斑块逆转与他汀类药物.ppt

MASS—多中心抗动脉粥样硬化研究 * Slide 20. ARBITER 2: baseline therapies By study design, all participants of ARBITER 2 were already treated with statins, typically simvastatin (93% of patients) at a mean dose of approximately 35 mg/d. The participants also were commonly treated with medications typical of secondary prevention of CHD, including beta-blockers and aspirin in most. Antioxidant vitamins were discontinued to avoid interference with the effects of niacin on increasing apolipoprotein A-I concentrations. Additional abbreviation on slide: ACE = angiotensin-converting enzyme. References: Taylor AJ, Sullenberger LE, Lee HJ, Lee JK, Grace KA. Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: a double-blind, placebo-controlled study of extended-release niacin on atherosclerosis progression in secondary prevention patients treated with statins. Circulation 2004;110:3512-3517. Cheung MC, Zhao XQ, Chait A, Albers JJ, Brown BG. Antioxidant supplements block the response of HDL to simvastatin-niacin therapy in patients with coronary artery disease and low HDL. Arterioscler Thromb Vasc Biol. 2001 Aug;21(8):1320-6. * 在ACS发病后，患者低水平HDL-C的风险何在? 1项新近的研究解答了这个问题。 1,032持续的ACS患者，植入了药物洗脱支架(DES) “低水平HDL-C” (n = 550), 男性 40 mg/dl; 女性 45 mg/dl (均值= 32 +/-7 mg/dl) “正常/高水平HDL-C” (n = 482),男性 40 mg/dl;女性 45 mg/dl (均值= 55+/-19 mg/dl) 终点: 在30天和1年时，发生死亡; Q-波 MI, TLR和MACE Statin使用率很高 (每组均达到98%) 在低水平和高水平HDL组中， LDL-C基本相同(102 108 mg/dl) (P = 0.26) What is the risk of low HDL-C in patients after an ACS episode? A recent study has addressed this question. 1,032 consecutive ACS patients had drug-eluting stents (DES) placed “Low HDL-C” (n = 550), 40 mg/dl in men; 45 mg/dl in women; (mean = 32 +/-7 mg/dl) “Normal/High HDL-C” (n = 482), 40 mg/dl in men; 45 mg/dl in women; (mean = 55+/-19 mg/dl) Endpoints: Death; Q-wave MI, TLR and MACE at 30 days and at 1 year Statin use was high (98% in each group) LDL-C was same (102 108 mg/dl) in lo