他汀临床应用指南PPT.ppt

指南与循证 — 关于他汀临床应用的再思考;冠心病的分型;各型冠心病指南的危险分层与他汀/血脂治疗原则;慢性稳定性心绞痛诊断和治疗指南;慢性稳定性心绞痛诊断和治疗指南 —他汀/血脂治疗原则;LDL-C保持在100mg/dL以下，胆固醇不易流入斑块 ;LDL-C75mg/dL提示无斑块进展;不稳定性心绞痛和非ST段抬高心肌梗死危险性分层;全球急性冠脉动脉事件注册（GRACE）危险评分系统;不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南 —他汀/血脂治疗原则;; There is a wealth of evidence that cholesterol-lowering therapy for patients with CAD and hypercholesterolemia or with mild cholesterol elevation (mean 209 to 218 mg per dL) after MI and UA reduces vascular events and death. Moreover, recent trials have provided mounting evidence that statin therapy is beneficial regardless of whether the baseline LDL-C level is elevated. More aggressive therapy has resulted in suppression or reversal of coronary atherosclerosis progression and lower cardiovascular event rates, although the impact on total mortality remains to be clearly established. These data are discussed more fully elsewhere. ;急性ST段抬高型心肌梗死诊断和治疗指南;冠状动脉及其他动脉硬化性血管病二级预防指南-2006 AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease;Furthermore, if it is not possible to attain LDL-C 70 mg/dL because of a high baseline LDL-C, it generally is possible to achieve LDL-C reductions of 50% with either statins or LDL-C –lowering drug combinations. ---- LDL-C70mg/dl 或降幅50% Moreover, this guideline for patients with atherosclerotic disease does not modify the recommendations of the 2004 ATP III update for patients without atherosclerotic disease who have diabetes or multiple risk factors and a 10-year risk level for CHD 20%. In the latter 2 types of high-risk patients, the recommended LDL-C goal of 100mg/dL has not changed. ;风险类别;Exp Opin Emerg Drugs 2004;9(2):269-79 N Engl J Med 2005;352:1425-35;《中国成人血脂异常防治指南》强调：严格分层治疗，降低心血管事件;慢性稳定性心绞痛诊断和治疗指南 —他汀/血脂治疗原则;JACC 2008;51(15):1512-1524ACC/ADA共同指出：血脂控制力度还需加大;2009《加拿大成人血脂异常及心血管疾病防治指南》;风险类别;血脂指南仍阻碍了他汀的正确应用？;LDL-C目标值？;;;JACC 2008;51(15):1512-1524 ;期待2011 AHA，in Nov. at Orlando, USA!;不论基线血脂水平如何，他汀治疗均显著改善预后（Jupiter 亚组分析）;多个试验纳入