培训课件-糖尿病肾病的血脂调控.ppt

推荐“有证据的他汀和有证据的剂量” * 2012年AHA上公布了一项比较阿托伐他汀和瑞舒伐他汀对肾功能影响的荟萃分析。荟萃分析纳入23项关于阿托伐他汀或瑞舒伐他汀的随机试验，共入组29,147例患者，平均随访52.56周，评估其对GFR和新发蛋白尿的影响。 结果显示，在高心血管风险患者中，常用剂量的可定?与阿托伐他汀具有相似的肾脏保护作用，经可定?治疗后的新发蛋白尿风险与阿托伐他汀相似。再次证明了可定?的肾脏安全性。 * 如上图所示，在新发蛋白尿的比较指标上，共有6项头对头比较可定?和阿托伐他汀的研究。结果显示，经可定?治疗后的新发蛋白尿风险与阿托伐他汀相似，P=0.473。 * 对我国5个省市、自治区7家三级甲等医院2002年至2003年收治的1239例慢性肾脏病患者进行流行病学调查， 发现慢性肾脏病(CKD)患者中心血管疾病(CVD)的患病率高。 Objectives We evaluated the efficacy of statin therapy in primary prevention among individuals with moderate chronic kidney disease (CKD). Background Whether patents with moderate CKD (estimated glomerular filtration rate [eGFR] 60 ml/min/1.73 m2) benefit from statin therapy is uncertain, particularly among those without hyperlipidemia or known cardiovascular disease. Methods Within the JUPITER (Justification for the Use of statins in Prevention–an Intervention Trial Evaluating Rosuvastatin) primary prevention trial of rosuvastatin 20 mg compared with placebo among men and women free of cardiovascular disease who had low-density lipoprotein cholesterol (LDL-C) 130 mg/dl and high-sensitivity C-reactive protein (hsCRP) 2 mg/l, we performed a secondary analysis comparing cardiovascular and mortality outcomes among those with moderate CKD at study entry (n 3,267) with those with baseline eGFR 60 ml/min/1.73 m2 (n 14,528). Median follow-up was 1.9 years (maximum 5 years). Results Compared with those with eGFR 60 ml/min/1.73 m2, JUPITER participants with moderate CKD had higher vascular event rates (hazard ratio [HR]: 1.54, 95% confidence interval [CI]: 1.23 to 1.92, p 0.0002). Among those with moderate CKD, rosuvastatin was associated with a 45% reduction in risk of myocardial infarction, stroke, hospital stay for unstable angina, arterial revascularization, or confirmed cardiovascular death (HR: 0.55, 95% CI: 0.38 to 0.82, p 0.002) and a 44% reduction in all-cause mortality (HR: 0.56, 95% CI: 0.37 to 0.85, p 0.005). Median LDL-C and hsCRP reductions as well as side effect profiles associated