随着中国大陆经济的高速发展和人们生活水平的显著改善，人群中患“高胆固醇血症”者不在少数，以至于高胆固醇血症随同“高血压、高血糖”被人们俗称为“三高”。已知长期的高胆固醇血症可以加速动脉粥样硬化的发生与发展及恶化冠心病。因此，如何降低业已升高的血清胆固醇就成了医生和患者共同关注的热点。那么，如何能够更好地降低业已升高的血清胆固醇呢？我个人认为对多数人而言，最为可靠和安全的方法是“合理膳食＋适量运动”（请参阅：http://blog.sina.com.cn/s/blog_690c29ec0100jycy.html和http://blog.sina.com.cn/s/blog_690c29ec0100jxin.html），而非服用降胆固醇药物（如含有statin的制剂）和接受胃肠旁路手术等。这是因为：

１、长期服用含有statin的药物（如Simvastatin）虽可有效降低血清胆固醇，但可破坏肌肉，损害肝、肾功能，增加2型糖尿病的发病率，甚至可因急性肾功能衰竭而危及患者生命（请参阅：http://blog.sina.com.cn/s/blog_690c29ec0100wiv2.html和英文附件）。

２、胃肠旁路手术虽然可以降低患者的体重、血清胆固醇，甚至血尿酸，但手术不仅增加了患者的痛苦和经济负担，且在手术的过程中及其接受手术治疗后患者还存在出血、感染、吻合口漏，甚至可因骨质疏松发生骨折等风险（请参阅：和http://blog.sina.com.cn/s/blog_690c29ec0100wgef.html）。因此，必须严格掌握胃肠旁路手术的适应证。

综上所述，合理膳食和适量运动是调控血清胆固醇的最佳方法。

High-Dose Statins May Increase Diabetes Risk

But heart benefits still outweigh potential downside, study authors say

TUESDAY, June 21 (HealthDay News) -- High doses of the widely popular cholesterol-lowering drugs known as statins may have a downside.

A new meta-analysis finds that intensive doses of statins, such as Lipitor and Zocor, upped the risk of being diagnosed with type 2 diabetes compared with moderate doses of the drugs.

But the review still revealed a lower incidence of heart attacks, stroke and death, meaning the balance remains tipped in favor of taking statins to protect your heart.

"The benefit with respect to heart protection still favors high-dose statins because those taking high doses of statins often have heart disease so are at very high risk of further events," said Dr. Kausik K. Ray, senior author of a paper published in the June 22/29 issue of the Journal of the American Medical Association.

"Patients should get annual checks of blood sugars and, if elevated, be treated appropriately," added Ray, a professor of cardiovascular disease prevention at St. George's University of London. "Of the agents tested, the net benefit was better with high-dose atorvastatin [Lipitor] as compared with high-dose simvastatin [Zocor]."

Statins have been very successful in lowering cholesterol levels and are used in people with and without diabetes, which is a major risk factor for cardiovascular disease.

According to Ray, only about 20 percent of patients taking statins are on high doses. About 80 percent take low to moderate doses.

Ray, along with colleagues from the University of Glasgow, pooled data from five randomized studies comparing intensive statin treatment with more moderate doses.

Essentially, all of the studies involved Lipitor and Zocor, either comparing them against each other, or comparing different doses of the same medication.

All together, they involved almost 33,000 participants and an average follow-up of almost five years.

People taking high doses (80 milligrams) of one of these drugs had a 12 percent higher risk for new-onset diabetes but a 16 percent reduced risk of cardiovascular events, compared with moderate doses.

That translates to one new case of diabetes for every 500 patients treated for one year with a high-dose statin compared with one fewer patient having a stroke or heart attack for every 155 patients treated for one year.

But the study had a number of limitations, other experts stated.

For one thing, it was a meta-analysis which, says Dr. Jacob Warman, chief of endocrinology at the Brooklyn Hospital Center in New York City, "doesn't prove anything." These types of analyses tend to be more "hypothesis-generating." (When researchers conduct a meta-analysis, they synthesize previous studies to look for patterns that would not show up in an individual study).

"It's suggestive but I don't know that it's conclusive," added Dr. Steven D. Wittlin, clinical director of the diabetes service at the University of Rochester Medical Center in Rochester, N.Y.

While there was a benefit seen in macrovascular complications, such as heart attacks, it's unclear if the same would be true with microvascular complications or those that involve small blood vessels and contribute to conditions such as neuropathy, Wittlin said. That could change the risk-benefit ratio, he noted.

Also, as the authors themselves pointed out, the biological mechanisms behind the effect are still not clearly understood.

SOURCES: Jacob Warman, M.D., chief of endocrinology, Brooklyn Hospital Center, New York City; Steven D. Wittlin, M.D., clinical director, endocrine-metabolism division, and director, Diabetes Service, University of Rochester Medical Center, Rochester, N.Y.; Kausik K. Ray, M.D., professor of cardiovascular disease prevention, St. George's University of London; June 22/29, 2011, Journal of the American Medical Association