长期应用降脂药物应遵循的基本原则.ppt

提 纲 长期应用他汀的意义 长期应用他汀的原则 长期应用他汀的安全性 长期应用他汀的意义 长期应用他汀的基本原则 应用他汀的时程？ ASCOT-LLA 主要终点：致死性冠心病和非致死性心肌梗死 他汀治疗时间和剂量与获益程度 LDL-C降低幅度与心脏事件减少（%） 2007－WHO心血管病预防指南他汀治疗应该长期坚持，可能是终生 长期或终身应用他汀！ 长期持续或间断治疗？ National Registry of Myocardial Infarction 4  Investigators(n=300823ptsAMI) 英国THIN换药研究从阿托伐他汀换为辛伐他汀对预后有何影响？ 从阿托伐他汀换为辛伐他汀，死亡和主要心血管事件风险显著增加30% 从阿托伐他汀换为辛伐他汀，中断治疗率是一直服用阿托伐他汀的2倍 LDL-C降低的程度？ Optimal Low-Density Lipoprotein Is 50 to 70 mg/dl Lower Is Better and Physiologically Normal Optimal Low-Density Lipoprotein Is 50 to 70 mg/dl Lower Is Better and Physiologically Normal A New Wave of Evidence from Clinical Trials： 强化达标－－获益更多 TNT:CV事件再发分析 缺血性心血管病综合危险的血脂异常分层 危险分层与目标值的确立 达标！低一些，结果更好！ 应用何种他汀及剂量？ 标准剂量他汀（降低LDL30%所需剂量）在164个临床试验中他汀类药物降脂疗效对比 Comparison of Cardiovascular Event Rates in PatientsWithout Cardiovascular Disease in Whom Atorvastatin or SimvastatinWas Newly Initiated 使用合适剂量的强效他汀! 他汀长期治疗的安全性 他汀安全性的困惑 肝脏功能的影响? 肾脏功能的影响? 肌肉系统的影响? 神经系统的影响? 肿瘤危险的影响? 糖尿病危险的影响？ 长期应用他汀遵循的原则 应用他汀！ 长期持续应用！ 达标强化！ 强效他汀！ 显示LDL-C降低幅度越大，时间越长、心脏事件减少（%）越多 Results Reductions in LDL cholesterol (in the 164trials) were 2.8 mmol/l (60%) with rosuvastatin 80mg/day, 2.6 mmol/l (55%) with atorvastatin 80 mg/day, 1.8 mmol/l (40%) with atorvastatin 10mg/day, lovastatin 40 mg/day, simvastatin 40 mg/day,or rosuvastatin 5 mg/day, all from pretreatment concentrations of 4.8 mmol/l. Pravastatin andfluvastatin achieved smaller reductions. In the 58trials, for an LDL cholesterol reduction of 1.0 mmol/l the risk of IHD events was reduced by 11% in the first year of treatment, 24% in the second year, 33% inyears three to five, and by 36% thereafter (P 0.001for trend). IHD events were reduced by 20%, 31%, and51% in trials grouped by LDL cholesterol reduction(means 0.5 mmol/l, 1.0 mmol/l, and 1.6 mmol/l) afterresults from first two years of treatment were excluded(P 0.001 for trend). After several years a reduction of 1.8 mmol/l would reduce IHD events by