医学PPT课件4S糖尿病亚组研究.pptVIP

Haffner SM, Alexander CM, Cook TJ, Boccuzzi SJ, Musliner TA, Pedersen TR, Kjekshus J, Pyorala K for the 4S Group Expanded 4S Diabetes Analysis Diabetes Mellitus by History 202 Subjects (Original 4S Diabetes Subgroup) FG 126 mg/dl, but No History of Diabetes 281 Subjects Impaired Fasting Glucose (FG 110-125 mg/dl) 678 Subjects Normal (FG 110 mg/dl) 3,237 Subjects Rationale Goals Rationale New ADA Diagnostic Criteria for DM (FG 126 mg/dl) New Category of IFG (FG 110-125 mg/dl) Goals Confirm previous data Perform analysis of 4S subjects with IFG Baseline Characteristics Normal IFG DM-FG DM - Hx n 3237 678 281 202 Age 59 59 59 60 Male (%) 80 84 89 78 SBP 138 139 141 147 Tot-C 261 261 261 259 LDL-C 189 189 186 189 HDL-C 46 45 44 44 TG 130 137 142 153 FG 95 117 136 175 Percent Change in Lipids and Lipoproteins in 4S Incidence of Major CHD Events by Glucose Status in the 4S Placebo Group 4S ~ Total Mortality IFG Subjects (n=678) Diabetic Subjects (n=483) Major CHD Events Absolute and Relative Risk Benefit of Simvastatin Therapy by Glucose Status for Major Coronary Events Summary - Diabetes Mellitus Higher event rate in diabetes group, by history, compared to other groups In combined DM group (by history and fasting glucose): Major Coronary Events were reduced by 42% (p=0.001) Revascularizations were reduced by 48% (p=0.005) Total and coronary mortality were reduced, but reductions not significant due to small sample size Summary - Impaired Fasting Glucose Reduced total mortality by 43% (p=0.02) Reduced coronary mortality by 55% (p=0.007) Reduced major coronary events by 38% (p=0.003) Reduced the need for revascularization procedures by 43% (p=0.009) Conclusions This analysis confirms and extends the benefit of cholesterol lowering with simvastatin in an expanded cohort of patients with diabetes and overt CHD CHD patients with impaired fasting glucose (FG 110 to 125 mg/dL) benefit from treatment with simvastatin by significant substantial reductions in tota