중단 후 총 콜레스테롤이 유의하게 증가하였다 (p<0.01). 낮은 혈중 고밀도지단백 콜레스테롤 (<40 mg/dL)을 보이는 경우는, 스타틴 치료 중단 2~3개월 후에는 전체의 67.4%였고, 치료 중단 4~6개월 후에는 75.5%로 증가하였다 (p=NS). 스타틴 치료 중의 LDL-C의 NCEP-APT III 치료 지침에 의거한 LDL-C의 치료 목표 달성률은 84.3%였다. 스타틴 중단 후 지속적으로 감소하였으며, 운동과 식이요법을 권고받은 상태에서 목표 달성이 이루어지지 않았던 환자들 중에 당뇨병과 심혈관질환의 비율이 높았다.
결 론
스타틴 치료가 중단되면 3개월 이내에 지질 수치의 악화가 발생하게 되고, 이는 주로 저밀도지단백 콜레스테롤, 총 콜레스테롤의 상승으로 나타난다. 또한 각 위험군별 저밀도지단백 콜레스테롤 치료 목표 달성률이 감소하였는데, 운동과 식이요법만으로 치료목표를 달성하지 못하는 환자 중에 당뇨병과 심혈관질환의 비율이 높았다. 향후 고지혈증의 치료에 있어서 스타틴 복약 유지에 의사들의 적극적인 개입이 필요하겠다.

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