고지혈증이 있는 급성 심근경색환자에서 statin/ezetimibe 병합요법의 효과 = The effect of dual inhibition of cholesterol in hyperlipidemia patients with acute myocardial infarction

국문 초록 (Abstract)

목적: 원발성 고콜레스테롤혈증 환자에서 상용량의 스타틴/에제티미브 병합요법은 고용량의 스타틴 단독요법에 비해 이상반응의 증가 없이 저밀도 지단백 콜레스테롤을 효과적으로 감소시켰다. 그러나 급성 심근경색 환자에 대한 스타틴/에제티미브 병합요법의 효과에 안전성에 대한 연구는 없는 상태이다. 방법: 본 연구는 급성 심근경색으로 본원에 내원한 82명의 환자를 대상으로 임상특성과 지질의 변화양상을 후향적으로 분석하였다. 대상 환자군은 흉통 발생 후 12시간 내에 응급 관상동맥 중재술을 성공적으로 시행 받았고, 이 중 저밀도 지단백 콜레스테롤이 100 mg/dL 이상인 고지혈증 환자이며, 입원 후 72시간 이내에 스타틴 단독요법 혹은 스타틴/에제티마이브 병합요법을 시행 받은 환자로 하였다. 그리고 두 군 간의 입원 당시 및 1개월, 6개월 후의 지질 수치, 안정성 등을 비교하였다. 결과: 초기의 총 콜레스테롤 및 저밀도 지단백 콜레스테롤은 병합요법군이 단독요법군에 비하여 유의하게 높았으나 치료 1개월 후의 총콜레스테롤은 병합요법군이 27.9±13.1%, 단독요법군이 17.0±15.0%였고(p=0.004), 저밀도 지단백 콜레스테롤은 병합요법군이 38.5±12.5%, 단독요법군이 25.1±18.9%로 병합요법군이 우수하였다(p=0.001). 안전성면에서는 CPK가 정상의 정상상한치의 3배 이상으로 상승한 경우가 병합요법군에서 1명, ALT가 정상상한치의 2배 이상으로 상승한 경우는 단독요법군에서 1예가 있었다. 결론: 응급 관동맥 중재술을 통하여 성공적으로 재관류가 이루어진 급성 심근경색환자의 경우 지질저하를 위한 병합요법이 단독 스타틴 요법에 비해 지질 저하 면에서 우수하며 안전한 치료법이라 판단된다.

다국어 초록 (Multilingual Abstract)

Background/Aims: A moderate dose of statin/ezetimbe combination therapy reduced the LDL-C (low density lipoprotein-cholesterol) in a fashion comparable to high dose statin without increasing the adverse events in patients with primary hypercholesterolemia. Yet there is no data on the effectiveness and safety of statin/ezetimbe combination therapy in patients suffering with acute myocardial infarction (AMI). Methods: We retrospectively compared the lipid profiles and clinical variables of 82 patients who were admitted to our institution with AMI. These patients were successfully treated with emergent coronary intervention within 12 hours after the chest pain onset and they were prescribed a single statin (statin group) or statin/ezetimibe combination therapy (dual inhibition group) for treating their hyperlipidemia within 72 hours after the admission. We compared the initial lipid profiles, the % reduction of total cholesterol (TC), the LDL-C at 1 and 6 months and the safety profiles between the two therapeutic groups. Results: Although the initial TC and LDL-C levels were significantly higher in the dual inhibition group than the statin group, one month later, the % reduction of the TC was 27.9±13.1% and 17.0±15.0% (p=0.004) and the % reduction of the LDL-C was 38.5±12.5% and 25.1±18.9% (p=0.001) in each group, respectively. One patient in the dual inhibition group showed CPK elevation more than 3 times the upper normal limit and ALT elevation more than 2 times of upper normal limit was observed in one patient in the statin group. Conclusions: Cholesterol dual inhibition therapy is superior to single statin therapy for the aspect of cholesterol reduction and safety in successfully reperfused AMI patients. (Korean J Med 74:59-67, 2008)

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