减少心血管疾病的剩留风险.ppt

Slide* Residual vascular risk acknowledgement is critical in patients with diabetes as it is responsible for the macrovascular events events or microvascular complications, described on this slide; diabetes prevalence will continue to grow over time: the total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. References: NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2006. Wild S, et al. Diabetes Care 2004;27:1047-53. Macro- and microvascular complications of diabetes represents a significant contributor to the total medical expenditure. As an example, 28% of total cardiovascular-related expenditure are due to macrovascular complications of diabetes. * In the PROVE IT-TIMI 22 triglycerides sub-analysis, patients with acute coronary syndrome (ACS) treated with 40 mg pravastatin or 80 mg atorvastatin showed a significantly reduced incidence of coronary heart disease (CHD) over a mean follow-up of 2 years. Interestingly, even among patients who had achieved very low LDL-C targets (70 mg/dL or 1.8 mmol/L), TG 150 mg/dL (1.7 mmol/L) reduced CHD risk by almost 50%, while TG 200 mg/dL (3.3 mmol/L) was associated with a 56% decrease in the risk of death, MI or ACS. These results support the concept that achieving low TG is an additional consideration beyond low LDL-C in patients after ACS. Reference Miller M et al. J Am CollCardiol 2008;51:724-30. The PROCAM prospective study of over 7,000 men in Germany found a clear prognostic inverse relationship between HDL-C levels and CHD morbidity and mortality, irrespective of LDL-C levels. Reference Assmann G et al. Eur J Clin Invest 2007;37:925-32. It has long been known that a low level of HDL cholesterol is a powerful predictor of increased cardiovascular risk, but it has not been clear whether a low HDL cholesterol level would remain a significant risk factor in people whose LDL cholesterol was reduced to very low levels. Indeed, it has been argued that if