ACS患者积极他汀治疗需要讨论的问题.pptVIP

* Mortality in acute coronary syndrome (ACS) and in chronic atherosclerosis are graphically represented here. These data show that most fatalities occur within the first 30 days following either an acute MI (AMI) or episode of unstable angina (UA). However by 90 days, death rates are similar among patients experiencing AMI and UA and are comparable to those observed in patients with stable angina. This high early mortality reinforces the need to maximize the therapeutic protection made available to patients immediately following an ACS event. * * * * 前面提到: 我们使用他汀主要目的是稳定、逆转斑块，减少事件发生。而立普妥正可以通过多种途径稳定/逆转斑块。 通过抗炎症、抗氧化作用，以及通过减少泡沫细胞形成来稳定斑块，使斑块内炎性细胞减少，纤维帽增后。 通过降低LDL-C，减少脂质核心，稳定斑块。 * GAIN研究的结果显示，立普妥组斑块的高回声指数增加42％，显著大于常规治疗，这种斑块高回声的变化，意味着斑块组成的改变，这种改变可能减少斑块破裂的危险。 * Slide 9 As already shown, event reduction with statin therapy in the 4S, CARE and LIPID trials was not an early phenomenon [8–10]. However, statin therapy has been shown to produce a variety of other potentially beneficial effects within a matter of days or weeks. These include an improvement in endothelial function, a reduced propensity for platelet–thrombus deposition, and anti-inflammatory effects at the site of lesions [12,13]. Such mechanisms are closely related to the pathophysiology of recurrent events in acute coronary syndromes. This, in turn, provides the basis for the theory that early intervention with a statin, following the occurrence of an acute coronary event, could reduce the risk of subsequent events in patients with acute coronary syndromes. References 8. Scandinavian Simvastatin Survival Study Group. Lancet 1994;344:1383–1389. 9. Sacks FM et al. N Engl J Med 1996;335:1001–1009. 10. The long-term intervention with pravastatin in ischaemic disease (LIPID) study group. N Engl J Med 1998;339:1349–1357. 12. Libby P. Circulation 1995;91:2844–2850. 13. Vaughan CJ et al. Lancet 1996;348:1079–1082. * Slide 9 As already shown, event reduction with statin therapy in the 4S, CARE and LIPID trials was