血脂治疗新循证的启示(CN).pptVIP

* * * 这是迄今为止最大规模的头对头的他汀疗效与安全性的比较研究－STELLAR研究的结果，可以看到治疗6周后，10-40 mg/天可定即可使LDL-C水平降低46-55％，而阿托伐他汀10-80 mg/天、辛伐他汀10-80 mg/天和普伐他汀10-40 mg/天分别降低了37-51％、28-46％和20-30％，提示可定的降LDL-C作用更强。 其中对于一般临床患者使用10mg的可定即可使LDL－C下降46％，表明在临床常用剂量之下可定疗效更高。 ? ? * 低HDL-C水平已被确认是重要的、独立的心血管疾病预测因素。 STELLAR研究显示，与等剂量甚至稍高剂量的阿托伐他汀、辛伐他汀、普伐他汀相比，可定还具有更强的升HDL-C作用，10-40 mg剂量范围的可定治疗可使HDL胆固醇水平上升7.7-9.6％。需要注意的是，阿托伐他汀随着剂量的增加而其升高 HDL-C 的效果却逐渐减小。 * 在下列大临床对照研究中，可定?10mg均可使LDL-C降低46%左右，其降LDL-C疗效显著优于阿托伐他汀 20 mg。 * 冠状动脉粥样硬化是一种慢性持续进展的病变，既往的大规模他汀类药物的降脂研究（如REVERSAL研究等）证实：他汀类药物治疗可预防动脉粥样硬化的进展，稳定动脉粥样硬化病变。 ASTEROID研究是首个用确凿证据来证明强化他汀类药物治疗能逆转冠状动脉粥样硬化脂质斑块沉积的大规模临床研究，具有里程碑式的意义。 * * ASTEROID is an open-label, multicentre study evaluating the effect of rosuvastatin 40 mg treatment on atherosclerotic disease as measured by IVUS in CAD patients undergoing coronary angiography. The study included 507 patients who had a baseline IVUS examination from 53 centres worldwide. 349 patients had evaluable serial IVUS examinations. The target coronary artery must have ≤50% reduction in lumen diameter throughout a segment of at least 40 mm in length. This vessel may be designated the target vessel if it is accessible to the IVUS catheter and if it has not undergone prior PCI or CABG, has not sustained a MI, is not currently a candidate for intervention or a likely candidate for intervention over the next 104 weeks, and is not a bypass graft. The same vessel will be reassessed by IVUS and QCA after 104 weeks of treatment with rosuvastatin 40 mg. Blinded QCA analysis of percent diameter stenosis (%DS) and minimum lumen diameter (MLD) was performed for up to 10 segments of the coronary arteries and their major branches with 25 percent diameter stenosis at baseline. For each patient, the means of all matched lesions at baseline and study end were calculated. There were 292 patients with 613 matched segments that met the criterion of 25 percent stenosis. There were dual primary endpoints:- change in PAV in the entire segment of coronary a