William Boden   美国Buffalo大学医学与公共卫生学院
 
    :  The HDL and triglyceride debate and the residual risk is a big question.  How far do you think the AIM study went towards answering that?

  《国际循环》：有关高密度脂蛋白（HDL）和甘油三酯的争论及其残留的风险仍是一个严峻的问题。您认为AIM研究离解决上述问题还有长的路要走？
 
    Prof. Boden:  We wanted to try to determine whether a group of patients with established heart disease who had very low HDL levels at baseline and know whether that was in fact the smoking gun of residual risk.  Whether or not we could show that raising those levels with niacin would be better than just continuing to treat with statin therapy.  The only study that has really looked at this was VA HIT， but they did not use statins and started out with LDL levels of 111， which was also 111 at the end of five years.  We started out with an LDL level of 71.  The point is that perhaps when you get down to such a low level of LDL that reverse cholesterol transport is not as such an important mechanism when you have already depleted so much LDL or oxidized LDL.  Even though this was not the answer we initially sought we did provide an important answer therapeutically， which is one of the questions we have all wanted to know the answer to: If you can achieve and maintain a low or very low level of LDL， do you need to bother to try to treat HDL?  I would say， on the basis of the findings of this study， that the answer to that is no.

    Boden教授:我们目前正在开展研究，以确定是否有些心脏疾病患者的HDL基线水平非常低以及探明其是否有残留的风险；并通过我们的研究证明提高烟酸水平是否较持续的单一的他汀类药物疗效更佳。目前只有VAHIT针对这方面开展过研究，但他们并未研究他汀类药物，且LDL起始基线水平为111，5年后研究结束时，受试者LDL水平仍维持在111。在我们的研究中，LDL起始基线水平为71，之所以选择低LDL水平，是因为在已经耗竭如此多的LDL或氧化LDL状态下，逆转胆固醇的转运已不是重要的作用机制。尽管如此，研究并未证实最初所设想的能为治疗提供一个重要的答案。其中我们都希望获得答案的问题之一有：如果你想让LDL达到或保持在非常低的水平，是否还有必要去治疗HDL? 我想说，本研究的结果发现根本不可能解决上述问题。