Cholesterol_guidelines3.1教程.pptVIP

FDA: Simvastatin labeling Simvastatin is more prone to drug interactions than other statins because it is extensively metabolism by CYP3A4 Rates of rhabdomyolysis with simvastatin 80mg is higher than with 80mg atorvastatin or 20/40mg of rosuvastatin. Summary Recent updates affect patients in high and moderate high risk categories. Encourages more aggressive lipid control due to evidence of significant reduction in vascular events regardless of baseline level of LDL. Some LDL goals are still optional. In general, patients with high and moderate high risk are targeted to lower LDLs. Summary When initiating statin therapy, initial dose should target at least a 30-40% reduction in LDL. If goal LDL requires more than a 50% reduction of baseline, then goal will likely be unattainable with current options. NCEP ATP III Cholesterol Guidelines and Updates Anoop Agrawal, M.D. Med-Peds Continuity Clinic Baylor College of Medicine Background Adult Treatment Panel of the National Cholesterol Education Program issued their third guideline for cholesterol management in 2001 - known as ATP III. Since publication, 5 major clinical trials of statin therapy have been published. This has resulted in an addendum to ATP III published in July 2004. Next update (ATP IV) expected in 2009. Background cont. - The 5 studies: Heart Protection Study - revealed 25% reduction in mortality regardless of baseline LDL levels ALLHAT - did not show statin benefit in those with HTN; result attributed to use of pravastatin as study drug PROVE IT - intensive statin therapy following acute coronary syndrome is superior PROSPER - demonstrated statin benefit even in the elderly ASCOT-LLA - LDL lowering with atorvastatin had considerable CVD risk reduction in those with multiple CVD risk factors. (in contrast to ALLHAT) NCEP Major Risk Factors Classification of an individual’s risk for cardiac events is based upon five risk factors: smoking hypertension low HDL (40) family history- 1st degree relative with