培训课件-心血管药物治疗.pptVIP

* Although all the statins are potent, reversible inhibitors of the enzyme HMG-CoA reductase, the key enzyme in cholesterol synthesis, there are major differences in the pharmacokinetic properties of the six available statins. These differences are due to differences in their chemical structures.1,2 Reference 1. Horsmans Y. Eur Heart J Supplements 1999;1(Suppl T):T7–12. 2. Vaughan CJ et al. J Am Coll Cardiol 2000;35:1–10. * This slide shows the comparative effects of the six currently available statins on lipid parameters. All reduce LDL cholesterol and triglycerides, and increase HDL cholesterol. Reference 1. Knopp RH. N Engl J Med 1999;341:498–511. * Epidemiological studies have shown that the incidence of CHD increases with an increase in serum total cholesterol and LDL cholesterol concentrations. These observations led investigators to determine whether cholesterol-lowering therapies, in particular statins, can reduce morbidity and mortality associated with CHD. A number of key studies have been undertaken since the results of the Scandinavian Simvastatin Survival Study (4S)1, published in 1994, showed that treatment with simvastatin improved survival in patients with CHD. These include the West of Scotland Coronary Prevention Study (WOSCOPS)2 in 1995, the Cholesterol and Recurrent Events study (CARE)3 in 1996, the Long term Intervention with Pravastatin in Ischaemic Disease study (LIPID)4 and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) 5, both in 1998. 4S, CARE and LIPID were secondary prevention trials in patients with existing CHD, and WOSCOPS and AFCAPS/TexCAPS were primary prevention studies in patients with no history or symptoms of CHD. The trials were all large, randomised, double-blind, placebo-controlled studies lasting approximately 5 years. References 1. The Scandinavian Simvastatin Survival Study Group. Lancet 1994;344:1383–9. 2. Shepherd J et al. N Engl J Med 1995;333:1301–7. 3. Sacks FM et al. N Engl J Med