高危患者降脂-YM幻灯片.pptVIP

高危患者降脂治疗策略 香港港安医院心脏科 高德谦 教授 内容大纲 他汀有效降低LDL-C，MACE及死亡率 仍然很多病人还没有治疗 高危病人要用高剂量 用药时间？何时开始？ 可以缩小斑块吗？ 安全性问题 HDL-C Statins proven effective in reducing – MACE – Mortality Implementation has been alarmingly low ACC evaluation of Preventive Trials (ACCEPT) found only 24 % of pts discharged after a CV event were placed on statins Pearson TA etal: JAC 1998; 3 (Suppl 2) : 186 A New York Presbyterian Hospital Pre-Discharge Standardized Protocol: →↑use of statins from 6.5% to 9.1% (P = 0.01) Biviano AB etal: Am J Cardiol 2003; 91: 1248 In response to CHUMP (Cardiovascular Hospitalization Underutilization UCLA Medical Center Implemented Management Problem) Cardiac Hospitalization Arteriosclerosis Management Program (CHAMP) Standard Orders Protocol →↑ use of statins from 6% to 86% in 2 years →↑ death and reccurrent M.I. from 14.8% to 6.4% (P 0.01) Tillisch J H etal: AJC 2001; 8 : 819-822 Pre-PCI Statin Reduces the Extent of Preprocedural Non-Q.M.I. 229 Statin-treated assessored by CK, Trop-T 67 control group 6, 12, 24 hrs post – PCI 229 Statin-treated 0.4% 67 control group 6.0% Herrmann J. etal Cricultation 2002 : 2180-2183 Final Result of the fluvastatin angiographic restenosis trial (FLARE) 1054 undergoing P.C.I. randomiz